Permit ._,..-.
CITY OF TIGARD
ELECTRICAL RESTRICTED ENERGY PERMIT
l^ DEVELOPMENT SERVICES PERMIT #: ELR2005 -00260
Ai �-- 13125 SW Hai Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 8/31/2005
PARCEL: 1S12600-00300
SITE ADDRESS: 09339 SW WASHINGTON SQUARE RD ZONING: C -G
SUBDIVISION: WASHINGTON SQUARE LOT: JURISDICTION: TIG
Project Description: Low Voltage HVAC.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: : HVAC: X PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER: .
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
WASHINGTON SQUARE LLC ARROW MECHANICAL
BY THE MACERICH COMPANY 10330 SW TUALATIN RD
9585 SW WASHINGTON SQUARE RD TUALATIN, OR 97062
TIGARD, OR 97223
Phone: Phone: 503 692 - 1565
Reg #: LIC 5193
ELE 34 -47CLE
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 8/31/2005 $75.00
[TAX] 8% State Surcharl 8/31/2005 $6.00
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and
all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not
started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires
you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010
through OAR 952-001-I .S O.Youu may obtain copies of these rules or direct questions to OUNC at 503 - 246 -6699.
Issued By: / -l./�.[.C./, Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N DATE:
LICENSE NO:
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
- Electrical Permit Africa. ' 1 host`OI Icli i�sl: ON 1..) -
- (City of Tigard • Recei ved �' !� Permit O `, _ eeb
13125 SW Hall Blvd., Tigard, OR 972 (19 I Plan � Revte ®`�, • r
Phone: 503.639.4171 Fax: 503.598.1960" r � 1 2 --- ua . " t p„lr -t I 'j • Dare/13 Other Permit
Inspection Line: 503.639.4175 _,_ . '_, .,, Date Ready/By. lads ® See Page 2 for
Internet: www.ci.tigard or.us CITY OF TIGARD Notified/Method. Supplemental Information
E MI I I I M WIARON • PLAN REVIEW
® New construction ❑ Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑Other: ❑ Service over 225 amps, comm'I 0 Hazardous location
0 Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
- - . CATEGORY OF CONSTRUCTION of I- and 2- family dwellings 4 or more new residential
❑ 1 - and 2- family dwelling gl CommerciaUindustrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
El Multi - family ❑Master builder ❑ Other: ❑ Building over three stories 0 Feeders, 400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION 0 Egress/lighting plan RV park
Job no.30 $ to Job site address: q586 , W, Y A " S1 SC1 ift,, ❑Health -care facility ❑der.
Submit 2 sets of plans with any of the above.
City /State/ZIP: Tire - r$ I41) , o i „ The above are not applicable to temporary construction service.
FEE* 'SCHEDULE
Suite/bldg. /apt. no.7 ( I Project name: 3 Va OE Description I try. I Fee. I Total I "'
Cross street/directions to job site: (4/f, 6 4 5 5 . 0 im 4 gi, New residential single- or multi- family dwelling unit.
Includes attached garage.
S A pF t A? C 4Q 44 "� p. e 1,000 sq. ft. or less 145.15 4
Subdivision: f Lot no.: Ea. add'I 500 sq. ft. or portion 33 40 I
Limited energy, residential 75 00 2
Tax map /parcel no.: Limited energy, non - residential 75.00 2
. DESCRIPTION OF WORK Each manufactured or modular
2 4 l t+ v - I� _ p dwelling, service and/or feeder 90.90 2
V �O lr I MO j Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER ❑ TEN ANT • 201 amps to 400 amps 106.85 2
' 401 amps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City /State/ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
. IR APPLICANT ® CONTACT PERSON A. Fee for branch circuits with
�R A w rci. f (04 l e/ S bran or feeder fee, each 6.65 2
Business name: bran circuit
e � B. Fee for branch circuits
Contact name: A'� 1 Sc �L He A, without service or feeder fee, 46.85 2
each branch circuit
Address: /033 a 6.0. T./A-M T 1 N I Each add'l branch circuit 6.65 2
City /State/ZIP:7 , , 7 y ® Q 7 0 6 2 Miscellaneous (service or feeder not included)
6 9) w! 9 7 Pump or irrigation circle 53.40 2
Phone: )69? ? - // " Fax: : ' Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited-
. CONTRACTOR . energy panel, alteration, or
extension. Describe: Page 2 2
Business name:4gIQ 0 MEC i #d( 7RPcyo- S
Address: ! o3 ...5 ,8 r r L / it f AT I N i) Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State/ZIP: •Tu °0 4 0 R 9 70 6, 2 Investigation per hour (I hr mm) 62.50
Phone:56 3j692 - 1 s6, - Fax:iced) 697 / _ j el 9 Industrial plant per hour 73 75
ELECTRICAL PERMIT FEES*
CCB Lic.:, ) 9 Electrical LicZL j C I Suprv. Lic.: 5v4.G p Subtotal OD •
Suprv. Electrician signature, required: X y Plan review (25% of permit fee) —
Print name: 3"e>,e R. F 1 1 -4 1 Date: State surcharge (8% of permit fee) . 0 0
TOTAL PERMIT FEE r 15
Authorized signature: A. r A�Acti e _ This permit application expires if a permit is not obtained within 180
F ® days after it has been accepted as complete
Print name: �/ �/ Date: $"- 5 • Fee methodology set by Tn- County Building Industry Service Board
•• Number of inspections per permit allowed. G
51. O
I \Building Werra ns\ELC- PermitApp doe 12/03 440-4615T(10/02/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information .
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined........ $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
El Garage Door Opener*
El Heating, Ventilation and Air Conditioning
• System*
El Vacuum Systems*
El Other:
I : COMMERCIAL WORK ONLY:
Fee for each commercial system. $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
El Boiler Controls
El Clock Systems •
❑ Data Telecommunication Installation
El Fire Alarm Installation
,[. HVAC
El Instrumentation
❑ - Intercom and Paging Systems
El Landscape Irrigation Control* •
❑ Medical
El Nurse Calls
❑ Outdoor Landscape Lighting*
•
❑ Prote Signaling
❑ Other
• Total number of commercial systems: 1
• J •
*No licenses are required. Licenses are required
for all other installations
I \Buildmg\Permits\ELC- PermttApp doc 04/03
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2005-00260
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/31/2005
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 11/14/2005 TIME: 7:12AM PAGE: 172
SITE ADDRESS: 09339 SW WASHINGTON UARE RD - CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE:
PROJECT NAME: JANEVILLE:_
DESCRIPTION: Low Voltage HVAC.
OWNER: WASHINGTON SQUARE LLC, PHONE #:
CONTRACTOR: ARROW MECHANICAL PHONE #: 503- 692 -1565
Inspection Request Scheduled For: Date: 1/14/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
35 ow voltag= 020995 -01 503 -692 -1565 N
Corrections /Comments /Inst ctions:
•
•
•
PASS n PARTIAL APPROVAL . ❑ CANCEL ❑ NO ACCESS
n FAIL , ❑ CALL FOR INSPECTION, ❑ ADDITIONAL FEES ASSESSED
Inspector: Gl■Rt N Date: 1,1 • • ar Phone #: (503) 718- 2 - 1 i4 1 :3 •
ti
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