Permit , fil
CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
4 DEVELOPMENT SERVICES PERMIT #: ELR2005 -00209
,, 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 7/28/2005
PARCEL: 1S12600-00300
SITE ADDRESS: 09345 SW WASHINGTON SQUARE RD ZONING: C -G
SUBDIVISION: WASHINGTON SQUARE LOT: JURISDICTION: TIG
Project Description: Limited energy for 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 HVAC INC
BY THE MACERICH COMPANY • 5188 SE INTERNATIONAL WAY
9585 SW WASHINGTON SQUARE RD MILWAUKIE, OR 97222
TIGARD, OR 97223
Phone: 503- 639 -8865 Phone: 503- 462 -4822
Reg #: LIC 50897
ELE 26-571CLE
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 7/28/2005 $75.00
[TAX] 8% State Surchar€ 7/28/2005 $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_Eules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010
through ,2�AR 952- 01 -0 0. You may obtain copies of these rules or direct questions to OUNC at 503 - 246 -6699.
Issued Permittee Signature:/ S Lµt,, Rbi t..44.,01.7,"
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.
r
Ele- c * ical Permit Application FOR OFFICE USE ONLY
City of Tigard Received g rn
Peut No f L 0 r
Date/B s ^
13125 SW Hall Blvd , Tigard, OR 97223 Plan Review
Phone 503.639.4171 Fax. 503 598 1960 44ia11 , 'i'', DateB Other Permit
Inspection Line: 503.639 4175 call Date Ready/By '' ® See Page 2 for
Internet: www.ci.hgard or us Notified/Method � �ISupplemental Information
i.. ; ,::: 3 :• 11 :::::;:' '`' -= .'i.:•TYI OPs'WORK'.' ,4 '' :':", , .-: .'--} :: '' .r - :PLAN .IEw
..1:4'd'ew construction ❑ Addition/alteration/replacement Please check all that apply
❑ Demolition ❑Other: ['Service over 225 amps, comm'l ['Hazardous location
❑Service over 320 amps - rating ❑Bulldng over 10,000 sq ft ,
. -. - r ' ;:CAT EGO RY'OF CONSTRUCTION•' of 1- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling ommerciaUtt dustnal ❑ Accessory building ['System over 600 volts nominal units in one structure
❑ Multi - family aster builder ❑Other: ❑Building over three stories ❑Feeders, 400 amps or more
['Occupant load over 99 persons ❑Manufactured structures or
`E;.;, 4 ,,,i ' ;- JOB ;SITE: NFORMA'I'ION1e_ ND'`LOCATION" ` 'Y � ,' i,: " � �' ❑Egress/lighting plan RV park
Job no.: Job site address: R 3� 1 5 a) LlktsC1 R C ❑Health -care facility ['Other
Submit 2 sets of plans with any of the above
City/State /ZIP: y� {�, / The above are not applicable to temporary construction service
r!J 1 IC/vt\ AajrY1 . - '` .. '"'"'":": 1 '''':k';' , ', : ' FEE * >.
Suite /bldg. /apt. no.. Project name J 16 ,,INS
C ="
LY Description I Qty. I Fee. I Total
Cross street/directions to job Site: New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq ft or less 145 15 4
Subdivision: Lot no.: Ea. add'l 500 sq ft or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75 00 2
.f- ,, ?"i _+ e,3t.' ,- : -.0 r. -,i f ;;- ' ; 1s: " Each manufactured or modular
jj /�[ �/ o dwelling, service and /or feeder 90 90 2
l ZC, 00 l f�CtQ (AAA/CAA T VLQdLO2� Services or feeders installation, alteration, and/or relocation
v 200 amps or less 80 30 2
r - v = ° � `'_❑'- PRQ,PERTY ° " '-' ", _;I .en ? '''a' ; ' ❑. TEhIANT`-,_,� ;,_, ; : :, '_ 201 amps to 400 amps 10685 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
's : r....,,- -.;, • % _,p, =" - •'-` _ 3 , -,A - A. Fee for branch circuits with
� ' -: i7 AP PLIGA; .;; ' �f ' , � ` x ,' 1 u ±' v � ® GQNTAGT' •PERSO�1, ±�; ;J ,.
� ' T „� service or feeder fee, each
Business name: branch circuit 6 65 2
Contact name: B. Fee for branch circuits
without service or feeder fee, 46 85 2
Address: each branch circuit
Each add'I branch circuit 6.65 2
City/State /ZIP: Miscellaneous (service or feeder not included)
Phone. ( ) F ( ) Pump or imgation circle 53 40 2
Sign or outline lighting 53 40 2
E - mail. Signal circuit(s) or limited -
;C> .:F ., {q ,F =...:: ;` 1' " :'' '.I ; r : ;; CONTRA TOR' .. ,.d1r. : i" . w - t ,.-.n• s energy panel, alteration, or 7500
"1 extension Descnbe / Page 2 2
Business name: /A.0
Address: 5 ( g. s e (.00-4_1 Each additional inspection over allowable in any of the above
Per Inspection 62 50
City/ State / ZIP. I V t_ �, c i.._ ()y Jae -7'i Investigation per hour (I hr nun) 62 50
Phone: (So3) C.j 2_ $�2` (Fax: (5o3 :
) L itot - S5 5 Industrial plant per hour 73 75
:;t:e;i - „ 'ff: ;Z':LECTRICAL':PERIVIIT FEES * '. • ;.' .
CCB Lic.: 7 Electrical Lica(, 57/ L E Suprv. Lie gloat -I (..r) Subtotal 7'
Suprv. Electrician signature, required Plan review (25% of permit fee)
Print name. ' `T l�lJ t ► 1 ``� S Date: 2gJ D S State surcharge (8% of permit fee) c)
f ( TOTAL PERMIT FEE 6/
Authorized signature: 2--- Sb �,a.�-) permit it application expires if a permit is not obtained within ISO
��l �wwv days after it has been accepted as complete
Print name: S cavyl e ____2•. p k t ,,, vs (5 Date. - 7 1 2405 f • Fee methodology set by Tn- County Building Industry Service Board
•• Number of inspections per permit allowed
r\Bmldmg1Pernuis\ELC- PermrtApp doe 12/03 440- 4615T(10/02/COM/WEB
r. 1
Electrical Permit Application - City of Tigard
Page 2 r Supplemental Information ' \:-
LIMITED ENERGY PERMIT FEES:
I715 f 77A) ; ORK3ONLY: . t 1 q4;=A i
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
NCO e. _ R f 707.0R1,MTIN :'. EP .x$-
Fee for each commercial system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
[3fHVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
0 Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
\Bu ldmg\Pe mio\ELC•PmnnApp doc 04/03
•
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2005.00209
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/28/2005
Phone: (503) 639 -4171 Akb
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 11/9 /2005 TIME: 7:09AM PAGE: 40
SITE ADDRESS: 09345 SW WASHINGTON SQUARE RD CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE:
PROJECT NAME: POTTERY BARN KIDS
DESCRIPTION: Limited energy for HVAC.
OWNER: WASHINGTON SQUARE LLC, PHONE #: 503 - 639.8865
CONTRACTOR: HVAC INC PHONE #: 503 -462 -4822
Inspection Request Scheduled For: Date: 11/9/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 \j Electrical final 020831 -02 603- 462 -4822 N
Corrections /Comments / Instructions:
•
•
•
•
•
•
d PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: 1 /N c r Phone #: (503) 718 -