Permit CITY OF TI GARD ELECTRICAL RESTRICTED ENERGY PERMIT
YI DEVELOPMENT SERVICES PERMIT #: ELR2006 -00012
� JI 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 1/10/2006
PARCEL: 1S126
S12600 -00300
SITE ADDRESS: 09393 SW WASHINGTON SQUARE RD ZONING: C -G
SUBDIVISION: WASHINGTON SQUARE LOT: JURISDICTION: TIG
Project Description: Low voltage for security.
fPc8S t c Z OATAS `t K►D
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:
INSTRUMENTATION: OTHER: SECURITY`. X
TOTAL # OF SYSTEMS: 1
Owner: Contractor: Ait t, &ILL " pcf0 ver6e,A-A1 S
WASHINGTON SQUARE LLC 30/ St..) l35
BY THE MACERICH COMPANY - I - 0 97008
9585 SW WASHINGTON SQUARE RD
TIGARD, OR 97223 t 5
Phone: Contact #: `??_k So % 3 ct — 4 I 4
F A - k 54) 3 — 0 1O /
FEES Reg #: 34-Go c--� -�
L IC 13 gip
Description Date Amount
[ELPRMT] ELR Permit 1/10/2006 $75.00 O
[TAX] 8% State Surchari 1/10/2006 $6.00 REQUIRED ITEMS AND REPORTS
Total $81.00
0
0
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and t'
all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not J�
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 95 01 -0100. You ma obtain copies ;: f the rules o to C ture: 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 Per E h D volt OFFICE USE ONLY
"0 ,
City of Tigard Received /B ••• p '4)19 ; i Permit No __,,, _oOO/
13125 SW Hall Blvd., Tigard, ORJA23 1 U 2006 Plan Review
, a ..[ Other Permit:
Phone: 503.639.4171 Fax: 503.598.1960 i ' Date/B .
Inspection Line: 503.639.4175CITY OF TIGA1 U _J__ . � x,, . r' IL� J • DateRead Juror El See Page 2for
Internet: www.ci.tigard.or.usBu. ••-• NG DIVISION Notified/Method: 7 Supplemental Information
TYPE OF WORK PLAN REVIEW
d New construction Addition/alteration /replacement Please check all that apply:
❑ Demolition ❑ O er: ❑Service over 225 amps, comm'I ❑Hazardous location
❑Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of I- and 2- family dwellings 4 or more new residential
❑ I - 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
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION RV
❑Egress /lighting park
Job no.: / 3 1/ Job site address: 53 93 o , ,v6{� SQ ❑Health -care facility ❑Other:
Submit 2 sets of plans with any of the above.
City/State/ZIP: — 1 - 1 G,-/Z Li OYZ The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: 43 e e br yr f) & /37 FEE* SCHEDULE
Description [ 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 1
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
5 e- ,14 � _ oFLG
dwelling, service and/or feeder _ 90.90 2
//� Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER I ❑ 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: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
Address: first branch circuit
Each add'I branch circuit 6.65 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) Fax:: ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
extension. Describe: Page 2 2
Business name: 4!7 F , f , e , i , tf pEiF /✓S 5eea('/ r-1
Address: gap 1 5 (,) 1'? Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State/ZIP: Investigation per hour (I hr min) 62.50
Phone: ( ) Fax: ( ) Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: /3 Sgg j Electrical Lic.3,.24 Suprv. Lic.:7277 tin—. Subtotal
Suprv. Electrician signature, required: /‘ Plan review (25% of permit fee)
Print name: S/ / Date: / -42 •---6. State surcharge (8% of permit fee)
L TOTAL PERMIT FEE ' j - —
Authorized signature: //t7 ! This permit application expires if a permit is not obtained within 180
� I / days after it has been accepted as complete
.J
Print name: d 4 via Date/ /e2 6 • Fee methodology set by Tn- County Building Industry Service Board
•• Number ofinspedions per permit allowed.
I \Building\Permits\ELC -Pem itApp doc 12/03 / 440- 4615T(10/02/COM/w®
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
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:
COMMERCIAL WORK ONLY:
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 .UBuilding\Permite\ELC- PermitApp doc 04/03
CITY OF TIGARD ,.
BUILDING DIVISION PERMIT #: ELR2006 •00012
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/10/006
Phone: (503) 639 -4171 A j l
Inspection Requests (24 Hrs.): (503) 639 -4175
.r it
INSPECTION WORKSHEET FOR DATE: 4/26/2006 TIME: 7:03AM PAGE: 69
SITE ADDRESS: 09393 SW WASHINGTON SQUARE RD CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE:
PROJECT NAME: ABf.RCR• , E3IE KIDS
DESCRIPTION: Low voltage or secu
OWNER: WASHINGTON 3 WARE L.LC, PHONE #:
CONTRACTOR: AMERICAN VETE`ANS PHONE #: 503 - 3194754
Inspection Request Scheduled For: Date: 4/26/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 02.8703 -01 503.008.9010 N
Corrections /Comments /Instructions:
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62 6 , y \ .60E;
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c
��i PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Qrr ��i I
Inspector: N 6 L a Date: J Z 0) Phone #: (503) 718- z40).
CITY OF TIGARD • •
BUILDING DIVISION PERMIT #:1;1,{ZtOOL OOO 1%-
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 1, • 11 • (3 ( TIME: PAGE:
SITE ADDRESS: 9393SW »S t NT a (4 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION: S'F -vit..1
OWNER: QGkoMBig K t5 PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
Corrections/Comments/Instructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G-is o &C Date: O'b Phone #: (503) 718 - 2.446