Permit CITY OF TI GARD ELECTRICAL PERMIT
PERMIT #: ELC2001 -00172
DEVELOPMENT H Hall Tigard. 639 -4171 SERVICES DATE ISSUED: 03/30/2001
PARCEL: 1S126C0-01107
SITE ADDRESS: 09459 SW WASHINGTON SQUARE RD A -14
SUBDIVISION: WASHINGTON SQUARE ZONING: C -G
BLOCK: LOT : JURISDICTION: TIG
Proiect Description: Installation of one (1) branch circuit. Job #3372
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: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 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:
PPR WASHINGTON SQUARE LLC ELECTRICAL DIMENSIONS INC
BY THE MACERICH COMPANY PO BOX 12146
9585 SW WASHINGTON SQUARE RD 3961 N WILLAMS AVE
PORTLAND, OR 97223 PORTLAND, OR 97212
Phone: 503- 639 -8860 Phone: 282 -7255
Reg #: LIC 44008
SUP 2964S
ELE 26 -432C
FEES Required Inspections
Type By Date Amount Receipt Ceiling Cover
PRMT CTR 03/30/2001 $46.85 2720010000( Wall Cover •
5PCT CTR 03/30/2001 $3.75 2720010000( Elect'I Final
EXPIRED
Total $50.60
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 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -1987.
PERMITTEE'S SIGNATURE �AL ICfAT[��I _�� /fin ISSUED BY: j��
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 639 -4175 by 7:00pm for an inspection the next business day
A, Electrical Permit Application
Date received: A , ii / Permit no.: . n .E _1I /..
101,..0i j
X Project/appl. no.: Expire date:
I A I„ City of Tigard
Ci ' 9ietip_1Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: Receiptno.:
Phone: (503) 639 - 4171
Fax: (503) 598 - 1960 i 64, Case file no.: Payment type: •
MAR 2 8 Z`' use approval:
r
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial Cl Multi - family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration /replacement ❑ Other. ' Partial
JOB SITE INFORMATION
Job address: � ',�J • Bldg. no.: Suite no.. " Tax map /tax lot/account no.:
Lot: Block: Subdivision:
Project name: F I Description and location of work on premises: �/( j (�� �' /�
Estimated date of completion/inspection: —j — 0
Job no: 33 72.- Fee Max
Business name: • � I Description Qty. (ea.) Total no. insp
_4 - "li // .1. ^ ,' � - • N eilresidential - single or mull -family per
Address: (�JL - 1TV� dwellingunit . Includes saattached garage. .
City: • * _ State:, - ! ZIP: .• _ Service included:
Phone: I L1
► / I, E-mail: 1 ft. or less . 4
Each ach additional 500 sq. ft or portion thereof
CCB no.: --/ L/ ) t Elec. bus. lic. no: Z to - 4 13 a C - Limited energy, residential 2
City /me . lic. no.: ( 7 -j Linuted energy, non-residential 2
_ `✓ -r ' L 4 03/2_7/" f Each manufactured home or modular dwelling
Si:nature of supervising electrician (required) Date Service and/or feeder 2
Services or feeders- installation,
Sup. elect, name (print): h .3 �r f� �i, L icense no: 6 y' 6 ' alteration or relocation: • - - • . - •-
PROPERTY OWNER 200 amps or less -. - . . 2
Name (print) : 201 amps to 400 amps 2
tint 401 amps to 600 amps 2
Mailing address: 601 amps to 1000 amps 2
City: I State: Iii Over 1000 amps or volts 2
Phone: I Fax: I E-M Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services or feeders - .
installation, alteration, or relocation:
which is not intended for sale, lease, rent, or exchange according to 200 amps or less • 2
ORS 447, 455, 479, 670, 701. 201 amps to 400 amps 2
Owners signature: Date: 401 to 600 amps 2
ENGINEER Branch circuits - new, alteration, . . .
or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: State: ZIP: - B. Fee for branch circuits without purchase Ii O i
of service or feeder fee, first branch circuit: d POD
Phone: Fax: E - mail: Each additional branch circuit
PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included):
❑ Service over 225 amps- commercial ❑ Health -care facility Each pump or irrigation circle 2
❑ Service over 320 amps- rating of 18E2 0 Hazardous location Each sign or outline lighting 2
family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
❑ System over 600 volts nominal more residential units in one structure alteration, or extension' _ 2
❑ Building over three stories • ❑ Feeders. 400 amps or more *Description:
❑ Occupant load over 99 persons - ❑ Manufactured structures or RV pare Each additional inspection over the allowable in any of the above:
0 Egress/lightingplan ❑ Other: Per inspection • I • I- - I I
Submit _ sets of plans with any of the above. Investigation fee
• The above are not applicable to temporary construction service. . • Other •
Per f ee $ - 4 4' a
as
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Plan review (a[ _ %) $ -
❑ Visa- ❑ MasterCard expires if a permit is not obtained
Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ � 30.77
Expires TOTAL as complete. TOTAL $ '-1 CP
Name of cardholder as shown on credit card
a EXPIRE®
Cardholder signature Amount 440-4615 (6i00aCON)
Electrical Permit Fees: Limited Energy Fees:
TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Compl Fee Schedule Below: Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total `, Check Type of Work Involved:
Residential - per unit
1000 sq. ft. or less $145.15 4 0 Audio and Stereo Systems
Each additional 500 sq. ft. or a
portion thereof $33.40 1 Burglar Alarm
Limited Energy - $75.00
Each Manuf'd Home or Modular Door Opener
Dwelling Service or Feeder $90.90 2 El
Services or Feeders E Heating, Ventilation and Air Conditioning System'
Installation, alteration, or relocation -
200 amps or less $80.30 2 Vacuum Systems
201 amps to 400 amps $106.85 2
401 amps to 600 amps $160.60 2 Other
601 amps to 1000 amps $240.60 2 0
Over 1000 amps or volts $454.65 2 '
Reconnect only $66.85 2 TYPE OF WORK INVOLVED - COMMERCIAL ONLY
Temporary Services or Feeders Fee for each system $75.00
or
200 amps or less .
ess _
Installation, alteration, or relocation $66.85 2 (SEE OAR 918-260 -260) .
201 amps to 400 amps $100.30 2 Check Type of Work Involved:
401 amps to 600 amps $133.75 2
Over 600 amps to 1000 volts, Audio and Stereo Systems
see "b" above. •
Branch Circuits. Boiler Controls
New, alteration or extension per panel
_ a) The fee for branch circuits Systems - -
with purchase of service or
feeder fee.
Each branch circuit $6.65 2 0 Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service ✓• - ❑ - Fire Alarm Installation -
or feeder fee. [�f
First branch circuit - I $46.85. - 7�'( - ❑
HVAC
Each additional branch circuit $6.65
Miscellaneous - IT Instrumentation -
(Service or feeder not included) - - -
.- Each pump or irrigation circle. $53.40 Intercom and Paging Systems
Each sign or outline lighting - $53.40 -
Signal circuit(s) or a limited energy Irrigation Control* - panel, alteration or extension $75.00
Minor Labels (10) $125.00 ❑
Medical
Each additional inspection over- ___ _. _
the allowable in any.of the above Nurse Calls _ -
Per inspection $62.50
Pc: hour $62.50- - r
In Plant. - $73.75 u Outdoor Landscape Lighting'
e
Fees: , - V - - E Protective Signaling .-. '
Enter total of above fees $ - O ther - .
8% State Surcharge $• Number of Systems
25% Plan Review Fee * No licenses are required. Licenses are required for all other installations
See "Plan Review! section on - - $
front of application.
Fees: - • -
Total Balance Due- - - - _ _ • • $ Enter total of above fees. $.
0 - Trust Account # -. - , .. • • . 8 %;State Surcharge $:,
• . - Total Balance Due $' 1
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