Permit 'f.
CITY OF T I CAA R D ELECTRICAL PERMIT -
RESTRICTED ENERGY
DEVELOPMENT SERVICES PERMIT #: ELR2003 -00198
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/9/03
SITE ADDRESS: 09491 SW WASHINGTON SQUARE RD A -4 PARCEL: 1S126C0 -01107
SUBDIVISION: WASHINGTON SQUARE ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
Project Description: JOB NO. 172144 87983
Tenant Improvement
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: 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: X
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
PPR WASHINGTON SQUARE LLC BROADWAY ELECTRIC - COCHRAN INC
BY THE MACERICH COMPANY 626 SE MAIN
9585 SW WASHINGTON SQ. RD. PORTLAND, OR 97214
PORTLAND, OR 97223
Phone: Phone: FAX - 238 - 2098
Reg #: LP(£4- 65600072942
SUP 3447S
ELE 37 -546C
FEES Required Inspections
Description Date Amount Ceiling Cover
[ELPRMT] ELR Permit 7/9/03 $75.00 Wall Cover
Elect'I Final
[TAX] 8% State Tax 7/9/03 $6.00
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and
all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not
started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires
you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 throuc
Issued by Permittee Signature /
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N DATE: .
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
4.
IN
r
i Electrical Permit Arprp, • ' l it n
e.: ;<. .. ..
„� U Date received: Permit no.: dip3 _ cT /9 g
:■11 ;; City of Ti ��� Project/appl.no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tig$ Ol 972134 Date issued: By: I Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 C.':1 "Y ®E-• - I IL AE I) Case file no.: - Payment type:
',-3'ji ,i)iNC. DIViStON •
Land use approval:
TYPE OF PEI61IT ,: s . -
❑ 1 & 2 family dwelling or accessory (Commercial/industrial U Multi- family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement U Other: ❑ Partial
JOB SITE INFORMATION . _ ,-
Job address: • I� [, Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: Block: Subdivision ■ ^n � �
Project name: 2-u Irv j e� I Description and location of work on premises: f:5,ll.SIN i 1 G Sy(SICi/i'l 0
Estimated date of completion/inspection: ui ' ( Y
.__ s., a .,. ", . FEE SCHEDULE
vi no: � l..( t ( K7 : Fee Max
Business name: r OM My Oe C v Description Qty. (ea.) Total no. insp
New residential - single or multi- family per
Address: (j SF OEU' dwellingunit. Includes attached garage.
City: 1 6-.( a,K4 I StateO ZIP: 9 7, -( Li_ Serricemcluded:
Phone: ail! (p I Fax: 23g2.03 rg I E -mail: moo sq. ft. or less 4
> 4 3 . 7, � � Each additional 500 sq. ft. or portion thereof
CCB no.: I Elec. bus. IIC. no: C__. Limited energy, residential 2
City /me ■ Tc. o.: Limited energy, non- residential 2
'" I gl Each manufactured home or modular dwelling
Signature of supervisi g electrician (required) Date Service and/or feeder 2
Sup. elect. name (print): .e.,ANL u _ License no: 3k.( •5 Services or Feeders — installation,
alteration or relocation:
PROPERTY OWNER 200 amps or less 2
Name (print): 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address: 601 amps to 1000 amps 2
City: I State: I ZIP: Over 1000 amps or volts 2
Phone: I Fax: I E -mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services or feeders -
which is not intended for sale, lease, rent, or exchange according to Ins l 0n,alte don, orrelocation:
200 amps or less 2
ORS 447, 455, 479, 670, 701.
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 am s 2
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: I State: I ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: 2
Phone: Fax: E -mail: Each additional branch circuit:
PLAN REVIEW (Please check all that apply) Misc. (Servlce or feeder not included):
❑ Service over 225 amps - commercial ❑ Health -care facility Each pump or irrigation circle 2
❑ Service over 320 amps -rating of 1&2 ❑ 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 park Each additional inspection over the allowable in any of the above:
❑ Egress/lighting plan ❑ 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
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $ —
❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $
Expires accepted as complete. TOTAL $ � I •
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440 -4615 (6/00/COM)
CITY OF TIGARD 24-Hour • c.
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested 1 — a S" AM PM BUP
Location 4 9 ( (.4) iQ'- - S 6z. • Suite MEC
Contact Person ( Ph ( ) s z z — 7 3 PLM -
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing • --
Foundation d ELC
Access. 3
Ftg Drain � • ELR
Crawl Drain
Slab Inspection Notes: � 40-4-A-) SIT
Post & Beam pl3y/
Ext Sr Sheath/Shear th / Srs Shear L, –C L
Ext eah/ � CC�.v1.�
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
• Final
PASS PART FAIL
MECHANICAL
Post -& Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL •
ELECTRICAL -
Service
Rough -In
UG
o ag
Fire m
ART FAIL 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
❑ Please call for reinspection RE: Unable to inspect – no access
Fire Supply Line
ADA Approach /Sidewalk Date — Inspector 0 - �.L -�!v _ _ _ -
Other:
Final DO NOT REMOVE this inspection record fr the job s - e.
PASS PART FAIL