Permit CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
4 DEVELOPMENT SERVICES PERMIT #: ELR2006 - 00080
'I I� 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 4/14/2006
PARCEL: 1S12600-00300
SITE ADDRESS: 09632 SW WASHINGTON SQUARE RD G - 9 ZONING: C - G
SUBDIVISION: WASHINGTON SQUARE LOT: JURISDICTION: TIG
Project Description: Data /Telecommunication. Job # 2006 - 05.
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 ADVANCED WIRING SERVICES INC
BY THE MACERICH COMPANY PO BOX 644
9585 SW WASHINGTON SQUARE RD CLACKAMAS, OR 97015
TIGARD, OR 97223
Phone: 503- 639 -8865 Contact #: PRI 503- 310 -3655
FAX 503- 698 -6372
FEES Reg #: ELE C7
LIC 162591
Description Date Amount SUP 4675S
[ELPRMT] ELR Permit 4/14/2006 $75.00
[TAX] 8% State Surcha 4/14/2006 $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:
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:
� e NTRACT • R I = ELATION ONLY
SIGNATURE OF SUPR. ELEC'N: , -;0" DATE: '/ /5/-d,
LICENSE NO: L 7f
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. ,• .electrical Permit Application roIZ orFici: usr ()NIA IA
City of Tigard Received ^�—�
`J g ,o � _- Date/B 4 / - 1 L i • U PerrmtNo.�� t : ■ b
- ° 13125 SW Hall B Tigard, OR 97223 Plan Review
- 13 , Phone' 503.639.4171 Fax: 503.598 1960 C DDate/B . Other Permit
.1.'1G n R D Inspection Line: 503.639.4175 APR 1 4 2006 Date Ready/By Inall ® See Page 2 for
Internet' www.tigard- or.gov H Notified/Method Supplemental Information
. TYPE qt �p1�KOY 1 �q � gT , PLAN REVIEW
New construction ❑ Additip t aeeln'�nt=�� 4 - Please check all that apply:
❑ Demolition ❑ Other:
0 Service over 225 amps, comm'I ['Hazardous location
❑Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION- of 1- and 2- family dwellings 4 or more new residential
❑ I - and 2- family dwelling Ep Commercial /industrial ❑ Accessory building OSystem over 600 volts nominal units in one structure
❑ Multi - family ❑Master builder ❑Other: ❑Building over three stories ❑Feeders, 400 amps or more
❑Occupant load over 99 persons 0 Manufactured structures or
JOB SITE INFORMATION AND - LOCATION ❑ Egress/lighting plan RV park
Job no.: 7004 —0 S Job site address: p1 632 SW K/A5P. Sq. P4, 6 —g ❑Health -care facility pother:
Submit 2 sets of plans with any of the above.
City/State/ZIP: T /(/-i > i 0 ,' • 97ZZ; The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: A' 4 Fob)/ >I Dee5 FEE* SCHEDULE
Description I Qty. I Fee. I Total I **
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. add'I 500 sq. ft. or portion 33.40 I
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
64 7D � dwelling, service and/or feeder 90.90 2
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
relocation
Phone: ( ) Fax: ( )
200 amps or less 66.85
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)
Phone: ( ) Fax:: ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited-
.
CONTRACTOR , energy panel, alteration, or / 0
G' I 146 extension. Describe: 1 Page 2 ? " 2
Business name: �1- A/si p vJ 1 e1 /S(, t
I
� G' ,
Address: p, 0, 2Up)( 691 Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State/ZIP: GLAc KAM AA i oe - 97615 Investigation per hour (I hr nun) 62.50
Phone: ( 56g ) g j 0 - 1.- Fax: ( c:, ) ( ° p — 4:57 Z. Industrial plant per hour 73.75
ELECTRICAL. PERMIT FEES*
CCB Lic.: ) Z9) Electrical Lic.: 7 . •rv. ic.: 94 $ Subtotal:
Suprv. Electrician signature, required: Lic.:
Plan review (25% of permit fee).
p State surcharge (8% of permit fee): G
Print name: -- 1.... _ 1 to i�G-TO N J D ate: a / pi /esee 0�
TOTAL PERMIT FEE QI
Authorized signature: This permit application 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
I \BuildingWennits\ELC- PeimitApp doc 03/23/06 440- 4615T(I 1/05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
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 $75.00
system
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I UBuilding\Pertnits\ELC- PamitApp doc 03/23/06
CITY OF TIGARD L � z$ 6 4 .
BUILDING DIVISION PERMIT #: Q o
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: OO D
Phone: (503) 639 - 4171' ^
Inspection Requests (24 Hrs.): (503) 639 - 4175 +` 1 I..
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
• SITE ADDR' S: gb32, Lo'AsN o8 9 21.. CLASS OF WORK:
SUBDIVISIO . U LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
' OWNER: PHONE #:
CONTRACTOR: PHONE #: '
Inspection Request Scheduled For: Date: Li`!lf I 66 Pour Time:
Code # Inspection Description Confirm # Contact # Message
Corrections /Comments /Instructions:
•
•
•
•
,PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: I v •93(..0)
Date: ` l 60 Phone #: (503) 718 - 1A410