Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00620
4 i DEVELOPMENT SERVICES DATE ISSUED: 10/8/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 1S126C0 - 01107
SITE ADDRESS: 09616 SW WASHINGTON SQUARE RD G -4 ZONING: C G
SUBDIVISION: WASHINGTON SQUARE
BLOCK: LOT : JURISDICTION: TIG
Project Description: Install 7 branch circuits.
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:
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: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 6 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:
PPR WASHINGTON SQUARE LLC L.E. ELECTRICAL
BY THE MACERICH COMPANY PO BOX 33706
9585 SW WASHINGTON SQ. RD. PORTLAND, OR 97282
PORTLAND, OR 97223
Phone: Phone: 503 - 997 -6352
Reg #: ELE 26 -1122C
LIC 150790
FEES SUP 4921S
Description Date Amount Required Inspections
[TAX] 8% State Tax 10/8/03 $6.94
[ELPRMT] ELC Permit 10/8/03 $86.75 Rough -in
Elect'I Final
Total $93.69
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 or
1- 800 - 332 -2344.
Issued By: � � Permit Signature: KAL.i A "
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 . t
SIGNATURE OF SUPR. ELEC'N: / � DATE: / 08` 03
LICENSE NO: .1,t
C 639 -4175 by 7:00pm for an inspection the next business day
•
Elecctrtcal Permit Application FOR OFFICE USE ONLY
Received Electrical , .5�'
O D 4—q 9 DateBy / � d 3 Permit No i � � .de
� 3 J �o�v
City of Tigard ��R 97' / Planning Apo al Sign
Date /By Permit No
13125 SW Hall Blvd. laG Plan Review Other
Tigard, Oregon 97223 a Date/By Permit No :
Phone: 503 -639 -4171 Fax. t , Q �� Post - Review Land Use
t..._ -, •+k Date/By Case No
Internet: www.ci.tigard.or.us ` ^ a ..I I I Contact Juns ® See Page 2 for
24 -hour Inspection Request: 503 -417 ` " Name/Method 'TA Supplemental Information.
u
TYPE 0i TIGnRD
[ii New construction BUILUIid ') 5101 PLAN REVIEW (Please check all that apply)
on emolition ❑ Service over 225 amps- ❑ Health -care facility
,� commercial ❑ Hazardous location
b i Addition/alteration /replacement El Other:
❑ Service over 320 amps - rating of 0 Building over 10,000 square feet,
CATEGORY OF CONSTRUCTION 1 & 2 family dwellings four or more residential units in
n 1 & 2- Family dwelling M Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stones ❑ Feeders, 400 amps or more
❑ Accessory Building El Multi- Family
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other
JOB SITE INFORMATION and LOCATION Submit _ sets of plans with any of the above.
Job site address: `361 Sub W The above are not applicable to temporary construction service.
v �, 6 ! FEE* SCHEDULE
Suite #: Rb -6k Bldg. /Apt.# Number of inspections per permit allowed
Pro ect Name: Ak _ i Description , Qty Fee (ea.) Total
Cross S eet/Directions to job site: New residential - single or multi - family per
dwelling unit. Includes attached garage.
CrQr1A.ci l ' /�/� N-C2 Service included:
1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 I
Subdivision: Lot #: Limited energy. residential 75.00 2
Limited energy, non residential 75 00 2
Tax map /parcel #: Each manufactured home or modular dwelling
DESCRIPTION OF WORK service and/or feeder 90 90 2
Services or feeders - installation,
alteration or relocation:
200 amps or less 80 30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
❑ PROPERTY OWNER I ❑ TENANT 601 amps to 1000 amps 240.60 2
Over 1000 amps or volts 454.65 2
Name: Reconnect only 66.85 2
Address: Temporary services or feeders - installation,
City/State/Zip: alteration, or relocation:
ty p 200 amps or less 66.85 I
Phone: Fax: 201 amps to 400 amps 100.30 2
❑ APPLICANT ❑ CONTACT PERSON 401 to 600 amps 133.75 2
Branch circuits - new, alteration, or
Name: extension per panel:
Address: A Fee for branch circuits with purchase of
service or feeder fee, each branch circuit 6.65 2
City /State /Zip: B. Fee for branch circuits without purchase of 1 /
service or feeder fee, first branch circuit 1 46.85 Li((• /(. 2
Phone: Fax: Each additional branch circuit 6.65 ? .'jO 2
E -mail: Misc.(Service or feeder not included):
CONTRACTOR Each pump or imganon circle 53.40 2
(��� Each sign or outline lighting 53.40 2
Job No: 0 Signal circuit(s) or a limited energy panel,
L _t5 A te- C1 �` _gam S _ alteration, or extension Page 2 2
Business Name: ,� , Say. d SriG
Description
Address: TO, :60. '33 Fc.
City/State/Zip: Q \ ^ _ C c� Each additional inspection over the allowable in any of the above:
0 oJ' I DT_ -( C_ �2
Per inspection per hour (min. I hour) 62 50
Phone: oS) — 635 Fax: (3) 2S1 -5c.o Investigation fee
? s CCB Lic. #: 7 07-9® Lic • • / Other
N. Electrical Permit Fees
h Supervising electrician I / ((2.2C it.-. `069 .7S
signature required: Plan Review (25% of Permit Fee) $
Print Name: (v114 c. #: 102,/ -S State Surcharge (8% of Permit Fee) $ & Gj
/a (_c,y TOTAL PERMIT FEE $ 93 .10
Authonzed Notice: This permit application expires if a permit is not obtained within
Signature: Date: 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
(Please pnnt name)
i \Dsts\Permit Forms \ElcPermitApp.doc 01/03
Electrical Permit Application - City of Tigard f
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved:
Audio and Stereo Systems
❑ Burglar Alarm
n Garage Door Opener
El Heating, Ventilation and Air Conditioning System
❑ Vacuum Systems
El Other
COMMERCIAL WORK ONLY:
•
Fee for each system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
n Boiler Controls
F l Clock Systems
11 Data Telecommunication Installation
❑ Fire Alarm Installation
HVAC
n Instrumentation
E Intercom and Paging Systems
Landscape Irrigation Control
n Medical
❑ Nurse Calls
0 Outdoor Landscape Lighting �h I
' 1 1
Protective Signaling
n Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations '
•
i. \Dsts \Permit Forms \ElcPermitAppPg2 doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING ttiispeCtion Line: (503) 639 -4175
INSPECTION DIVISION Business Line: . (503) 639 -4171 MST
BUP
Received Date Requested / AM PM BUP
Location Ce l ( W Ai- • SQ , 02 D Suite — 1 4 MEC
Contact Person Ph ( ) 81 ? 5 SUS LM
Contractor Ph (�. ) S C �c
BUILDING Tenant/Owner ' / . ELC 3--o0 (o O
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab - Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear •
Int Sheath/Shear
Framing •
Insulation
Drywall Nailing
Cf
Firewall
Fire Sprinkler
Fire Alarm
fr
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
P FAIL •
CELECT
Service / �i - ,i/
-
Rough -In
UG/Slab I
Low Voltage L s ue .
Fire Alarm
= PART FAIL 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 /2 Inspector /-C� ES ��"` Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL