Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00960
� DEVELOPMENT SERVICES DATE ISSUED: 12/15/2005
` � f II 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1312600 - 00300
SITE ADDRESS: 09354 SW WASHINGTON SQUARE RD ZONING: C -
SUBDIVISION: WASHINGTON SQUARE LOT : JURISDICTION: TIG
Project Description: (2) sign lightings.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG: 2
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HM/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
WASHINGTON SQUARE LLC MEYER SIGN CO OF OREGON
BY THE MACERICH COMPANY 15205 SW 74TH AVE
9585 SW WASHINGTON SQUARE RD TIGARD, OR 97223
TIGARD, OR 97223
Phone: 503 - 639 -8865 Contact #: . PRI 620 -8200
FEES
Description Date Amount Reg #: LIC 64014
[ELPRMT] ELC Permit 12/15/200: $106.80 ELE 20- 190CLS
[TAX] 8% State Surcharge 12/15/200: $8.54
Total $115.34 REQUIRED ITEMS AND REPORTS
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Speaalty 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
suspende r mo n 180 days ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center Those
rules a set forth in OA 52 -I .1-0110 through OAR 952-001-0100 You may obtain copies of these rules or direct q • ons • OUNC at
503 -2 6 - 6699 or 1- 800 -33 - 4
Issu d By: I / v1��1./ Permittee Signature: : •�� ri
OWNER INSTALLATION ONLY
411
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 Application Received FOR OFFICE USE ONLY
Electrical � w �
Date/By: /¢- /S / 4 / Permit No e e/5 O�
Planning App .val Sign
City of Tigard Date/By Permit No..
. 13125 SVW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By Permit No.:
Phone: 503- 639 -4171 Fax: 503 - 598 -1960 & Post- Review Land Use
Date/By: Case No.:
Internet: www.ci.tigard.or.us ,..41„,,11 Contact J /t 0 See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name /Method: �co- Supplemental Information.
TYPE OF WORK . . PLAN REVIEW (Please check all that apply) ' -
❑ New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
❑ Addition / alteration /replacement ['Other: ,61 ❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet,
CATEGORY OF CONSTRUCTION • _ 1 & 2 family dwellings four or more residential units in
❑ 1 & 2- Family dwelling E Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
❑ Accessory Building ❑ Multi- Family 1 ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
JOB SITE INFORMATION and LOCATION Submit _ sets of plans with any of the above.
J The above are not a to temporary construction service.
Job site address: y' Jsai �/,44/a797a1` - , Qd- FEE* SCHEDULE
Suite #: W /5 Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: 74 t{/gAii ,- Co • Des Qty Fee(ea.) Total
New residential - single or multi - family per
Cross street/Directions to job site: dwelling unit. Includes attached garage.
1 . / _ Service included:
v S ` � ' �S r Q C 1000 sq ft or less 145.15 4
Each additional 500 sq ft. or portion thereof 33.40 I
Limited energy, residential 75.00 2
Subdivision: Lot #: Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
DESCRIPTION OF WORK service and/or feeder 90 90 2
: 6 ape ; /� 7- ice - installation,
�Q� P- �� m �Gvl�.t tes1C Sery alteratis on or or feeders relocation:
tad( ( U' 200 amps or less 80.30 2
I �L� 201 amps to 400 amps 106.85 2
I 40l amps to 600 amps 160.60 2
'PROPERTY OWNER I ❑ TENANT .• 601 amps to 1000 amps 240.60 2
Eli Over 1000 amps or volts 454.65 2
Name: . IV L LLC_ Reconnect only 66.85 2
Address` Mr ,U /4/4 r . PA • i Temporary services or feeders - installation,
alteration, or relocation:
City /State /Zip: - t64Iz 5 OA .. ?72 2 200 amps or less 66.85 i
F ax: 201 amps to 400 amps 100 30 2
Phone: (, �q —�S6U 401 to 600 amps 133.75 2
❑ APPLICANT ❑ CONTACT PERSON Branch circuits - new, alteration, or
Name: 0", Rui_ day' (i extension per panel:
A Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 6.65 2
City /State /Zip: B Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46.85 2
Phone: Fax: Each additional branch circuit 6 65 2
E -mail: Misc (Service or feeder not included)
CONTRACTOR Each pump or imgation circle 53.40 2
Each sign or outline lighting ,, 53.40 /66). ifC 2
Job No: Signal circuit(s) or a limited energy panel,
alteration, or extension Page 2 2
Business Name: i bt., 't1lL S76r41 a, i D.R. Description•
i i/le
Address: /52_0c (,ti 2 -
Each additional inspection over the allowable in any of the above:
City /State /Zip: -r( -(L.'b � m . ?I z 2_11 Per inspection per hour (min. 1 hour) 62.50
/` Fax: , 2C..)- 20 7Ll Investigation fee Phone: , -2,0_1 ether
CCB Lic. #: (0 ( 7 Lic. #: z D •- (QO c L S Electrical Permit Fees*
Supervising electri Subtotal $ /66 • g0
signature required: Plan Review (25% of Permit Fee) S
Print Name: n (4-1 (, `= . .1 I►1 Lic. #: S(GS(o h Sta te Surcharge(8% of Permit Fee) $ S• 54,____
V TOTAL PERMIT FEE $ / /d5 $
Authorized i
Signature: Noti ce: This permit application expires if a permit is not obtained within
V Date: 1 2 - - -14 -115-
- -I 4 S 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
r- 0- •(1-Q (., ' 4
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Electrical Permit Application - City of Tigard
Page 2 - Supplement Information --
LIMITED ENER Y PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved ',
❑ Audio and Stereo Systems '
rl
❑ Burglar Alarm
❑ Garage Door Opener
n Heating, Ventilation and • • it Conditioning System • •
p ❑ Vacuum Systems .
❑ Other i
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918 - 260 -260) j
Check Type of Work Involved:
• ❑ Audio and Stereo Systems
n Boiler Controls "
❑ Clock Systems "1
El D Telecommunicatio Installation
Fire Alarm Installati n ,
n HVAC
n Instrumentation r.
n Intercom and Paging Systems
❑ . Landscape Irrigation Control '
n . Medical
10
❑ Nurse Calls
,, ❑ Outdoor Landscape Lighting
r.
n Protective Signaling
n � Other {
f •
Number of Systems '
* No licenses are required. Licenses are required for all
other ' installations
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