Permit CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
„ A • I" DEVELOPMENT SERVICES PERMIT #: ELR2005 -00398
s`�� 13125 SW H all Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 11/7/2005
PARCEL: 1S12600-00300
SITE ADDRESS: 09359 SW WASHINGTON SQUARE RD ZONING: C -G
SUBDIVISION: WASHINGTON SQUARE LOT: JURISDICTION: TIG
Project Description: Low voltage: Burglar and video.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: X 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:
INSTRUMENTATION: OTHER: BURG ALARM X
TOTAL # OF SYSTEMS: 2
Owner: Contractor:
WASHINGTON SQUARE LLC DIEBOLD, INC
BY THE MACERICH COMPANY 15100 SW KOLL PKWY
9585 SW WASHINGTON SQUARE RD BEAVERTON, OR 97006
TIGARD, OR 97223
Phone: 503- 639 -8865 Phone: 503-469-1700
Reg #: LIC 994493
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 11/7/2005 $150.00
[TAX] 8% State Surchart 11/7/2005 $12.00
Total $162.00
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 dopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010
through OAR 9 -001 -0 0. You ma tain copies of these rules or direct questions to OUNC t 503 - 246 -6699.
Issued By. Permittee Signature: e .---
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 Pe >p FOR OFFICE USE ON 1_,N .
City f Tigard Received / Permit No
1 3 r n Date/Br. 1 (/7 /O S 6.6 dUS a d 3`7 .
13125 SW Hall Blvd., Tigar ,41Ri 97223 '1005 Plan Review I
i'hone• 503.639.4171 Fax 5D3 598.160 L //'. , - ! : . r �, I l l, Date/By: Other Permit.
Inspection Line: .503.639.4175 _ _ " -'I � -, Date Ready/By: I • El See Page 2 for
Internet: www.ci.tigard.or.tls ITY OF TIGARD Notified/Method. re Supplemental Information
BUILDING WORK . PLAN REVIEW.,
[�'�New construction ❑ Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑ Other: OService over 225 amps, comm'I ['Hazardous location
['Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of 1 -and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling (' Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi - family ❑Master builder ❑ Other: ❑Building over three stories ['Feeders, 400 amps or more
DOccupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION , RV
0Egressllightingp1an park
Job no.: Job site address: C13S y sw i..Az31f /RGToL SQv42 (Z,J ❑Health -care facility ['Other:
Submit 2 sets of plans with any of the above.
City/ State/ZIP: 'p (., /\-yip 0 /L q 7) 2 3 The above are not applicable to temporary construction service.
FEE* SCHEDULE
Suite/bldg. /apt. no.: -T--2. Project name: 5 r wCi--s Description Fee 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
MDESCRIPTION OF WORK Each manufactured or modular
a r dwelling, service and/or feeder 90.90 2
/A, S -( �-R SYS - Al C V / t2c� c YS-R Services or feeders installation, alteration, and /or relocation
�/ 200 amps or less 80.30 2
,❑ PROPERTY OWNER 1O TENANT 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
[APPLICANT I ❑ CONTACT .PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: . 0 i L g / IJUC, branch circuit
B. Fee for branch circuits
Contact name: bk.) t_f y T without service or feeder fee, 46.85 . 2
Address: i j 0 Su-) � � w 1 4 I f t' fi
each branch branch it
I' Each add'I branch circuit 6.65 2
City/State/ZIP: 6 L t' s f u lA ToN on. 7006 Miscellaneous (service or feeder not included)
Phone: (( t i,64_ 1 70 p Fax:: g '3 ) t — / ? s i -- J Pump or irrigation circle 53.40 2
/� (11 Sign or outline lighting 53.40 2
E -mail: fro L_ ( () 19 I t= !'j.I� ' C O /Lt Signal circuit(s) or limited-
CONTRACTOR _ energy panel, alteration, or
� ( -0 i /l, extension. Describe: Page 2 2
Business name: r
Address: I cl G U S 1,i_ p ,, `f l: Each additional inspection over allowable in any of the above
Per inspection 62.50
City/ State/ZIP: (,t Z h7rr J\.) a vL q ?OM Investigation per hour (I hr min) 62.50
Phone: (113 ) C6' q - (7iJ Fax: 4 ) Y,61-(7.1 9 Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.:(4/(3 Electrical Lic.: 3Y- lob -Cl Suprv. Lic.: Subtotal j�
Suprv. Electrician signature, required: Plan review (25% of permit fee)
State surcharge (8% of permit fee) /..----
Print name: Date:
j� *lit /� TOTAL PERMIT FEE
Authorized signature __L �� A_ J�( This permit application expires if a permit is not obtained within 180
I days after it has been accepted as complete
Print name: ,A 1 L 'f Date: i (— 7 Q • Fee methodology set by Tri- County Building Industry Service Board
•• Number of inspections per permit allowed. ��
i \Budding\Permn ®
s\ELC- PermitApp doe 12/03 440- 4615T(10/02/COM/W
Electr at Permit A 1 1 lication - City of Tigard
Page 2 - . upplemental Information
LIMITE i ENERGY PERMIT FEES:
FfIESIDENT ^ , WORK ONLY:
Fee for all reside i tial systems combined........ $75.00
Check Type of Wo Involved:
❑ Audio and Ster. • Systems*
❑ Burglar Alarm .
❑ Garage Door Opener
❑ Heating, Ventilation and • it Conditioning
System*
❑ Vacuum Systems*
❑ Other: .
[ WORK ONLY: T ^ 1
Fee for each commercial system. y5.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ ata Telecommunica on Installation
Fire Alarm Insta .tion
❑ HVAC
❑ Instru entation
❑ I I ercom and Paging Systems
❑ ` Landscape Irrigation Control* .
❑ Medical
❑ Nurse Calls .
❑ Outdoor Landscape Lighting*
❑ Protective Signaling '
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
i \Bwldin PermiWpp doc 04/03
CITY OF TIGARD , ZoaS 043111
BUILDING DIVISION PERMIT #: ELC2005 -00
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 - 4171 I
Inspection Requests (24 Hrs.): (503) 639 -4175 lit
INSPECTION WORKSHEET FOR DATE: 11/15/2005 TIME: ' 7:02AM PAGE: 104
SITE ADDRESS: 09359 SW WASHINGTON SQUARE RIB CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE:
PROJECT NAME: STARBUCKS
DESCRIPTION: T.I. Limited energy systems are: audio/stereo wiring, data, fire alarm, HVAC and intercom /paging.
Job No. 50636R
OWNER: WASHINGTON SQUARE LLC, PHONE #: 503-639-8865
CONTRACTOR: STONER ELECTRIC PHONE #: 503 -462 -6500
Inspection Request Scheduled For: Date: 11/15/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
130 Ceiling cover 021173 -01 603804 -6578 N
Corrections/Comments/Instructions:
s• •
‹)i 2\ 3 -
- 41i=
Irk PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 1 v ®B L Date: 1 I 8Th Phone #: (503) 718- 2141.