Permit CITY OF T I G A R D ELECTRICAL PERMIT -
RESTRICTED ENERGY
21111 DEVELOPMENT SERVICES PERMIT #: ELR2004 -00351
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/12/2004
SITE ADDRESS: 09650 SW WASHINGTON SQUARE RD G -15 PARCEL: 1S12600 -00300
SUBDIVISION: WASHINGTON SQUARE ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
Proiect Description: Low voltage: DATA
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 LIBERTY COMMUNICATIONS
BY THE MACERICH COMPANY 2191 NE LIBERTY AVE.
9585 SW WASHINGTON SQ RD GRESHAM, OR 97030
TIGARD, OR 97223
Phone: Phone: 503 674 - 4922
Reg #: LIC 101807
ELE 26- 1035CLE
SUP 3990LEA
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 1 1/12/2004 $75.00 Elect'I Final
[TAX] 8% State Surchari 11/12/2004 $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 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699.
Issued by Permittee Signature 0)-1
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 639 -4175 by 7:00 P.M. for an inspection needed the next business day
•
4 11/.9/2094 1 '39 FAX 5035981960 CITY OF TIGARD 11001 /003
Electrical Permit A H 0\ Fait OFFICE 1:S F. (1 L'
Reeeved
City of Tigard I r 0 • I'ermltNa_ ., i ._ . • ....e (2
13125 SW Hal Blvd., Tigard. OR 97223 , \ . b lyi ^ . - . Hee • . Other te+mte
Phone 503.639.4171 Fax 503398.1960 ' "
I.. Datr1Br
%spe Jmv VI see rase 2 for
c-non Litter 503.639.4175 - al l '`iI . Date >:m d y/Br '/ I SappletaeuUttarnrmatloo
Internet www.ei.tdgard.or.us on , �� � NvdRodlMahod:
Addition/alt entancplaoement Please check all that apply:
❑ Now construction ik ['Service over 225 amps, eomm 1 ['Hat lour location 1
❑ Demolition ❑ usher: QService over 320 amps -rating nitnildng over 10.000 sq. ft.,
= .. of 1 - and 2- family dwellings 4 or MOM new residential
• • r .: CAT �R1`, .Qikr units in one strum= .
.. � -. QSyatemover 600 volts nominal
❑ 1 - and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building ❑B1rsYtlirtg over three stories [' .ceders, 400 amlm ortaore
ID Muhi•fitmily 0 Master builder ❑ Other. ['Occupant load over 99 persons ['Maaufectueil structures or
:talk TE INFORMATION 'AMY I•oe.A !now: ' • • . ['Egress/lighting RV park
ngpion ❑per
. ' _ 1 ['Health -eats facility
Job no.: I Job site address: CI Lj 7 0 3 LLl . Um k . Submit .2,. sots ofpleffi with any of t above.
1 . �^ /�d1 n 7,2 1 3 (�I me above are not applicable to temporary Construction service. • Ciry/StstdZlP: + ' -"'T� ' 1 !K �( `'1 / : • .... ..... • ; E.01/i<.E. _ .
SuitelSldgJ>ypt. no.: P roject name: :��', '1'• -_ .7c : ' .•.::. -.. r oae+v .a : oa e spy. Re, Tatar
• ��__�.�- • ���' . ".
• , I I . l NeW residential single - or muhl - Ibmiy dwelling unit.
Cross sttoet/ditutiws m job site: , %chid= ateaelted garage.
1.000 sq. ft- or leas J � 145.15 - a
Lot no.: Ba. add'1 sq. ft. or portion 33.40 1
Subdivision: — Limited ewer 1, nsidmtial 75.00 2
Tax map /parcel no.: _ Limited energy. non- iendeatial 75.00 2
•
,1 tforl 01?' WORK •- ... ' • , : • •• . , ••; . " • • , Each lmauthenaed or modular •
dwellln�aervico and/or feeder 90.90 2
,l Tit Servka or feeders Installation, alteration, and/or antecede
200 amps or less 80.30 2
. .
201 amps m 400 amps 106.85 2
❑ PROP73't1lTY+ :OWNER.' ['' 401 amps to 600 amps 160.60 2
Name:
1,04_ L 601 amps to 1,000 amps 240.60 2
� `` --11A �/►`� Over 1,000 arias or wits 454.65 2
Address: �J� �C J>R Reconnect only 66.85 2
City/Stare/ZIP• J i ,4-/L (2 9 7 '5 Temporary or feeders Installation, amruten, and/or
t
Fax: ( ) rdecat
Phone: CIO 200 amps or lax 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 maps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 turps m 600 amps 133.75 2
Owner signature: Date: Branch circuits - sew. alteration or extension, jper panel
A Fee for branch circuits Wish •
❑' APp LYCANT ' . (� CbPiT+11E� • PE1i5O1B : « •, • service or feeder fix eaalt
•. � . �.i J' ': ' • � 6.65 2
Business name: branch circuit
13_ Fee for branch ennui's
Contact name: wilhout service or feeder fee. 46.85 2
_ each broach circuit
Addzgs; Each add.'I branch circuit 1 6.65 2
City /State/ZIP MIscellaneous (service or feeder Sat Ineinded)
Pump or irrigation circle 53-40 2
( ) I Fax:: ( ) Sign or outline lighting 53.40 ._ 2
E -mail: Signal eir'cuit(s) or limited-
. _ CONTRA 'OR . , : .. . - energy panel, alteration, or ...„-
extension. Describe: I Page 2 • l J ' -- 2
Business name - . ' A II i Each additional inspection over allowable in any of the above
Address: , `, I R I �; 13 f'i�c'.1"1 Pamspectlon 62.50
City/State/ZIP: L ClOir (I % r\ � fz.» C 7 C! 3() Investigation per hour (1 Inn en) 6230 .
al C ^� Industrial plant per bout 73.75
/ Phone: a ., C Fax: ) iv : • ''ELEG'I_'aiCAL TRAMIT :FLS 6 ' :
D i Di . / CCE Lin.: / b/ , L Electrical Lie.: — - . . . Lin.: 7 - 1 --0 Sut>lotal I ° G.
Supcv. Ele triCiatl signature, required: - 1 -> ` ` : L' V • Plan review (25% of permit fee)
; �/ l (� Stalls surcharge (0% of pesmit fee) 6 v
Print name: �� / _ •
(( t �' �� �� " ! �� Tax A . PERMIT MB g l .w—
Aithorieed signature: This penal appnoaoa expires if a psnail la eat obtained within ISO
days after It bas been erupted as complete
Date: • Pea meen solos r derby Tri Building industry Service Board
Print name: **Numbered isrpections perecomie allowed.
a tzbo 410-401s1•l1ola2I'naldlWSO
I 'd ZE6b.- .17L9-EOS 314I'141.103 Al213H11 dl7E : I0 170 6O (toW
CITY OF TIGARD 24 -Hour
BUILDING • Inspectioq Line: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested ( — I AM PM BUP
Location LOA" S Suite MEC
Contact Person Ph ( ) 6 7 - '{Q Z
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access.
Ftg Drain ELR o? I7z)% 00 35/
Crawl Drain
Slab Inspection Notes: • SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING J ul
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
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab -
Low Voltage /
Fire Alarm
�
111 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
ART FAIL
S Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA `� li-�-
Approach/Sidewalk DateDate/0 Date/0 �— l ✓ � Inspector /4c- Ext
Other:
Final DO NOT REMOVE this inspection record f m the Job site. •
PASS PART FAIL
•