Permit F. rII
CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
;•,+�I'° DEVELOPMENT SERVICES PERMIT #: ELR2005 -00298
'� II 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 9/22/2005
PARCEL: 1S12600-00300
SITE ADDRESS: 09368 SW WASHINGTON SQUARE RD ZONING: C -G
SUBDIVISION: WASHINGTON SQUARE LOT: JURISDICTION: TIG
Project Description: Audio system.
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:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
WASHINGTON SQUARE LLC VERSATILE CABLING, INC.
BY THE MACERICH COMPANY 12606 NE 95TH ST #C -130
9585 SW WASHINGTON SQUARE RD VANCOUVER, WA 98682
TIGARD, OR 97223 •
Phone: 503- 639 -8865 Phone: 360 -816 -1021
Reg #: LIC 161614
ELE 37- I048CLE
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 9/22/2005 $75.00
[TAX] 8% State Surchart 9/22/2005 $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 -0100. You may obtain copies of these rules or direct questions : 0 - NC at 503 - 246 -6699.
Issued By: , 9,� .4, . 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 Appi 7AI " - `I,I FOR OFFICE USE ONLY NED
City Tigard Received 9 - 0,5 A �iR� o 4 cz7 -% V
Ci of Ti and
Permit No.:
13125 SW Hall Blvd., Tigard, OR 97223 2 2 2005 P lan Revie
Phone: 503.639.4171 Fax: 503'.598.19 / /d„dte;M1, •1' Other Permit:
,I�I' � Date/By:
Inspection Line: 503.639.4175 Date Ready /By: mats El See Page 2 for
Internet: www.ci.tigard.or.us � C t I � TYY � O ( F TIGARD Notified/Method: Supplemental Information
a -,,ti;',- Y, ti,Fr 'T'PE � I O F • 4 81 P 0 -� ' , . ' ' , _ t , " ; ALAN RENO -W "' ° ',7!' . •
' New construction ❑ Addition/alteration/replacement Please check all that apply.
OService over 225 amps, comm'l ElHazardous location
12 Demolition ❑Other:
❑Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
- ,- !, 4, ;;„..4 'i ', CAT GO0Y= OFr,CONSTRU,CT_ ION,, :. - . ' , = k. of I- 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
❑Building over three stories ❑Feeders, 400 amps or more
❑ Multi- family ❑Master builder ❑ Other:
❑Occupant load over 99 persons ❑Manufactured structures or
' ' J,OB SITE 7NFORMATJON AND "LOCATION ❑Egress/lighting plan RV park
Job no.: I Job site address: q Sts S s lu ❑ Health -care facility ❑
Wa S h S Submit 2 sets of plans with any of the above.
City/ State/ZIP: ' j (-t e - 8 Da C 1 Q 3 The above are not applicable to temporary construction service.
. ',FEE?: _SGHEDULE r: - '`t; -, .... ,
Suite/bldg. /apt. no.: I Project name: �ei ri r' e -1- fU (.—./< ''
Description I Qty. I Fee I Total I
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 l
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
`' € :` 'i' - ' ,, ,. k � �r•,i`'' 3. ESCRYPT O' F.; ' . . ''�, k "T r s 1oW "..- "' C '
- e ; b. `
_ `�' ''' % , : _ . - ; ' � . �+ •/ r _ T''+F :..� s, Tia.1 i' Ea
- ch manufactured or modular
L , CQ �' � /J , O oS �/ „ M dwelling, service and/or feeder 90.90 2
(, Services or feeders installation, alteration, and/or relocation
(/ 200 amps or less 80.30 2
v ' A PROPE'R'I Y *it "— y , -- .1•' ,' ❑ } TENANT' pt' • .;" ; 201 amps to 400 amps 106.85 2 •
(`' : 5 ., 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
Phone: ( ) I Fax: ( ) relocation -
200 amps or less 1 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
-' . _ . ,c"t/iD-4PPL1OANT,jr:' ,lefki4J a -te !cgtKe"04, ;CT *E'44:5 , ; # ,3; `,. A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: 4f Q at / e .h///7 th branch circuit
B. Fee for branch circuits
Contact name: 7„ jg G 0 0 without service or feeder fee,
each branch circuit 46.85 2
t
Address: Each add'I branch circuit 6.65 2
City/State/ZIP: 0 (/- Miscellaneous (service or feeder not included)
0)' �69 0 1/ .Yl� Fax: : ( ) Pump or imgation circle 53.40 2
Phone:
I Sign or outline lighting 53.40 2
E -mail: - Signal circuit(s) or limited -
f�ri, -,
r,,_ - ; -,- .. �,e• if 4 ' *.,.F, , 4 :,,, , ;: <d ksf r - • ". • `,-,- . 3 energy panel, alteration, or "�
°K. i`iti ) .'"�>i • ... :.�CQ 'rah , -.x _:: „.;. W4, 4 O
` Business name: + ,r + I ' CC I r - % `( � extension. Describe: I Page 2 �. 2
Address: I a .-e. O Lp 0E Q s i~ s G-- c- ISO Each additional inspection over allowable in any of the above
I Per inspection 62.50
City/ State/ZIP: V (.,(,/I Cam ' A \ f -eA I (. 9 (.9$ D. Investigation per hour (i hr min) 62.50
Phone: (a c(:), g I 1p I O - 2- ( Fax: 0100 g l l•p _ b au, 2. Industrial plant per hour 73.75
E lect rical L ic. C u rv. Lic.: ''` '' t'"`” fit ' Cvililtit ;OXI S &Y#4 `
CCB Lic.:
/!o/(o/ :.`7 YbC, P • 3a(oaL Subtotal -7' 0-i
Suprv. Electrician signature, required: Plan review (25% of permit fee) VV
K State surcharge (8% of permit fee) LP ,
Print name: C4 2 . , ie �.,,:•ae: 0 _ / O S
TOTAL PERMIT FEE I ) , D D
Authorized signature: This permit application expires If a permit Is not obtained within 180
days after it has been accepted as complete
Print name: Date: • Fee methodology set by Tri -County Building Industry Service Board
•• Number of inspections per permit allowed.
i:\Building\Pamas\ELC -P rmitApp.doe 12/03 440- 46i5T(i0 /07/COM/WEB
J•
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LINIITED ENERGY PERMIT FEES:
�.RESIDEN,TIAL; WORK�;ONLY:.:'�:�. #.::-, ;'�. .. T••..; �,,.�. ,'f� �, .
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*
p Vacuum Systems*
❑ Other:
F ' e g'CUITAVOVOS NLY u • f _;?; ,. ' P •�;;},•k 1
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
❑ HVAC
❑ Instrumentation
❑ Intercom 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 \ Bui lding\Permvs\ELC- PcrmitApp.doc 04/03
CII OF TIGARD
BUILDING DIVISION PERMIT #:E/- 1 00298'
13125 SW Hall Blvd., Tigard, OR 97223 t t i o DATE ISSUED:
Phone: (503) 639 -4171 c
Inspection Requests (24 Hrs.): (503) 639 -4175 I I..
1
INSPECTION WORKSHEET FOR DATE: /0 TIME: PAGE:
SITE ADDRESS: 6)533 I4 V 4I'r , , Ad • CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: V ` , t
V
DESCRIPTION: ` k f
5 ,
OWNER:_• PHONE #: -0/6 - /024
CONTRACTOR: fe f PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
35 --reAtess
Corrections /Comments /Instructions:
F (1,c. fkk_A>a, y iN '.E•NtOs t "a 6 6 v r4zintki7 .
X PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: & • Iv 69 L G Date: ` L i O Phone #: (503) 71 S- 2*
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2005 -00298
1312 Blvd., Tigard, OR 97223 DATE ISSUED: 9/22/2005
Phone: (503) 639-4171
Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 11/4/2005 TIME: 7:08AM PAGE: 76
•
SITE ADDRESS: 09368 SW WASHINGTON SQUARE RD CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE:
PROJECT NAME: JANIE & JACK
DESCRIPTION: Audio system.
OWNER: WASHINGTON SQUARE LLC, PHONE #: 503 - 639.8865
CONTRACTOR: VERSATILE CA NIG, INC. PHONE #: 360 - 816 -1021
Inspection Request Scheduled For: Date: 11/4/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
L ' 020313 -01 503 - 449 -1013 Y
•
ections /Comm /lnstruc ns:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: v N 1 -14) Date: Li - 0 3 Phone #: (503) 718- 2444