Permit CI TY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00273
l DEVELOPMENT SERVICES DATE ISSUED: 4/22/2005
�� II 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1S12600-00300
SITE ADDRESS: 09642 SW WASHINGTON SQUARE RD G -12 ZONING: C -G
SUBDIVISION: WASHINGTON SQUARE LOT : JURISDICTION: TIG
Project Description: 1 branch circuit for jewelery case lighting.
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: 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:
WASHINGTON SQUARE LLC ATLAS ELECTRICAL CONTRACTORS
BY THE MACERICH COMPANY 4403 SE ROETHE RD
9585 SW WASHINGTON SQUARE RD MILWAUKIE, OR 97267
TIGARD, OR 97223
Phone: Phone: 659 -2212
FEES Reg #: SUP 2581S
1532
Description Date Amount LLC
ELE 3 -2C -2C
[ELPRMT] ELC Permit 4/22/2005 $46.85
[TAX] 8% State Surcharge 4/22/2005 $3.75 REQUIRED ITEMS AND REPORTS
Total $50.60
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR Speaalty 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: �� , �'� � Permittee Signature: cy---1,\ c~ /k t �`+
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.
E1; ctrical Permit Application F1' FOR OFFICE USE ONLY
• Rec eived
City of Tigard Permit No
13125 SW Hall Blvd , Tigard, OR 97223 4 ":' R e "
Phone 503 639 4171 Fax. 503 598 1960 II Date /By Other Permit
Inspection Line 503 639 4175 a Juns RI See Page 2 for
c.
Internet: www ci tigard or us pry O �0 1 i �'o� 1 RD r1C Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction El Addition /alteration/replacement Please check all that apply:
❑ Demolition ❑Other: ❑Service over 225 amps, comm'l ❑Hazardous location
['Service over 320 amps – rating DBuildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of 1 - and 2- family dwellings 4 or more new residential
1:' i - and 2 family dwelling ® Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
['Building over three stories ❑Feeders, 400 amps or more
1=1 Multi - family 0 Master builder 0 Other:
['Occupant load over 99 persons EManufactured structures or
JOB SiTE INFORMATION AND LOCATION ['Egress/lighting plan RV park
Job no.: J site address' ❑Health -care facility ['Other
12778 9641 SW Washington Square Rcadsubmit 2 sets of plans with any of the above
City /State /ZIP: Tigard, Oregon 97223 The above are not applicable to temporary construction service.
FEE* SCHEDULE
Suite/ bldg. /apt. no : Project name:
Silver Street Description I Qty. 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 Lot no : Ea add'l 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
Remove and install owner provided lighting in Services or feeders installation, alteration, and /or relocation
jewelery case. 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 1
Owner installation: This installation is being made on property that 1 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 ❑ CONTACT PERSON A Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: Atlas Electrical Contractors, Inc. branch circuit
B Fee for branch circuits
Contact name' Ty Shepersky without service or feeder fee,
each branch circuit
Address: 4403 SE Roethe Road 1 46.85 46.85 2
Each add'I branch circuit 6 65 2
City /State /ZIP: Milwaukie, Oregon 97267 Miscellaneous (service or feeder not included)
Pump or irrigation circle 53 40 2
Phone: ( 503 659 -2212 Fax: ( 503 ) 659 -4944 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 Atlas Electrical Contractors, Inc.
Address 4403 SE Roethe Road Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State /ZIP- Milwaukie, Oregon 97267 Investigation per hour (i hr nun) 62.50
Phone ( 503) 659 -2212 Fax: ( 503) 659 -4944 Industnal plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic 1 3 Electrical L c.: Supry Lic.: s s , Subtotal
46.85
Suprv. Electrician signature, required: A WI Plan review (25% of permit fee)
State surcharge (8% of permit fee) 3
Print name: Ty S pe ky Date 4/20/05
TOTAL PERMIT FEE 50.60
Authorized signature This permit application expires if a permit is not obtained within 180
NNN days after it has been accepted as complete
Print name: Ty Shepe ky Date: 4/20/05 • Fee methodology set by Tn- Cowity Building industry Service Board
•* Number of inspections per permit allowed
i \Bu idmg \Perms \ELC- PennnApp doe 12/03 440- 4615T(10/02 /COM/WEB
CITY OF TIGARD. • �. • .
BUILDING DIVISION PERMIT #: ELC2005-00273
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/22/2005
Phone: (503) 639 -4171 vd '�pnll I�i,
Inspection Requests (24 Hrs.): (503) 639 -4175 `_ _..
INSPECTION WORKSHEET FOR DATE: 5/24/2005 TIME: 7 :09AM PAGE: 52
SITE ADDRESS: 09642 SW WASHINGTON SQUARE RD G - 12 CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE:
PROJECT NAME: SILVER STREET
DESCRIPTION: 1 branch circuit for jervelery case lighting.
OWNER: WASHINGTON SQUARE LLC, PHONE #:
CONTRACTOR: ATLAS ELECTRICAL CONTRACTORS PHONE #: 659-2212
Inspection Request Scheduled For: Date: 5124/2005 Pour Time:
Code # Inspection Description Confirm # ' Contact # Message
199 Electrical final 007584 -01 503- 901 -5348 N
•
_'C rections /Comments /Instructions:
•
O ., PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date -' Phone #: (503) 718-