Permit CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
DEVELOPMENT SERVICES PERMIT #: ELR2005 -00358
..��I DATE ISSUED: 10/20/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 1S12600 -00300
SITE ADDRESS: 09345 SW WASHINGTON SQUARE RD ZONING: C -
SUBDIVISION: WASHINGTON SQUARE LOT: JURISDICTION: TIG
Project Description: Burglar Alarm.
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: PROTECTIVE SIGNAL: X
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
WASHINGTON SQUARE LLC ADT SECURITY SERVICES, INC
BY THE MACERICH COMPANY 2815 SW 153RD DR
9585 SW WASHINGTON SQUARE RD BEAVERTON, OR 97006
TIGARD, OR 97223
Phone: 503- 639 -8865 Phone: 503- 469 -7244
Reg #: LIC 59944
ELE 26- 209CLE
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[TAX] 8% State Surcha 10/20/200E $6.00
[ELPRMT] ELR Permit 10/20/200E $75.00
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 -0100. You may obtain copies of these
rules or direct questions to OUNC at 503 - 246 -6699.
A J
Issued By: Permittee Signature: S
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.
10/19/2005 15:25 FAX 5034697110 ADT SECURITY 11001
/� , EMectrical Permit Application Foil OFFICE USE ONLY of Tigard Recei
1 SW Hall Blvd., Tigard, OR 97223 PIECE
r ,� Date/B : _ % Permit No.: QQ Q' / *i�
Phone: 503.639.4171 Fax: 503.598.190 9� 9L• Iv fir...,, Plan Review Other Permit:
I'�'yFtl' 1 • Date/13
Inspection Line: 503.639.4175 -j F,l i •� i pate R g1 See Page 2 for
Internet: www.ci.tigard.or.us s CT 19 1! Notified/Method: II Supplemental Information
,1 1 j 7j1 � i t i i 1 I j � l , �� i _�; s l i rt l '1 c os t r y ,. y
u. %4, ,r " �` i rt -ti`,.,1r Sittl J lr .l 11 . ,'I :§s,. ■!IF�I,. y , Ji l' � l g': YF; ..1j ii aeole.I' , . j SU S 1,,x'�r�c(`.r.pet 4 ,b . ''•
�.� r .. ..} n . .._,..:;u. ?s_l_. :�_ . r _uM. -. i`t u I!�t, :i.� , l_'� .1 +:�14Yi��^'.:r2hi:� _:t! :,r. U:w-. - •
/: New construction
❑ AdditionMt w in , rEA • �e Please check all that apply:
❑ Demolition ❑ oth BUILDIN Vl ❑Service over 225 amps, comm'I ['Hazardous location
r� f n i ire e �, �� r , ['Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
� i ` ` a y , ? u � _1i a ; (iy n l�U L 1 , 1 {, 1u } s + IF a o f s ' ,�u I ru ,r 4� ti of
❑ 1 - and 2- family dwelling 1- and 2-family dwellings 4 or more new residential
LL
r I t Y g
�'Commercial/industrial ❑ Accessory building ❑ System over 600 volts nominal units in one structure
❑ Multi- family ❑Master builder ❑Other:
DBuilding over three stories ['Feeders, 400 amps or more
,,,i , ,.Lr - , 0 Occupant load over 99 persons ❑Manufactured structures or
?jr t 11 i 1 4 1 L.,14,7,,,.);,,,,:_,:,,..,,, S 1(E 1: 5 i I r1t1 •1.1 t y / h°) i 1L 11 X c ,� � :,�v k ^",r,Y} , �S' RV
._.t,.3'1... _ _ S IIL: , ... . I . 'I � .L_ ;.1R � ? i _u. ,�,�r ,. -.5-1 _ ,.._ .._i ❑ park
P
Job no.: 1:4 • 9 Job site address: ❑Health -care facility ['Other: - � ' %1b I Submit sets of plans with any of the above.
�
City/State/ZIP: ` y , i as a IC' The above are not applicable o temporary construction service. • � l r` L t i s 11 • hib-.1 i t l.lr).z'l 7 � 1%i l a . 0.•:' •.., _
Mt' . dgJapt. no.� < Project na .� 1; L i nom` ...____ - ti_, �: � . . l �- . '
Tit
Qry. Fee. rota;
Cross street/directions to job Site: — IF ew 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
Limited energy, residential 75.00 2
Tax map/parcel no.: Limited energy, non - residential 75.00 2
.:1q . :> ` ∎ . /.5 � ( ;l1 y1 g
�;.� ) cV :' ',�r] d ;01
, , A r i. j . L i ' F 1 v t4,;..,� Each manu fa c tured or m odu la r
al-VS(11r
A f 1 1 1 M - dwelling, service and/or feeder 90.90 2
t A Services or feeders installation, alteration, and/or relocation
[1
200 amps or less 80.30 2
'
q.:li, T i ` ,y ,. r'iE , ', [ ,, � �,1 i - J {1n m �SF rg.j, 201 amps to 400 amps 106.85 2
I g ia, .•• cif r. iI? r ., �7� l ,t �yi, a i vu ,, ; b, ?,.. L "I,i�.� w a b � . ,
r`,1r � f,. � � � i �,r,[,a " 1 ,...1. 401 amps o600amps 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
Phone: ( ) Fax: ( ) relocation
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 1 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 70L 401 amps to 600 amps 133.75 2
Owner signature: Date: { 2 Branch circuits - new, alteration, or extension, per panel
YD i . ,14 � t" - - : . : 71 `5 b , 1 1 y r i 1 i' .L, .:. ! - �r , ? i ' e 11 •`.. f 1 1_i l , a` . i} i* , �t i . ; " ; :1 4 ' ?-72 I , 1 A. Fee for branch circuits will!
service or feeder fee, each 6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: `' V ye, t(1 A Qq t without service or feeder fee,
�.�` each branch circuit 46.85 2
Address:
Each add'I branch circuit 6.65 r 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) I Fax: : ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E-mail: !T Signal circuit(s) or limited-
r1Y.fl� i i .: i ai ,l,,i l tl ! 1 11177111 _C i P } : t "L, I 1 p it ( t4 11 ir qf 9, , 'V 1, RT,E1f c energy panel, alteration, .1:! 1 k t .ti �t t. C..__ it ..hu , i'� 1, LIt I F-? ., e.,' L L ti SIj I Ii, 1 gYP l , l , or
extension. Describe: 1 Page 2 15, (X) 2
Business name: ADT SECURITY SERVICES, INC.
Address: '1815 S.W. 153rd DR. Each additional Inspection over allowable in any of the above
BEAUFRTON, f1R 417(10.6 Per inspection 62.50
City /State/ZIP: (503) 469 -7100 Investigation per hour (1 hr min) 62.50
Phone; ( ) Fax ( ) Industrial plant per hour 73.75
1 1 : =!_O ii. - r.OF6 '71-'...7-':7-'2.4N
��Ill;�1'�`1 1, . r ;li
CCB Lic.: 59011.44 Lic.: ,..20151 CAE 3uprv. Lic.: go' A Subtotal
Suprv. Electrician signature, required: • �_ _ t Plan review (25% of permit fee)
v /� ^r State surcharge (8% of pemtit fee) b.to
Print name:
keel - ifQ.lA.&. Date: 1 i � "1 l JC 1
TOTAL PERMIT FEE 81 DD
Authorized signature: This penult application expires If a permit Is not obtained within 180
Print name: d ays after It bas bean accepted as complete
Date: • Pee methodology set by Tri -County Building Industry Service Board
" Number of inspections per permit allowed.
l:\ Buitdiag WerrvtiEELC- pentitApp.doe 12/03 40.461S1(IO/O2JCOM/WFB
• CITY OF TIGARD _ .
BUILDING DIVISION PERMIT #: ELR2005 -00358
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/20/2005
Phone: (503) 639 -4171 a'
Inspection Requests (24 His.): (503) 639 -4175
INSPECTION WORKSHEET FOR • DATE: 11/9/2005 TIME: 7:09AM PAGE: 83
SITE ADDRESS: 09345 SW WASHINGTON SQUARE RD CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE:
PROJECT NAME: POTTERY BARN KIDS
DESCRIPTION:. Burglar Alarm.
OWNER: WASHINGTON SQUARE LLC, PHONE #: 503 -639 -8865
CONTRACTOR: ADT SECURITY SERVICES, INC PHONE #: 503 -469 -7244
Inspection Request Scheduled For: Date: 11/9/2005 Pour Time:
• Code # Inspection Description Confirm # Contact # Message
133 Low voltage 020635.01 503 - 469 -7212 N
Corrections /Comments /Instructions:
•
\AN . ),q 7 1,0A 110\ •
•
•
•
•
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: /i ��— Date: Phone #: (503) 718-