Permit A , CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
�� DEVELOPMENT SERVICES PERMIT #: ELR2005 -00425
.� II 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 12/14/2005
PARCEL: 1S12600-00300
SITE ADDRESS: 09510 SW WASHINGTON SQUARE RD H -1 ZONING: C -G
SUBDIVISION: WASHINGTON SQUARE LOT: JURISDICTION: TIG
Project Description: Limited energy for fire alarm. Job No. 13370
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: X OUTDOOR LANDSC LITE:
OTHER: : HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
WASHINGTON SQUARE LLC OREGON ELECTRIC GROUP
BY THE MACERICH COMPANY 1010 SE 11TH AVE
9585 SW WASHINGTON SQUARE RD PORTLAND, OR 97214
TIGARD, OR 97223
Phone: 503- 639 -8865 Contact #: FAX 503 -535 -2763
PRI 503- 234 -9900
FEES Reg #: LIC 203
SUP 4460S
Description Date Amount ELE 26 - 95C
[ELPRMT] ELR Permit 11/23/200f. $75.00
[TAX] 8% State Surchar€ 11/23/200E $6.00 REQUIRED ITEMS AND REPORTS
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
through OAR 95 . 001 -0100. You may obtain copies of these rules or direct questions to OUNC 03- 246 -6699.
Issued By:. _ _1 ' Permittee Signature: ,i/a(1.1(..k../
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.
V ,
^trical Permit Application ,i, . 1;
'FoR OFFICE USE ONLY
It of Tigard Received /� MA Permit No
13125 SW Hall Blvd., Tigard, OR 97223 ,, ,m 7 Plan Review
���u .: '"� �
Phone: 503.639.4171 Fax: 503.598.1 y " �� Other Permit
Fy ����� Date
Inspection Line: 503.639.4175 �t!�t� Date Ready /By. 1 /� ® See Page 2 for
Internet: www.ci.tigard.or.us �: W' Notified/Method: /Let Supplemental Information
11111 '1 i% PLAN REVIEW,
r Please check all that apply:
1:1 New construction Iition/alteration/replacement , PP y
❑ Demolition ❑ Other: ❑Service over 225 amps, comm'l ❑Hazardous location
OService 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 ® Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi - family ❑Master builder ❑Other: 0 Building over three stories ❑Feeders, 400 amps or more
❑Occupant load over 99 persons ['Manufactured structures or
JOB SITE INFORMATI8 AND LOCATION ❑Egress/lighting plan RV park
Job no.: 13370 Job site addres : 958 . W Washington Square Rd ❑Health -care facility ❑Ocher.
Submit 2 sets of plans with any of the above.
City /State/ZIP: Tigard, OR 97223 510 The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: 111 Project name: Regis FEE* SCHEDULE
Description I Qty. I Fee. 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: Lot no.: Ea. add' 1 500 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
Install low voltage wiring and cabling for Fire Alarm 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
401 amps to 600 amps 160.60 2
Name: Washington Square LLC 601 amps to 1,000 amps 240.60 2
Address: 9585 SW Washington Square Rd Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City / State/ZIP: Tigard, OR 97223 'Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) 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: Oregon Electric Group, Inc. branch circuit
B. Fee for branch circuits
Contact name: Low Martin without service or feeder fee,
each branch circuit 46.85 2
Address: 1010 SE 11 Ave
Each add'I branch circuit 6.65 2
City / State/ZIP: Portland, OR 97214 Miscellaneous (service or feeder not included)
Phone: (503) 234 -9900 Fax: : (503) 535 -2620 Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E -mail: loni @oregon - electric.com Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
extension. Describe: ! Page 2 /'5 2
Business name: Oregon Electric Group, Inc.
Address: 1010 SE 11 Ave Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State/ZIP: Portland, OR 97223 Investigation per hour (t hr min) 62.50
Phone: (503) 234 -9900 Fax: (503) 535 -2620 Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES'
CCB Lic.: 203 Electrical Lic.: S rv. Lic.: Subtotal
Suprv. Electrician signature, required: ' /G' ,r1 / wc. Plan review (25% of permit fee)
' State surcharge (8% of permit fee) 7
Print name: Date: 1123 5 b
/ TOTAL PERMIT FEE 3
Authorized signature agd-li ^4 ;^,. This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: ate. 11/23/05 • Fee methodology set by Tri- County Building Industry Service Board
•• Number of Inspections per permit allowed
i \Buildwg\Pernws\ELC- PennitApp doe 17/03 440- 4615T(10/02/COM/WEB
CITY OF TIGARD i _
BUILDING DIVISION PERMIT #: ELR200f ,-00425
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/14/2005
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 ,' °'ll
INSPECTION WORKSHEET FOR DATE: 12J1&2005 TIME: 7 :06AM PAGE: 81
SITE ADDRESS: 09510 SW WASHINGTON SQUARE RD H - 1 CLASS OF WORK:
SUBDIVISION: WASHINGTON . QUARE LOT #: TYPE OF USE:
PROJECT NAME: REGIS
DESCRIPTION: Limited energy for fir - -larm. Job No. 13370
OWNER: WASHINGTON SQUARE LC, PHONE #: 503 -G39 -8865
CONTRACTOR: OREGON ELECTRIC GRO► • PHONE #: 503.2349900
Inspection Request Scheduled For: I te: 12/1612005 Pour Time:
Code # Inspection Description Con m # Contact # Message
199 Electrical final 0235B• 11 503 -793 -7177 N
Corrections /Comments/ Instructions:
"i "t ■ tO to. ?sASAblvt f ' cri Rs--€. 1,:c s ..
x PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: I \ 6 e is Date: III 1 (l or Phone #: (503) 718- 144) '