Permit CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
DEVELOPMENT SERVICES PERMIT #: ELR2005 -00207
�a♦ II 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 7/27/2005
PARCEL: 1S12600-00300
SITE ADDRESS: 09410 SW WASHINGTON SQUARE RD K -11 ZONING: C -G
SUBDIVISION: WASHINGTON SQUARE LOT: JURISDICTION: TIG
Project Description: Limited energy for audio /stereo wiring.
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 MERLIN POINTE TECHNOLOGIES
BY THE MACERICH COMPANY 11800 NE 95TH ST STE #230
9585 SW WASHINGTON SQUARE RD VANCOUVER, WA 98682
TIGARD, OR 97223
Phone: 503- 639 -6685 Phone: 360 - 892 -0065
Reg #: LIC 155924
ELE 37- 100CLE
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 7/27/2005 $75.00
[TAX] 8% State Surcharl 7/27/2005 $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 within18.0 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires
you o low rules a. •pted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010
thr ugh OAR 952- 0010100.,'j•` /•btain cosies of these rules or direct ques' ns to OUN 03- 246 -6699.
J
� / 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 if 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 FOR OFFICE USE ONLY
City of Tigard
Received 7�
Date/B p Permit No. 1 s
.0 11,
13125 SW Hall Blvd., Tigard, OR 97223 O P lan Review
Phone 503.639 4171 Fax: 503 598 1960 g ''''4'.14:. i `? DateB . Other Permit
Inspection Line: 503.639.4175 - _-_a ' i i Date Ready/By. ® See Page 2 for
Internet: www.ci.tigard.or.us J Notified/Method: at. Su pplement al Information
TYPE OF WORK PLAN REVIEW
N _New construction ❑ Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑Other: ❑Service over 225 amps, comm'I 0 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 Il 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 ❑ Mann factured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park
G Si.. ❑Health -care facility ❑Other:
Job no.: Job site address:
1 4 in SW iL;As(4IAi6 V 3 KO Submit 2 sets of plans with any of the above.
City /State/ZIP: ' f d 2 q-, o',„ +2 . 3 The above are not applicable to temporary construction service.
Q � FEE* SCHEDULE
Suite/bldg. /apt. no.: Project name: Le- Q_ �9r�� Q t 7T l Description 1 Qty. 1 Fee. Total 1 "
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: I Lot no.: Ea. add'I 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
(.54 dwelling, service and/or feeder 90.90 2
l�� - c O 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
S ^ Pi 401 amps to 600 amps 160.60 2
Name: �A.c f T Q � c ?6R u -, . �L-Q : 601 amps to 1,000 amps 240.60 2
Address: �vJ "�� �� 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
(f 21 / ? I ( ) relocation
Phone: lJ (Q 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: each branch circuit
Each add'I branch circuit 6.65 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone:
( ) I Fax: : ( )
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: to P �-
79(.-1.'i
Address:. - Each additional inspection over allowable in any of the above
��d A).6.-- (7S �N S S � � ' � 3) Per inspection 62.50
City/State/ZIP: t fx 7 tier_ 44�,9 56'_z Investigation per hour (I hr min) 62.50
Phone: (340) 2 o I Fax: ( ) ' lap Industrial plant per hour 73.75
/j ELECTRICAL PERMIT FEES*
CCB Lic.: Iss Iaa'- Electrical Lic.: 3j...j 7G Suprv. Lic.: 36 f y z619, Subtotal -75:0
Suprv. Electrician signature, required: Plan review (25% of permit fee)
Print name: � f i Date: 2 _ S—
# State surcharge (8% of permit fee) , ��
TOTAL PERMIT FEE O foe
Authorized signature: S � g ; _ This permit application expires if a permit is not obtained within 180
`� �_ days after it has been accepted as complete
Print name :� / Date: 7 • Fee methodology set by Tn- County Building Industry Service Board
•• Number of inspections per permit allowed.
i \Budding\Permits\ELC- PetmitApp doe 12/03 4404615T(10/02/COM/WEB
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:
F.COMMERCIAL WORK ONLY: l ,
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*
0 Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I \ Bwlding\Pertnns\ELC- PermnApp 04/03