Permit •
CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
DEVELOPMENT SERVICES PERMIT #: ELR2005 -00196
- 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 4.171 DATE ISSUED: 7/19/2005
PARCEL: 1S12600-00300
SITE ADDRESS: 09516 SW WASHINGTON SQUARE RD H -4,5 ZONING: C -G
SUBDIVISION: WASHINGTON SQUARE LOT: JURISDICTION: TIG
Project Description: Low voltae.
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: 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 7/19/2005 $75.00
[TAX] 8% State Surcharl 7/19/2005 $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 95 -001 -0100. You may • btain copies of these rules or direct questions to OUNC at 503 - 246 -6699.
Issued By: / � I Permittee Signature: G - > 6 " 21,
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.
... ........ 1 .,4., r„...„._..„
A Ele 111 e . .2 .) lt ical Permii,Application FO or 1, °NA' I
-=-
City of Tigard • i ik'i ,• F .,- t, ilk, 8 Hrlived
g, pcmiit No e 2 cr..
.• 1 SW Hall 13Ivd., Tigard, OR 97223 '.' . .,,,,' r. v .,--..- do ,
Phone: 503.639.4171 Fax: 503.598.1960 4:■•74` . - ,, q 1 A Lr 1 4.11°W
Other Permit:
Inspection Linc: 503.639.4175 1 I141!■i,,_ u nto i i 1 unteiB .
, .1.. ,.., r-, ,.,rcady/By: .1 .: ,- 121 See Page 2 for
Internet: www.ci.tigard.or.us ' e . 14otificd/Methcd;
4.1 Supplemental information
'':...0#:.W0*:VOT:Itt )11:i i' 1: ..::':;,:i::;:::!:.:.;:.1;lii:■1..:::::::,:..''1k;OVi'14*::'.'....;..:::.:';
0 New construction ill Addition/alteration/tit iiitIOS -- 4 V' DIVISIOk ,i Please check all that apply:
El Demolition El Other C.., 2 C/J ) - 00, OServiee over 225 amps. comm CHazirdous location
OService over 320 amps - rating 1:113uildng Over 10,000 sq. 11..
4...E.0 4i I .' .;". of I and 2-family dwellings 4 or more new residential
0 1- and 2-family dwelling 2 Commercial/industrial 0 Accessory building CISystem over 600 volts nominal units in one structure
['Building over three Stnries nPecdcrs, 400 amps or more
0 1%40lb 0 Master builder 0 Other:
['Occupant load over 99 persons DManufactured structures or
4013.,Stit . ,.:': POW 1 , 0 , 1 PION: :.v il*PJOAT:iti14... ; ; ., : : :: ; :, :;;"...: ; . ::::::: .. .' ' m DEgressnighting plan 1W park
Job no.: Job site address: h r 'a 17 / if nHealth-care facility ['Other:
Submit 2 sets of plans with any of the above.
City/State/ZIP: / dp„ if rr - --- 3 The above are not applicable to temporary construction service.
,/ 1.:: : ::: :: :. :E l ....: : :': -1 ::::'..,..: : .. .•....:':.:;:rttf,S011.Eligtft$2..:,::;',.1,:::',:',' : , :::: : :: : .: , :'.::
Suite/bldg./apt. no.: Project name: Jr / ' •
P ........4. m'A ,,
., ,•_, k . A -7 P twrIptino Qty. For_ 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: Lot no.: Ea. tide! 500 sq. ft, or portion 33.40 i
Limited nergy, residential 75.00
Tax map/parcel no.:
Limited energy, non-residential 75.00
111
tiggOterIOS1'()P:W.Cift.':: . ...,;:';:'::•:;,,::, ...'.'';..:'''''''''', Pesch anufactured or modular
dwellinuicrvice and/or feeder 90.90
Services or feeders installation, alteration, and/or relocation
200 amps or less 80,30 2
106.85 2
4:3" .; ,;;:, ......:., ;:;:.;;...,!:!. :: .;:;1:3...timo Py. ..: , r .. 201 amps to 400 amps 401 amps to 600 amps 160.60 2
Name:
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volt! 454.65 2
Reconnect only 66.85 2
City/State/ZIP:
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. I f
401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits- new, alteration, or extension, per panel
;.... Atip00‘ . .i . ';..: : e ; . : .:: ;.:: ..:...:„: :;:::[;)• •Oliqgf.!..?:05:..19.1!4ii:.:.;.,:1i. A. F ec i f cc or o b r ran fe c e l d i e e f ircuit e s a w c i h di
6A5 II
Business name:
branch circuit
B. Fee for branch circuits
Contact name:
without service or feeder fee,
each branch circuit 46.85
Address:
Each addi branch circuit 6.65 Il
City/State/Z1P:
Miseelia aeons (service or feeder not included)
_
Pump or irrigation circle 53.40
Phone: ( ) Fax: : ( )
Sign or outline lighting 53.4
E-mail:
Sinai circuit(s) or limited.
.;..:::::: .:! :::::::;::: .!,',' ,...' CrOg...::: .:" '%.......:.,......,.;,:: !,..',..,.:! energy panel, alteration, or
extension. Describe: Page 2
Business name: )4/ ' 4 ° LLIA..oa * MOgA
Address: r ar(110 FY . 4 11 M/ 1 /77 .1 5F 2 -- 1, /ffirriMik- I Each additional inspection over allowable in any of the above
'.‘" -F Aill 4, " - . ;.- -Angli Pcr inspection Mill 62.50 MI
City/State/ZIP: WI/ 1 girAratr/ _ investigation per hour (t hr min) NM 62.50 MI
.
In 73.75 = I
r I, z „,...
0 ,' r . • 07) I irarkgrifrzm,
. Industrial plant per hour
- Ig r ,. MFAV
CCB Lic.: .11 Electrical Lic.i A i, 1_,,, , ! i ii o r M. : , Subtotal r .4 70
Suprv. Electrician signature, require.. .'. ., '- -- -l Plan review (25% of perrnit fee)
:....--'---
r a..-- 7 ,,2 State surcharge (8% of permit , fee) • . 00
Print name: je j a it . el Date: -'6, / /7 co
TOTAL PERMIT FEE IF:fifrilt.
Authorized signature: c /(, ,/
This permit applicotirtn expires if a permit Is not obtained within 180
days after it has been accepted as complete
Print name: Date: • Fee methodology set by Tri•County Building Industry Service Board
----- ** Number of inspections per permit allowed.
1 ;\RoildimpormioAELC - PertrtitAop.doc IVO 440 (wax o wylea
. _ . . - •
' ear- cal Permit Application - City of Tigard 513-5
Page 2 - Supplemental Information
•
LIMITED ENERGY PERMIT FEES:
.I - �/,�■. y ,J f�' _rj� ■y�Iyry{}I.'.1 ��
V W IAL 1•' 1:IL1,
Fee for all residential systems combined........ $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
9 Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System *
❑ Vacuum Systems*
❑ Other:
Fee for each commercial system $75.00
(SEE OAR 918 -260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑
C)elc Systems
• 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: 1
*No licenses are required. Licenses arc required
for all other installations
i:\ DundioR Tpttuitu \ELC- PermitApp,doe 04/0:1
CITY_OF TIGARD s.
BUILDING DIVISION PERMIT ELR200. '0199
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUES • 7/21/2005 -
Phone: (503) 639 -4171 164414111
Inspection Requests (24 Hrs.): (503) 639 -4175 .,
INSPECTION WORKSHE OR DATE: 9/8/2005 TIME: 7 :09AM PAGE: 74
SITE ADDRESS: 09516 S•WASHING' • N SQUARE RD H - 4,5 CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUAR LOT #: TYPE OF USE:
PROJECT NAME: BEN BRIDGE JEWELERS
DESCRIPTION: Low voltage for fire alarm.
OWNER: WASHINGTON SQUARE LLC, PHONE #: 503,.639-8865
CONTRACTOR: ADT SECURITY SERVICES, INC PHONE #: 503 - 469 -7244
Inspection Request Scheduled For: Date: 9/0/2005 Pour Time:
Code # Inspection Description Confirm # Con :ct # Message
,•e 015142 -01 503- 639 t65 N
Via r. S AL.
Co -- • •mments /Inst - ctions:
AL,5co E LK -Lao 6' 41 I*
( fl135
��PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ` \Y '`� ` . Date: 1( j Phone #: (503) 718- Z- •