Permit _ CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00261
DEVELOPMENT SERVICES DATE ISSUED: 4/19/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 - 4171
PARCEL: 1S12600-00300
SITE ADDRESS: 09463 SW WASHINGTON SQUARE RD Al2 ZONING: C -G
SUBDIVISION: WASHINGTON SQUARE LOT : JURISDICTION: TIG
Project Description: Electrical TI, (31) branch circuits.
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: 30 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: 503 - 639 -8865 Phone: 282 -7255
FEES Reg #: LIC 44008
tion Date Amount SUP 2964S
Description ELE 26 -432C
[ELPRMT] ELC Permit 4/19/2005 $246.35
[TAX] 8% State Surcharge 4/19/2005 $19.71 REQUIRED ITEMS AND REPORTS
Total $266.06
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Speoalty 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 fo ar�180 days. ATTENTION Oregon law requires you to follow rules adopted by the Oregon Utility Notifjcation Center Those
rules are forth in OAR • -2 -00 00 + through OAR 952 - 001 -0100 You may obtain copies of thpso les or direct questions to OUNC at
503 -24 6699 r 1- 800 -332- • 4 /
Issu By: , / � I ' & A-0 Permittee Sign = . - • fi d ,
,
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: _ —. __- �' i – ' e'O — DATE:
LICENSE NO: 019 eO / 5
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 FOR OFFICE I SE ONLY .
City offiigard ®® RECE
Received / / � � l Perm No
, ` -. 0 Date/B � � � � . _ ,A±� -1Z1016 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 pp is ";r't),: - ]I 'N Date/By. Other Permit
Inspection Line: 503.639.4175 API _IA . .'J : J Date Ready/By r ` la See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method /tad Supplemental Information
petr TEC3/1R D
TYPE OF t�Il�'MlR}IdFPR PLAN REVIEW
❑ New construction ❑ Addition/alteratipn/ cement Please check all that apply:
❑ Demolition Other: , f / 'i ['Service over 225 amps, comm') ❑Hazardous location
❑Service over 320 amps - rating DBuildng 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
DOccupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION 6 A . L . -A-j2. ❑Egress/lighting plan RV park
lob no.: lob site address: ' ?4./ 3 St Os r� Jl�" � � 0 Health-care facility DOther:
Submit' sets of plans with any of the above.
City/State/ZIP: . 1 .- ( 9 /i-R Proj ` ect n ame: 0 2 7 Z 3 The above are not applicable to temporary construction service.
g./ ap t no.: I � u � ( ��� � , FEE* SCHEDULE
Suite/bld name:
Description I Qty. J Fea' 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: I Lot no.: Ea add'I 500 sq. ft. or portion 33.40 I
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
, y v r—va c5 C.fA) G` (- -L1 + , T dwelling, service and/or feeder 90.90 2
� 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
/' �� w / T' 401 amps to 600 amps 160.60 2
Name: (�(4 . ,�() 601 amps to 1,000 amps 240.60 2
Address: 95.g5,,, bA�� 04 . 4V . Over 1,000 amps or volts 454.65 2
/t D/L Reconnect only 66.85 2
City/ State/ZIP: --I i) l 7,9',9`5 Temporary services or feeders installation, alteration, and/or
..-- relocation
Phone: (5) 6 3 gg 65 I 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,
each branch circuit 46.85 ( 2
Address: Each add'I branch circuit /5 6.65 'rj y,SZ9_ 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: (L - Mitt____ Qr ,-,,A) 5 E , )
Address: G Ai t ���Q_ • � � t) � Each additional inspection over allowable in any of the above
Per inspection 62.50
City/ State/Z1P: R7- t-/-2,0 0 / ® I ,?.. 7 Investigation per hour p In rain) 62.50
Phone: (S 0 3) Zg Z — 7 I Fax: (1�v3) 2-750 -- /(�, /1 Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES* i
CCB Lie.: y Li O r ., I Electrical Lic.: 6- Z , Suprv. Lie.: 2.1 G S S ubtotal Z [ {( � �
Suprv. Electrician signature, required: A . Plan review (25% of perm fee) ..2146,
�p Date: t� State surcharge (8% of permit fee) / I ,
Print name:
` 6 _� ` ��S-E Oil/ TOTAL PERMIT FEE 2 6,6 r
Authorized signature: This permit application expires if a permit is not obtained within ISO
days after it has been accepted as complete
Print name: 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 �5
❑ G arage Door Opener*
❑ H eating, 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 "
El B oiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
El Fire Alarm Installation
❑ H VAC
p Instrumentation
❑ Intercom and Paging Systems
•
❑ Landscape Irrigation Control*
❑ Medical
❑ N urse Calls
❑ Outdoor Landscape Lighting*
El P rotective Signaling
•
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
CITY OF TIGARD
` BUILDING DIVISION PERMIT #: ELC2005.00261
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/1912005
Phone: (503) 639- 4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 6/3/2005 TIME: 7:09AM PAGE: 51
SITE ADDRESS: 09463 SW WASHINGTON SQUARE RD Al2 CLASS OF WORK:
• SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE:
PROJECT NAME: SUNGLASS HUT
DESCRIPTION: Electrical TI,EJ:branch�circuits)
OWNER: WASHINGTON SQUARE LLC, PHONE #: 503-639 -8865
CONTRACTOR: ELECTRICAL DIMENSIONS INC PHONE #: 282 -7255
Inspection Request Scheduled For: Date: 6/3/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message •
199 Electrical final 008349-01 503- 282 -7255 N
Corrections/Comments/Instructions:
L . ;
•
•
•
•
1p PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 6r /e 1- 1 / Date � Phone #: (503) 718- .