Permit •
CITY Ti GARD ELECTRICAL RESTRICTED ENERGY PERMIT
DEVELOPMENT SERVICES PERMIT #: ELR2005 -00112
� I I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 5/12/2005
PARCEL: 1S12600-00300
SITE ADDRESS: 09642 SW WASHINGTON SQUARE RD G -12 ZONING: C -G
SUBDIVISION: WASHINGTON SQUARE LOT: JURISDICTION: TIG
Project Description: Thermostat.
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: X PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
WASHINGTON SQUARE LLC ARROW MECHANICAL
BY THE MACERICH COMPANY 10330 SW TUALATIN RD
9585 SW WASHINGTON SQUARE RD TUALATIN, OR 97062
TIGARD, OR 97223
Phone: Phone: 503 692 - 1565
Reg #: LIC 5193
ELE 34 -47CLE
• FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 5/12/2005 $75.00
[TAX] 8% State Surchart 5/12/2005 $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 .et forth in OAR 952 - 001 -0010
through OAR 952 -001 -1100. You may obtain copies of these rules or direct ques ',r 1 4 at 503 - 246 -6699.
Issued By: Permittee Signature: I�
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, o 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.
. •
Electrical Permit Ap> n_ FOR
ate/By OFFICE USE ONLY
_ D
City of Tigard R eceived /J (/ _! Permit No -6L41C4
13125 SW Hall Blvd.. Tigard, OR 97223
Plan Review
Phone: 503 639 4171 Fax. 503.598 1960{ AY
iJ v ` Date y Other Permit
Inspection Line 503 639 4175
2 2005 ^_• / 11 Date Ready/13y ins 0 See Page 2 for
Internet: www.ci.tigard or us � ( OF TI ���� Notified/Method T v Supplemental Information
C iB Si ®! ' PLAN RF .
❑ New construction [4] Addition/alteration /replacement Please check all that apply:
❑ Demolition ❑ Other: ❑Service over 225 amps, comm'I ❑Hazardous location
❑Service over 320 amps - rating ❑ Buildng over 10,000 sq ft.,
. - CATEGORy.p,F "CONSTRUCTION - of 1- and 2 -family dwellings 4 or more new residential
❑ l- and 2 family dwelling Commercial/mdustrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑Building over three stones ['Feeders, 400 amps or more
❑ Multi family 0 Master builder ID Other
J OB SITE INFORMA,TION:• AND LOCATION ❑Occupant load over 99 persons ['Manufactured RV park
structures or
. . LI Egress/lighting plan P
Job no Job site address: q , 4 Z A/5 H f .5 Q e..o. p ❑He 2 -care facility
fp ay ❑ abo e
� _ J Ic...C.YT' Submit 2 sets of plans with any of the above
City /State/ZIP ' j V ha / Oa_ The above are not applicable to temporary construction service
Suite/bldg. /apt no G.--' 7 Project name C4- N FEE' SCHEDULE Qty. j ••
Description I Qty. I Fee. Total
Cross street/directions to job site W 05 H JAl 6-Tn _ ` 5c + A - 2 d r' New residential single- or multi - family dwelling unit.
uV 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 1
Tax map /parcel no
I amded energy, residential 75 00 2
Llmtted energy, non - residential 75 00 2
DESCRIPTION OF WORK Each manufactured or modular
/ ' V- h / � � dwelling. service and/or feeder 90 90 7.
`±1136 ,( iii m CSV '�/ y � l- Services or feeders installation, alteration, and /or relocation
200 amps or less 80 30 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 100 am 106 85 2
401 amps to 600 amps 160.60 2
Name
601 snips to 1.000 amps 240 60 2
Address Over 1.000 amps or volts 454 65 2
Reconnect only 66 85 2 - 1
City/State/ZIP I •temporary services or feeders installation, alteration, and /or '
Phone ( ) (: ( relocation
2 _(10 amps or less 66 85 1
On ner installation: Ibis installation is being made on property that I own which is not . 201 gimps to 400 .imps too 30
intended for sale. lease. lent, Dr exchange. according to ORS 447, 449, 670, and 70I 401 amps to 600 amps I t3 75 2
Owner signature Date. Branch circuits - new, alteration, or extension, per panel
❑ APPLICANT Iii CONTACT PERSON A lee for branch circuits math I
A�Q service or feeder the. each
Business name 04 Vi a' "I9 is � CJ ,+ r�S branch circuit 6 65 - i
� 7 13 Fee for branch circuits
Contact ratite fJ 5C / � 9G11 .1 without service or feeder fee,
Address G � 6 C'' / .
L L each branch circuit
85 2
V f w -/A, =) Each add I branch circuit 6 65 2
City /State/ZIP. jU L „,„ O Q e e) / (O ) Miscellaneous (service or feeder not included)
f v t`- 7 e' (� Pump or irrigation circle 53 40 2
Phone (S lP ) /_ 1 z �/ �/ (0 Fax: (5`43 ) 69/ /Fr 7 /
Sign or outline lighting 53 - 40
E - mail Signal circuit(s) or limited -
CONTRACTOR energy panel alteration or
Business name nag 0 / C/J 91, / e,s co , ` extension. Describe, Page 2 2
Each additional inspection over allowable in any of the above Address J
/e 3 3 0 j w T� 9 4, gT,,J 8019
Per inspection 62 50
City /State/ZIP �u7 A r re q' 706 Z Investigation g' per ( mm) r hour I hr min 62 50
Phone ) Industrial plant per hour 73.75
(53 41 2 -/.5-4,_ Fax. x. 03 ) 6 9/ ._/ 79 ELECTRICAL PERMIT FEES*
CCII Lie 5713 Electrical I,ic '417 Supry tic 25-41 t‘s
Subtotal
Supry Electrician signature, required Plan re‘ row (25' o of permit fee) —
1
r ear // e n — — State surchar (8 °o of p ermit fee)
Print name I/ Date s -1
IJIt- ' L - - -- I -- TOTAL PERMIT FEE ¢/
J I
rAuthorized signature L O
I Phis permit application expires if a permit is not obtained within ltin
— — - -- — --- - - - - -4 class after it has heen accepted as complete
1 I'1 lilt name 1 )ale • 1 inrthodai,im .et n■ I n ('nuntu liwldine Indu,tn, , tersic e ii, Ord
-- --
Electrical Permit Application - City of Tigard -
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
- Fee -for alt- residential systems combined
Check Type of Work Involved: -
-;❑ Audio Stereo Systems* -
❑ Burglar Alarm
❑ 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
El 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
El Other
Total number of commercial systems: (
*No licenses are required. Licenses are required
for all other installations
CITY OF TIGARD ,
BUILDING DIVISION PERMIT #: ELR2005-00112
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/12/2005
Phone: (503) 639 -4171 �n�a,, „m „iq
Inspection Requests (24 Hrs.): (503) 639 -4175 � ' : !+� I
INSPECTION WORKSHEET FOR DATE: 6/8/2005 TIME: 7:12AM PAGE: 85
SITE ADDRESS: 09642 SW WASHINGTON SQUARE RD G -12 CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE:
PROJECT NAME: CACHE .j
DESCRIPTION: Thermostat. •
OWNER: WASHINGTON SQUARE LLC, PHONE #:
CONTRACTOR: ARROW MECHANICAL PHONE #: 503-692-1565
Inspection Request Scheduled For: Date: 6/8/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low voltage 008661 -02 503-692 -1565 Y � Lee
Corrections /Comments/ Instructions:
(11 4/ Mt / r 4W X13-5
. /VfC Al(f4 obkavria
ASS ❑ PARTIAL APPROVAL ❑ CANCEL ' ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ; ,Li A , Date: / , / Phone #: (503) 718-
•