Permit • CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2006 -00106
� I� DEVELOPMENT SERVICES DATE ISSUED: 2/8/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 1S12600-00300
SITE ADDRESS: 09459 SW WASHINGTON SQUARE RD A14 ZONING: C -
SUBDIVISION: WASHINGTON SQUARE LOT : JURISDICTION: TIG
Project Description: (1) wall sign.
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: 1
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: W /SERVICE OR FEEDER: 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 MEYER SIGN CO OF OREGON
BY THE MACERICH COMPANY 15205 SW 74TH AVE
9585 SW WASHINGTON SQUARE RD TIGARD, OR 97223
TIGARD, OR 97223
Phone: 503 - 639 -8865 Contact #: PRI 620 -8200
FEES
Description Date Amount Reg #: LIC 64014
[ELPRMT] ELC Permit 2/8/2006 $53.40 ELE 20- 190CLS
[TAX] 8% State Surcharge 2/8/2006 $4.27
Total $57.67 REQUIRED ITEMS AND REPORTS
•
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR Speaalty 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 U i y 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 dire t questio to OUNC at
503 - 246 -6699 or 1- 800 - 333
Issued By: 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.
_ Eletctrical Permit A • t1Ori FOR OFFICE USE ONLY
Received n Electrical {�!_
j DateBy] Q'6 / — Permit No.: C.C.J0 p 001 g
Planning Approval Sign
City of T1gaICC� Date /By: Permit No •
13125 SW Hall Blvd. Plan Review Other
®8 , 1006
Tigard, Oregon 97223 FEB Date/By • Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post- Review Land Use • OF � � � �a� I t� Date/By: Case No.:
Internet: www.Ci.tlgati r i t ul 1V ^ � _�, n . ' I Contact Juris : ® See Page.2 for
24 -hour Inspection s /41 Name/Method T 1 ( f Supplemental Information.
TYPE OF WORK - - PLAN REVIEW (Please check all that apply) . .
LI New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility / commercial ❑ Hazardous location
❑ Addition/alteration/replacement Other: �/i - ❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet,
- .. ,CATEGORY OF CONSTRUCTION - . I & 2 family dwellings four or more residential units in
n I & 2- Family dwelling ® Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stones ❑ Feeders, 400 amps or more
❑ Accessory Building ❑ Multi- Family i ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other.
q qs q JOB'SITE INFORMATION and LOCATION Submit _ sets of plans with any of the above.
The above are not applicable to temporary construction service.
Job site address: 4 61 I WASX01/&1-6 ■1 -z , Oil . FEE* SCHEDULE
Suite #: 4 — )'4 I Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: f - L c -LR— Description Qty Fee(ea.) Total
New residential- single or multi - family per
Cross street/Directions to job site: dwelling unit. Includes attached garage.
Service included:
1000 sq ft. or less 145.15 4
W. ' �irx ! /v`T li/t,�r �,( A _L.C— Each additional 500 sq. ft. or portion thereof 33.40 1
Limited energy, residential 75.00 2
Subdivision: Lot #. Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
- 'DESCRIPTION OF WORK service and/or feeder 90.90 2
Services or feeders - installation,
e� ` A , s C Gl (f , ` alteration or relocation:
200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
[LPROPERTY OWNER I ❑ TENANT -- - • 601 amps to 1000 amps 240 60 2
, /� Over 1000 amps or volts 454 65 2
Name: IA/4- , 5Mutr1_Q / b2 VI rr Reconnect only 66.85 2
r
/��,,/ , (Cr
Address: y`,y8s �Gt.) y't/}T�S/'f- //l�-7� p er+ � Temporary services or feeders - installation,
alteration, or relocation:
City /State /Zip: 1- rG-A-{2-\ � - 97� �3 200 amps or less 66.85 1
Phone: (0 Pl b Fax: 201 amps to 400 amps 100.30 2
401 to 600 amps 133.75 2
❑ APPLICANT ❑ CONTACT PERSON Branch circuits - new, alteration, or
Name: extension per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 6.65 2
City /State /Zip: B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46.85 2
Phone: I Fax: Each additional branch circuit 6.65 2
E -mail: Misc.(Service or feeder not included)
CONTRACTOR Each pump or irrigation circle 53.40 / 2
4 Each outline lighting / 53.40 53 - 0 2
Job No: Sign cg or a li energy panel, 2
alteration or extension Page 2
Business Name: (�Y �i�a �� � � V Description
Address: i,52_0 .sw 7 n_,.:4 ,2 '
Each additional inspection over the allowable in any of the above:
City /State /Zi .: is _ £7 Z Per inspection per hour (min I hour) 62.50
Phone: to - -g 2c.,c7 ax: 47,9-70 Investigation fee:
Qther:
CCB Lic. #: tin Lic. #: - zo --I 9 c L. Electrical Permit Fees*
Supervising electrici. Subtotal S3 LP) si ! ature re I uired: I I, , Plan Review (25% of Permit Fee) _Ss
Print Name: IFES ' (• hil # State Surchar_e 8% of Permit Fee $ /� 7
TOTAL PERMIT FEE $ .5 7. ln
Authorized i � ►' ( � / N This p ermit application expires if a permit is not obtained within
Signature: \ ..�: Date: 3 -0,6, 180 days after it has been accepted as complete.
1 *Fee methodology set by Tri- County Building Industry Service Board.
0
(Please pnnt name)
i \Dsts\Permit Forms \ElcPermitApp.doc 01/03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information -- • '
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved:
n Audio and Stereo Systems
❑ Burglar Alarm
Garage Door Opener
❑ Heating, Ventilation and Air Conditioning System
Vacuum Systems
n Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
n Audio and Stereo Systems
n Boiler Controls
n Clock Systems
Data Telecommunication Installation
Fire Alarm Installation
HVAC
F - 7 Instrumentation
LI Intercom and Paging Systems
n Landscape Irrigation Control
Medical
0 Nurse Calls
n Outdoor Landscape Lighting
Protective Signaling
n Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
i:\Dsts\Permit Forms \ElcPermitAppPg2.doc 01/03
CITY OF TIGARD
BUILDING DIVISION PERMIT #: �U6 r� D(,
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171
.11 ,10 Requests (24 Hrs.): (503) 639 -4175 ^''
INSPECTION WORKSHEET FOR DATE: TIM.�� ); PAGE:
SITE ADDRESS: `(7844 C5 Wavo lk re.V Ad I CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE # s )J / 5 -07 2�
CONTRACTOR: Vi L vl ✓1,.— F0(17 `® e g/,r•,n PHONE #:
Inspection Request Scheduled For: Date: q - 3 —0 6 Pour Time:
Code # Inspection Description Confirm # Contact # Message
J /t/L---
- -nts/lnstructions:
C \S F T L
diNP •
•
•
PASS ❑ PARTIAL APPROVAL • ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: tVZe ` ° Date: 4 3 do Phone #: (503) 718- A) •