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Permit • - ELECTRICAL PERMIT CITY OF TIGARD PERMIT #: ELC2005 -00821 AP, DEVELOPMENT SERVICES DATE ISSUED: 10/20/2005 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 1S12600-00300 SITE ADDRESS: 09546 SW WASHINGTON SQUARE RD H -16 ZONING: C -G SUBDIVISION: WASHINGTON SQUARE - LOT : JURISDICTION: TIG Project Description: Sign lighting. 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 RAMSAY SIGNS BY THE MACERICH COMPANY 9160 SE 74TH AVE 9585 SW WASHINGTON SQUARE RD PORTLAND, OR 97206 TIGARD, OR 97223 Phone: 503 - 639 -8865 Phone: 777 -4555 FEES Reg #: LIC 63422 ELE 26- 106CLS Description Date Amount SUP 493SIG [ELPRMT] ELC Permit 10/20/200' . $53.40 [TAX] 8% State Surcharge 10/20/200: $4.28 REQUIRED ITEMS AND REPORTS Total $57.68 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 9 2 -001 0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direc •uestions to O NC at 503 - 246 -6699 or 1 -80'.• 2 -2 Issued By: I 4) ( I 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. 4,- lectrical Permit Application FOR OFFICE USE ONLY Received Cit of Ti and I Permit No 1312 SW Hall Blvd., Tigard, OR 9 C E VVE D � Plan R view D I D J � �D� Ov I Phone: 503.639.4171 Fax: 503.598.1960 4 ''�rn 2 l"c 'I Date /By Other Permit: Inspection Line 503.639.4175 OCT 2 0 2005 As- �'' I Date Ready /By r See Page 2 for Internet: www.ci tigard.or us Notified/Method �� Su pplemental Information �(gySP ©10$114' PL REVIEW New construction �ti.i4RiitWifrdG7i$ placement Please check all that apply: Demolition ❑ Other: ['Service over 225 amps, comm'l ['Hazardous location ['Service over 320 amps — rating ['Bullring 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 ❑S over 600 volts nominal units in one structure ['Building over three stories ❑Feeders, 400 amps or more El Multi family Master builder ❑Other: ❑Occupant load over 99 persons ['Manufactured structures or JOB SITE INFORMATION AND LOCATION ['Egress/lighting plan RV park Job no.:`90 ,3� Job sitf'd r sS:G��A/� s5 /0 DHealth-care facility DOther. Submit 2 sets of plans with any of the above. City /State /ZIP: �;& D, O,_ , 97 e P-3 The above are not applicable to temporary construction service. Suite/bldg. /apt. no.: eb Project name: -y6og itliv//i'% FEE* SCHEDULE Description I Qty. Fee. I Total I ** Cross street/directions to job site: L u(761-766 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'l 500 sq. ft. or portion 33.40 1 Limited energy, residential 75.00 2 Tax map /parcel no.: Limited energy, non - residential 75 00 2 DESCRIPTION OF WORK Each manufactured or modular / dwelling, service and/or feeder 90.90 2 � Y Services or feeders installation, alteration, and /or relocation 200 amps or less 80.30 2 ❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2 401 amps to 600 amps 160 60 2 Name: 601 amps to 1,000 amps 240.60 2 Address: Over 1,000 amps or volts 454.65 2 Reconnect only 66.85 2 City/State /ZIP: Temporary services or feeders installation, alteration, and /or Phone: ( ) //7x: ( ) relocation 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 CONTACT PERSON A. Fee for branch circuits with i , service or feeder fee, each Business name: / 1 / F l _2/T l Are branch circuit 6.65 2 � ,n y / B. Fee for branch circuits 1 / Contact name: l[/. without service or feeder fee, Address: y 724; / / ��� each branch circuit Ea 46.85 2 Each add'1 branch circuit 6.65 2 City/State /ZIP: (/ �z Miscellaneous (service or feeder not included) Phone: (���% ,7" 9 F ax: . 777,-.Z.0 Pump or on circle 53.40 Sign or outliutline ne lighting / 53.40 2 E - mail: Signal circuit(s) or limited 1 CONTRACTOR energy panel, alteration, or i'7 , e - extension. Describe: Page 2 2 Business name: ��� Address: 4t Each additional inspection over allowable in any of the above Li Per inspection 62.50 City/State /ZIP: \ Investigation per hour (I hr mm) 62.50 � / Industrial plant per hour 73.75 Phone: ( ) Fax: ( ) ELECTRICAL PERMIT FEES* CCB Lici�Z1 . �, �/ -_ Suprv. Lic. �J ` Subtotal / Suprv. Electrician signature, required: / " Plan review (25% of permit fee) Print name: i�,��i/� f 6 Date: State surcharge (8% of permit fee) / TOTAL PERMIT FEE J�� i/ / / , CCCfff/// Authorized signature: / � r / , � This permit application expires if a permit is not obtained within 180 Print name: ale,% J days after it has been accepted as complete !/� Date :lQ �� * Fee methodology set by Tn- County Building Industry Service Board ** Number of inspections per permit allowed. r \Building \Permiis\ELC -PernutApp doc 12/03 440- 4615T(10/02/COM /WEB CITY OF TIGARD BUILDING DIVISION • PERMIT #: E C,?'S.— ga / 1 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: Phone: (503) 639 -4171 4 0010 Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: TIME: PAGE: SITE ADDRESS: q S 7 b. J CLASS OF WORK: SUBDIVISION: 144 LOT #: TYPE OF USE: PROJECT NAME: DESCRIPTION: 15 N OWNER: PHONE . #: CONTRACTOR: PHONE #: Inspection Request Scheduled For: Date: (— t 7 ` O Pour Time: Cod- • Inspection Desc • - Confirm # Contact # Message .1 NL, Az.6d;e 3 9 orre • omments /Instructions: - • • PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS LI FAIL �❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED C u Inspector: ' lCL- N Date: I Phone #: (503) 718 -14%