Permit CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
i � DEVELOPMENT SERVICES PERMIT #: ELR2005 -00408
Adil- ��II" 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 11/14/2005
PARCEL: 1S12600-00300
SITE ADDRESS: 09580 SW WASHINGTON SQUARE RD ZONING: C -G
SUBDIVISION: WASHINGTON SQUARE LOT: JURISDICTION: TIG
Project Description: Data /telecommunication.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: X NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER:
• HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER: :
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
WASHINGTON SQUARE LLC MATRIX COMMUNICATIONS
BY THE MACERICH COMPANY 4243 SE INTERNATIONAL WY
9585 SW WASHINGTON SQUARE RD STE C
TIGARD, OR 97223 PORTLAND, OR 97214
Phone: 503- 639 -8865 Phone: 503 -513 -9152
Reg #: LIC 74332
ELE 26- 694CLE
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 11/14/200f. $75.00
[TAX] 8% State Surchart 11/14/200f. $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
through OAR 952- 01 -0 00. You may obtain copies of these rules or direct questions to OUNC at 503 -2 6- 99.
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 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.
Elcdrical Permit Application 1.01; Orrl(•I'; !Isl.'. O:Ni.'
City of Tigard Received r '
D , Inyo Permit No.,
13125 SW Hall Blvd., Tigard, OR 97223 i . - Plan Review other Permit
Phone: 503.63914171 Fax: 503.598.1960 f i l. " '' s; � -= I ' Datc/Hy, -
Inspection Line: 503.639.4175 ill- ���... J s, _►,1.� ' - ',u_. I Dn+r RaadyBy C Ei see Paste 2 for
Internet: www.ci.tigardor.us Notified/Method: supplemental Information
E `, '�r:i•'� "'•'na `d' �EYi:1l,:,1` 111' �������y rWOp�,..4�1'��.l�
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El New construction El Addition /alteration/replacement Please check all that apply:
t DScrvice over 225 amps, comm'l ❑Hazardous location
❑ Demolition �y ❑ Othe iTY Ul' 11L ' PQ " , ['Service over 320 amps .— rating ❑ Buildng over 10,000 sq. ft.,
'y;i4� 'i;.I, , �'�f r,;∎1:i t ii ,',:�1: Lre V b si'l: i'` ! : i' i
f, .)''i : ?i ,/ 7 `' , : '' p "4i al l , i.';!ii :1 ;i ;,:'; . i; of 1- and 2- family dwellings 4 or more new residential
::4.Y •} rp,i ' -r i „ • '� ,,,,; .�.� , 4 ?i,/2) � e a ' 1 ' Mr ,.,,L,.% ' 2 ,il .: drlr :■. .
❑ System over 600 volts nominal units in one structure
❑ 1 - and 2 family dwelling 11 7 ommercial�ndustrial ❑ Accessory building ❑Building over three stories ❑Feeders, 400 amps or more
❑ Multi- family 0 Master builder ❑ Other: ['Occupant load over 99 persons ❑Manufactured structures or
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y ,11,1 "f '
),; I.; 'rl,;.' 11.!;l t: ir� :� iAtiW'Siiilt tide '' }11RO .i ettilift :; ;!:; 4):: ; •rl: .1i1r, ❑ lighting plan RV park
` " -+'•? r -Y� *. r . a ��}ler:
Job no.: Job site address: i '` ' i� + ❑Health -care facility
a s ; At A ll Submit 2 sets of plans with any of the above.
City/State /ZIP: 7 , -'' 11. " + The above are not applicable to construction service.
0 1 rw . 1: ,, .1 "ter "i r 'rj_'h�li• 111r:n.
Suite/bldg./ t. no.: P roject name V iak(i',i+�'p '? �'' 1 1' 1 i ,
Description 1 QV/.J Tee. I Total "
Cross street/directions to job site: New residential single- or multi-gustily dwelling unit
includes attached garage, -
1,000 sq. fl_ or less 145.15 4
Subdivision: Lot no.: Ea, add'l 500 sq. R. or Portion 33.40 1
Limited energy, residential 75.00 2
fax map /parcel no.: Limited energy, non - residential 75.00 2
,1, s' ,} �t wy11.,, N+7 { 1r ^. .: r` r• ;•.';r:
. c. '- i ,:I.{ ;"' " i , :!)!I)V. �M1 to 4 " I 'S r ` ;n Each manufactured or modular
�l''ki; ;,l , ;,a' '7�;, 1 1 ,'i: ' �n.':rr ��.��, i3�' : ✓�:•. +. ::: ; ' t.� ,�4
- 1 ►, / n A dwelling, service and/or feeder 90.90 2
v '( / �V Services or feeders installation, alteration, and/or relocation
e.O 200 amps or Ices 80.30 2
'''-'' I ii i 6k[f lor test' t.,;,'i,; ° "" 201 amps to 400 amps 106.85 2
�,
1 ;Aim,' t „ 1, •„,,, us A , I r,� , 160.60 2
i . it i ,l`'' , , 1 i- .,`� i . " i' " `:'4YU } "! '` ." - ' ' ''"" +'It
401 amps to 600 amps
Name: 60I amps to 1,000 amps 240.60 2
Address: - •, Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 �
City /State /ZTP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) 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 10030 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
} ; y ,: ; fi r dl+� ;<<, 'lc,'• , r; jH A. Fee branch circuits with
1 r ". r:1 �, ,ms;µ �..�{�il %I ;'';,�,rdi`
1 ' i' ' ; 'i 1 ' f ' 'Cl 7 `;'',1,. . np tWd 41t!l\ v ayR'' , tUl`! 1,'•:i1 1 „
` � ',
>.. L
service ce or feeder fcc, each 6165 2
Business name: branch circuit .
B. Fee for branch circuits
Contact name: without service or feeder fee, 85 2
each branch c ircuit _
Address: Each add'I branch circuit 6.65 2
City /State/ZIP: Miscellaneous (service or feeder not included)
Phone: Pump or irrigation circle 53.40 2
( ) I Fax:: ( ) Sign or outline lighting 53.40 2
- E -mail: Signal circuit(s) or limited -
x' i
•; I” ., "; ,•�(+ r l 1.1 1' r.'rr 1 ° i :.Y ; ' n,t' ' r , 0 . cncrgy panel. alto ration. or
'' �('ii !Ill:d 7;Up,! • L +�:' t ^ ' I'i: %C6 i't t., „ , '1 ,.W ' 1 :
l ; . 1r4i' l4 + *t, P It ? '.rd[rt :
:b u•;e'I.:'1r. i r`1 Page 2 2
1: � �� extens Describe: ge
Business name: h ii`, iii , i A.
Address: 4 a ,, / Each additional inspection aver allowable In any of the above
IA N ,.L ` . r c , i! er,e , i a Ira/ Per inspection 62.50
City/State/ZIP / 1 0 /� _ 1 , _ Investigation per hour (1 hr min) 62.50
Phon • . I r Fax: t Industrial plant per hour 73.75
t:° ,,,,'
CCB Lic.. ` Electrical Li I �• � y • ic.. Subtotal r I' •
Suprv. Electrician signature, , uired: . Plan review (25% of permit fee)
Print name: . • v ,, .. U� Date: -- State surcharge (. %cif permit fee)
TOTAL PERMIT PEE ' , -
Authorized signature: This permit application expires if a permit is not obtai ed 'thin 180
days after It has been accepted as complete
Print name: Date: • Fee Methodology act by Tri- County Building industry Service Board
e• Number of inspection per permit allowed.
I•\ Building \PormitiAl.I-C- PermItAppdoe I 7/0d 440 461 $T(I0/02/COM/WBD
CITY OF TIGARD
BUILDING DIVISION PERMIT #: l LR200r�(�iy4�j8
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
9 11/i412005
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 1/23/2006 TIME: 7:04/ M PAGE: 13
SITE ADDRESS: 08 680 SW WASHINGTON SQUARE RD CLASS OF WORK:
, SUBDIVISION: WASHHIN - 2TON SQUARE LOT #: TYPE OF USE:
PROJECT NAME: GUEST S .: VICES
DESCRIPTION: . „Dip /[®laws unIcatso0 - •
OWNER: WASHINGTON ;mss UARE LLC, PHONE #: 60 ,639 8A35
CONTRACTOR: MATRIX COMMU • .: PHONE #: 503 513 -9152
Inspection Request Scheduled For: Date: 1/23/2006 Pour Time:
Code # • Description Confirm # Contact # Message
135 026402 -01 503 -513 -916 N .
Corrections /Comments /Instructions:
•
IA PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 6 (" N o lam- Date: V2-3 -06 Phone #: (503) 718- 1-1140