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Permit
ELECTRICAL PERMIT CITY OF TIGARD PERMIT #: ELC2005 -00451 DEVELOPMENT SERVICES DATE ISSUED: 6/24/2005 ° 'III 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 1S12600-00300 SITE ADDRESS: 09410 SW WASHINGTON SQUARE RD K -11 ZONING: C -G SUBDIVISION: WASHINGTON SQUARE LOT : JURISDICTION: TIG Project Description: (1) service, (24) branch circuits. Job #109639. RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS 1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION: EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG: LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL: MANF HM/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10): SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS 0 - 200 amp: 1 W /SERVICE OR FEEDER: 24 PER INSPECTION: 201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR: 401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT: 601 - 1000 amp: PLAN REVIEW SECTION 1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL: Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC: Owner: Contractor: WASHINGTON SQUARE LLC ELECTRICAL DIMENSIONS INC BY THE MACERICH COMPANY PO BOX 12146 9585 SW WASHINGTON SQUARE RD 3961 N WILLAMS AVE TIGARD, OR 97223 PORTLAND, OR 97212 Phone: Phone: 503 - 282 - 7255 FEES Reg #: LIC 44008 Description Date Amount SUP 2 ELE 26 -432C [ELPRMT] ELC Permit 6/24/2005 $239.90 [TAX] 8% State Surcharge 6/24/2005 $19.19 REQUIRED ITEMS AND REPORTS Total $259.09 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 to OUNC at 503 - 246 -6699 or 1- 800 - 332 -2344. Issued By: 1i 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 Application roll Orflcl, l ?l: a City of Tigard ma y : . -0� ,p -07 _ Permit No.: C d U - GQ OD 5/5/ 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 14 */ h'rtiyq ' Date/By: Other Permit: Inspection Line: 503.639.4175 -'� � , Date ReadyBy: / la See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: Q I Supplemental Information TYPE OF WORK PLAN REVIEW ❑ New construction ❑ Addition/alt n/replacement Please check all that apply: El Demolition Other; / A= ❑Service over 225 amps, comm'l ❑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 [Occupant load over 99 persons ❑Manufactured structures or JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park Job no.: C 139 Job site address: G� C/ 0 l �� S � S K 1 ❑H� facility n y ❑�r� " Submit sets of plans with an of the above. City/State/ZIP: WI il-Q. N s a - L[ � The above are not applicable to temporary construction service. ill Suite/bldgJapt. no.: 1(-- l \ I Project name: Le ,© < ea FEE* SCHEDULE J Qty. 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.: Fa add9 500 sq. R or portion 33.40 1 Tax map /parcel no.: Limited energy, residential 75.00 2 Limited energy, non - residential 75.00 2 CJ ESCRIPTION OF WORK Each manufactured or modular �1 _ dwelling, service and/or feeder 90.90 - 2 Services or feeders installation, alteration, and/or relocation 200 amps or less i 80.30 'Qt 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 Business name: branch circuit 6.65 (e5 B. Fee for branch circuits Contact name: without service or feeder fee, 46.85 2 each branch circuit Address: Each add9 branch circuit 6.65 2 City /State/ZIP: Miscellaneous (service or feeder not included) Phone: ( ) I 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: 1_� vl 61).�4/1) v Address: Z,A'6 ( 4e! r w r, � Each additional inspection over allowable in any of the above HD / Per inspection 62.50 City/State/ZIP: HD RT. / ® p G,i 2 —Z Investigation per hour (I hr min) 62.50 � Phone: (5�f �7� "7-2„4"-S- 1 / �/ Industrial plant per hour 73.75 I Fax: ( )24C)— Q eq ELECTRICAL PERMIT FEES* CCB Lic.: /./4008 Electrical Lic.: -4...R Suprv. Lic.: 2/611-S Subtotal q, . Suprv. Electrician signature, required: 1 Plan review (25% of permit fee {� � � a :C4 2/85 Stale surcharge (8% of permit fee) (�( ( 7 Print name: --1 ( y 9/ ` TOTAL PERMIT FEE 2-59 .m 7 Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete Print name: I Date: • Fee methodology set by Tri -County Building Industry Service Board • • Number of inspections per permit allowed. 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 CITY TIGARD • BUILDING DIVISION PERMIT #: ELC2005-00451 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/24/2005 Phone: (503) 639 -4171 i Inspection Requests (24 Hrs.): (503) 639 -4175 `' INSPECTION WORKSHEET FOR DATE: 8/24 /2005 TIME: 7:08AM PAGE: 55 SITE ADDRESS: 0 t 410 SW WASHINGTON SQUARE RD K - CLASS OF WORK: 11 SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE: PROJECT NAME: LEGO\ DESCRIPTION: (1) service, (24) branch circuits. Job #109639. OWNER: WASHING N SQUARE LLC, PHONE #: CONTRACTOR: ELECTRICAL Q MENSIONS INC PHONE #: 503.282 -7255 Inspection Request Scheduled For: Date: 8/24/2006 Pour Time: Code # Inspection Description C• • ' # Contact # Message 199 Electrical final 014181 -01 503-282-7265 N Corrections /Comments /Instructions: • • • • • If ; 'ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: ° Date: S "1'"05 Phone #: (503) 718 - •