Permit CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
_� i DEVELOPMENT SERVICES PERMIT #: ELR2006 -10023
�' II DATE ISSUED: 3/20/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 - 4171
PARCEL: 1S12600-00300
SITE ADDRESS: 09581 SW WASHINGTON SQUARE RD B8 ZONING: C -G
SUBDIVISION: WASHINGTON SQUARE LOT: JURISDICTION: TIG
Project Description: DATA CABLING INSTALL
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:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS:
Owner: Contractor:
WASHINGTON SQUARE LLC SERVICE COMMUNICATIONS INC
BY THE MACERICH COMPANY 4120 SE INTERNATIONAL WY A -109
9585 SW WASHINGTON SQUARE RD MILWAUKIE, OR 97222
TIGARD, OR 97223
Phone: Contact #: PRI 503- 723 -6415
FAX 5037236416
FEES Reg #: ELE 3- 365CLE
LIC 90175
Description Date Amount SUP 1127JLE
[ELPRMT] ELR Permit 4/5/2006 $75.00
[TAX] 8% State Surcha 4/5/2006 $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 952 - 001 -0100. You may obtain copies of these
rules or direct questions to OUNC at 503 - 246 -6699.
Issued By: . ,, Permittee Signature:? Lta
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.
•
U WE)
Electrical Permit Application — -- i OIrc)I l• ICE USE — — -•
4-,l co-s<y of'Tigard MAR 21 2006 ae/BU, 0' , 8 Permit No _ /bp2
vs
13125 SW Hall Blvd., Tigard, OR 97223 Plan Re.
Phone: 503.639.4171 Fax 5 e * ,r , I ,•; Date/BY Inspection Line: 503.639.4 5 •. " ther Perms% , r / r 4
� 1 , � _ _ Date Ready/By eady/By l ® u See ... ge 2 for
_- �' � .
Internet: www.ci.tigard.or.t j n l t \T , )i1, TTST , '\ J Notified/Method c. Supplemental Information
l [
' TYPE OF WORK - , . PLAN REVIEW ,
• New construction ❑ Addition/alteration/replacement Please check all that apply:
Demolition ❑ Other: ❑Service over 225 amps, comm'I ❑H azardou s locati
❑Service over 320 amps -rating ❑ Buildng o ver 10,000 on sq. ft.,
' CATEGORY OF CONSTRUCTION • of 1 -and 2- family dwellings 4 or more new residential
❑ 1- and 2 - family dwelling xi Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi - family ❑Master builder ❑Other: ❑Building over three stories 0 Feeders, 400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park
Job no.: Job site address: ❑Health -care facility ❑mar:
95 / S2 .-t IA ills erTo. -I ..S 2 4 Submit 2 sets of plans with any of the above.
City/State/ZIP: P�7 77.,;.7..7.3. The above are not applicable to temporary construction service.
Suite/bldg /apt no.: Project name: / / FEE* SCHEDULE .
�� /fir 1 ✓ C �G Description I Qty. I Fee. I Total
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: 1 Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
dwelling, service and/or feeder 90.90 2
— „ // - 7A �.t#,eld, -v i-- 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: 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: ( ) I Fax: ( ) 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 -- 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, 46.85 2
Address: first branch circuit
Each add'I branch circuit 6.65 2
City / State/ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) I Fax :: ( ) 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:
Address: Each additional inspection over allowable in any of the above
4%070 ,j - _0=V7Z/ln/Aiita.0vAL bjA . A'/0 9 Per inspection 62 50
City/ State/ZIP> z,Avl� J c c 7, 9 ., Investigation per hour (I hr min) 62.50
Phone* ) 7 �- Asp Fax:, ) 7 - 6 4 /6 Industrial plant per hour _ 73.75
ELECTRICAL PERMIT .FEES*
C t - o f - Electrical Lic.• — •••• Suprv. Lic.:3s3 7sr
� 4.6•••••• (� � Subtotal
ir R. et
Suprv. Electrici. sty a re, require � %� Plan review (25% of permit fee)
Print name: Date: State surcharge (8% of permit fee) 6 • o to
l .D/�/2/2 «/ /7.tv smsez. TOTAL PERMIT FEE rll a
Authorized signature: >'� This permit application expires if a permit is not obtained within ISO
days after it has been accepted as complete
Print name: 4 l aq / 6_ Date: f� �� • Fee methodology set by Tn County Building Industry Service Board
-
•• Number of inspections per permit allowed
t \Buildtng\Permits\ELC•PenmtApp dos 12/03 440- 4615T(10/02/COM/WEB
Electrical Permit Application - City of Tigard
.Page 2 - Supplemental Information 1
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
❑ Garage Door Opener*
❑ Heating, 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
❑ Boiler Controls
❑ Clock Systems
X Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1'. BuildingTermitMELC- PamitApp.doc 04/03
CITY OF TIGARD
BUILDING DIVISION PERMIT #:ct RD6 — 1 vv D-3
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 =4171 4,a1q
Inspection, Requests (24 Hrs.): (503) 639 -4175 ' 'I � ..
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: AStt CT- � igd CLASS OF WORK:
SUBDIVISION: V LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:4 — o
CONTRACTOR: VY e--;"- PHONE #:
Inspection Request Scheduled For: , ate: 3 —2 — 0 c, Pour Time:
• - •ecti. • I - - - _ = Con ' # Contact # Message
4.(2;) c) F 10 L { J I � c,
Corr- •• _ _ • m gents/Instructions:
0 & cs) . 1
ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL • CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: 23 (A Phone #: (503) 718 -