Permit fy
.; CITY OF TIGARD
ELECTRICAL RESTRICTED ENERGY PERMIT
DEVELOPMENT SERVICES PERMIT #: ELR2005 -00171
A 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 7/14/2005
PARCEL: 1S12600-00300
SITE ADDRESS: 09410 SW WASHINGTON SQUARE RD K -11 ZONING: C -G
SUBDIVISION: WASHINGTON SQUARE LOT: JURISDICTION: TIG
Project Description: Thermostat
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: THERMOSTAT. X
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
WASHINGTON SQUARE LLC ARROW MECHANICAL
BY THE MACERICH COMPANY 10330 SW TUALATIN RD
9585 SW WASHINGTON SQUARE RD TUALATIN, OR 97062
TIGARD, OR 97223
Phone: Phone: 503 692 - 1565
Reg #: LIC 5193
ELE 34 -47CLE
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 7/14/2005 $75.00
[TAX] 8% State Surcharl 7/14/2005 $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 95 01 -0100. You may obtain copies of these rules or direct questions to OUNC at 503 - 246 -6699.
.L
Issued By: i �C r /2- s Permittee Signature: j � ,�ra jz S __
G i;�
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 cans shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans am required on the job site at the time of each inspection.
1
Electiical Permit Application FOR OFFICE 1 S1: o
C of Tigard P CE0 VA �� Re ceive d _ �
13125 SW Hall Blvd., Tigard, OR 97223 L AY: 6 r � q � , )��t No. aa / /
Rhone: .503.639.4171 Fax 503.598.1960 l JUN + . Plan it " Pte -
Inspection Line: 503.639.4175 7 r 1 " Date/By. e e R
www.citigarclor.us 1 1 � Date C&Mc BO: hem: ® see P 2 for
Internet ei ti or us .K-!..1t,'"
Notts `` Supplemental
ti ed/Md�d I �+PPi Intbrmatloa
; 44� ° - } Please check all that apply: c r
❑ New construction Addition/alteratio . ,
❑ Demolition ❑ Other • ['Service over 225 amps, comm'l ❑Hazardous location
µ 1 r - , ❑Service over 320 amps -raring ❑Barking over 10,000, sq. ft,
- 2 `; -, dwe ® Comm ," .r'g] ,,+ i :,,,,,!,.,.,t
,, t r .x c . , '',.:•,2,,,,,,.:,, -- , . ,,,`sr, dwellings of 1- and 2- family dwe 4 or more new residential '
❑ ,, and
etch ` industrial ` Accessory building 0 System over 600 volts nominal units in one structure
['Building over three stories ['Feeders, 400 amps or more
12 Multi - family ❑ Master builder ❑ Ott
i 4 '� Z .+ a: ['Occupant load over 99 persons 0 Manufactured structures or
1, s ' I, {1` ,3 ❑Egress/Olin P� RV park ,
Job no.: Job site trddless: l ❑ Health -cme facility • � t` I' u Submit 2 sets of plans with any of the above.
C i t y / S t a t e IP: , el ( b oft_ T e above are not applicable to temporary consiniction service:
Suite/bldg./apt no.: — i Project name: _ .. _ , .:.,n ._� :. 4 - -.. r,`_ ' ,,tt :; �, .:; ..:::::..., DesaiptIon Qtr. Pea Tote
Cross street/directions to job site: New residential single- or multi -family dwelling unit. .
Includes attached garage..
1,000 sq. R or less 145.15 '4
Subdivision: L no.: Ea add'l 500 sq. R or portion 33.40 1
Tax map/parcel no.: Limited energy, residential 75.00 2
t,
zs { -� , !� f 4 is s , mL y r v J � Limited energy, non-residential 75.00 2
.L. A .,J,9 s? 1 j) d t L ei
- _••_,.. ...,_ . .,: ur... '! :; __ • . f_ S � manufactured Or modular
. ., : Each manufactured
dwelling, service and/or feeds 90.90 2
Services or feeders
Installation, alteration, and/or rdoeatlon
200 amps or less 8030 2
l .$ ` ...`.�r; i ,tS t,'. hs < ' ?, t m� . rrr r . .,• , r 201 amps to 400 amps 106.85 2
Name: i µ y _ 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City/State/ZIP:
only 66.85 2
Temporary services or feeders installation, alteration, and/or
Phone: ( ) Fax ( )
Owner Installation: This installation is made on 200 or less 66.85 1
lease, being property that I own which is not 201 amps to 400 amps 10030
intended for sale, 2
e, ease, tent, or exchange, according to ORS 447, 449, 670, and 701.
401 a to 600
Owner signature: amP amps 1 33.75
O 2
Date: Branch elrcatts - new, alteration, or extension, anel
` h ' a + + e y r �L ! ' i r panel
a.. � 1 i : t 5 + ?:. t i r G1 r "�' A Fee for branch circuits with
Business service or feeder fee, each
R w h1 44 l : L • . t i.: •( .,..
— service . branch circuit 6.63 2
usiness name. •
Contact name: G t n
B. Fee for branch circuits
without service or feeder fee, 46.85 2
Address: •
each each branch circuit
/ t Each add'! branch circuit 6.65 2
City/State/ZIP: . L pt. i l / r 7 Miscellaneous (service or feeder not Included)
Phone. o ) (pct Z - 1 5(ps Fax: : (503) ei / _ P or irrigation circle 53.40 2
E -mail:
Sign or outline lighting 53.40 2
., Signal circuit(s) or limited -
:.-� t •.Yxr,o, rw •3 -
KV `. 2 Y,y �'rr''' t t o a �.p le , ett . a'; , s s 4); - � t r . energy panel, alteration, or [
+49t:� f.,-- _�.*.. _. � ..... ...�t..t�.xis, -!��. l�cwf- :, a;m,ror... 4h� 1...... _..f � ✓,,.t�_.t.:N - - '��..�:.1::.:
Business name: v W C t _ _r.... extension. Describe: Page 2 2
/ c ' .w I At- , o� a 1.,\I TwouviDsr ,
Address: / 3 T. • L 4-77,/ A . 0 • Each additional Inspection over allowable in any of the above
Per inspection 62.50
City /State/ZIP: er t Li , brt e , 2 Investigation per hour (I hr min) 62.50
Phone: (5 ) G 9 C- —/6 Fax: (5 ) ( q / -/ 0 79 Industrial plant per hour 73.75
CCB Lic.: 5 - • ry . ic: . Sup_. Zs41 I- i Q
� Subtotal
Suprv. Electrician signature, required: — IMIIIIIIIII Plan review (25% of permit fee)
Print [tame: .f exit : 1 t L L • a_ Date: L _1 -Or State surcharge (8% of permit fee)
Authorized si lure: TOTAL PERMIT FEE ' , 00
!'
This permit application expires Ira permit Is not obtained within 180
Print name: Date: after it has been accepted as complete
Date: • Fee methodology set by Tri- County Building Industry Service Board