Permit CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
f DEVELOPMENT SERVICES PERMIT #: ELR2005 -00414
- 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 11/15/2005
PARCEL: 1S12600-00300
SITE ADDRESS: 09384 SW WASHINGTON SQUARE RD ZONING: C -G
SUBDIVISION: WASHINGTON SQUARE LOT: JURISDICTION: TIG
Project Description: Fire alarm low voltage.
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: X OUTDOOR LANDSC LITE:
OTHER: : HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
WASHINGTON SQUARE LLC OREGON ELECTRIC GROUP
BY THE MACERICH COMPANY 1010 SE 11TH AVE
9585 SW WASHINGTON SQUARE RD PORTLAND, OR 97214
TIGARD, OR 97223
Phone: 503 - 639 -6685 Phone: 503- 234 -9900
Reg #: LIC 203
SUP 4460S
FEES ELE 26 -95C
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 11/15/200: $75.00
[TAX] 8% State Surchart 11/15/200: $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 95 1 -01 0. You ma btain copies of these rules or direct questions to OUNC at 503 - 246 -6699.
Issued By: Permittee Signature: ."el
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 Applicaf 1i 1 ' ErI F ; FOR OFFICE USE ONLY
i — i
City of Tigard DateBy° N S 05 Permit No. _ 006 ..12() 4
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 NOV 1 4 lai +� Date/By: Other Permit:
Inspection Line: 503.639.4175 IV` 1 `� • s � 1 Date Ready/By: 1 la See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Notified/Method: Supplementallnformation
TYI � W r 1IGA1<i5
DIVISION PLAN REVIEW
❑ New construction ®A g i e acement t Please check all that apply:
El Demolition ❑ Other: ❑Service over 225 amps, comm'l ['Hazardous location
['Service over 320 amps — rating DBuildn 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 OSystem over 600 volts nominal units in one structure
El 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 ❑Egress/lighting plan RV park
Job no.: Job site address: 9585 SW Washington Square Rd ❑Health - care facility ❑Other:
Submit 2 sets of plans with any of the above.
City /State/ZIP: Tigard, OR 97223 The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: R7 Project name: Shutterbug FEE* SCHEDULE
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'I 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
DESCRIPTION OF WORK Each manufactured or modular
Install low voltage wiring and cabling for Fire Alarm 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: Washington Square LLC 601 amps to 1,000 amps 240.60 2
Address: 9585 SW Washington Square Rd Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City /State /ZIP: Tigard, OR 97223 Temporary services or feeders installation, alteration, and/or
Phone: relocation
( ) 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
0 APPLICANT I ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: Oregon Electric Group, Inc. branch circuit
B. Fee for branch circuits
Contact name: Loni Martin without service or feeder fee,
Address: 1010 SE 11` Ave each branch circuit 46.85 2
Each add'I branch circuit 6.65 2
City /State /ZIP: Portland, OR 97214 Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: (503) 234 -9900 Fax: : (503) 535 -2620
Sign or outline lighting 53.40 2
E - mail: loni @oregon electric.com Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or / S �i
extension. Describe / Page 2 7 2
Business name: Oregon Electric Group, Inc.
Address: 1010 SE 11 Ave Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State/ZIP: Portland, OR 97223 Investigation per hour (1 hr min) 62.50
Phone: (503) 234 -9900 Fax: (503) 535 -2620 Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: 203 Electrical Lic.: Suprv. Lic.: Subtotal
Suprv. Electrician signature, required: I'�' Plan review (25% of permit fee)
V ! j" j � � �- State surcharge (8% of permit fee) /P s
Print name: OA (iV (vt t<1C Cam/ / Date: 11/14/05 G/ OU
TOTAL PERMIT FEE O
Authorized .
g r This permit application expires if a permit is not obtained within 180
� / days after it has been accepted as complete
Print name: I V ✓Vl L c Date: 11/14/05 * Fee methodology set by Tn- County Building Industry Service Board
•• Number of inspections per permit allowed
t•\Budda%\Pernuts\ELC- PemutApp doc 12/03 440- 4615T(10/02/COM/WEB
CITY OF TIGARD
BUILDING DIVISION PERMIT #1.1.g.2.006 004
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 +yg i ?"
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: t,` • `" . d TIME: PAGE:
SITE ADDRESS: \32L S IA) + sa- • CLASS OF WORK:
SUBDIVISION: � LOT #: TYPE OF USE:
PROJECT NAME:
__- ? _t
DESCRIPTION: .
OWNER: 1/431 PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date \I, I 1 • W Pour Time:
Code # Inspection Description Confirm Contact # Message
BSc F'1'�44■L...
Corrections /Comments /Instructions: FIRE I' la
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Irle).Alvt: NM-A
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j4 PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G N6 L Date: I I 1 Or Phone #: (503) 718 - 1,44O •
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