Permit ` , CITYOFTIGARD ELECTRICAL PERMIT-
RESTRICTED ENERGY
l DEVELOPMENT SERVICES PERMIT #: ELR2004 -00304
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/30/2004
t r
SITE ADDRESS: 09650 SW WASHINGTON SQUARE RD G -15 PARCEL: 1S12600 -00300
SUBDIVISION: WASHINGTON SQUARE ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
Project Description: Limited energy for audio /stereo.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: X 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 MUZAK LLC
BY THE MACERICH COMPANY 3318 LAKEMONT BLVD
9585 SW WASHINGTON SQ RD FORT MILL, SC 29708
TIGARD, OR 97223
Phone: Phone: 503 254 - 7400
Reg #: LIC 142760
ELE 26- 1055CLE
MET 00006434
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 9/30/2004 $75.00 Elect'I Final
[TAX] 8% State Surcharl 9/30/2004 $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 t• •w-ru es adopted by the Oregon Utility Notification Center. Those rules are set •rth i OAR •i.2- 001 -0010
thrr ugh OAR 952- 1 -0100. You may obtain copies of these rules or direct questio • s t' ()UN( at (50 1) 246 -6699.
Iss ' ed by Permittee Signature l' ,J
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
Electrial Permit Application FOR OFFICE USE ONLY
Cit.:of T'igard Received el se 0 le 41.1 •
Date/By: 7 J r Permit No fag •••• Cligina
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
PhonF. 503.6.39.4171 Fax: 503.598.1960
Date/By. Other Permit:
Inspetion Lit e: 503.639.4175 .irif Date Ready/By. Jun_ See Page 2 for
Intem6t: www.ci tigard or us Notified/Method. ....--- /ter. Supplemental Information
1
1, la." ! 'i'`i" :'';.?...* - :4eiV 4%.6itiC: V:'1'.'el.;%:4744?-fTjic-c.V--'S217.74.-,.?1, f):;;:.f„:vr,,:,-:;..wi,:-:',j:t=',:;-2:,;>i.,;:z',.jixiii4i.isdivv',:,';,,-:
,-=---,._, ' °r '- ta--"•-• - ' ' ',- . ',., A - . • • • - • ' .. 4 ` -••'• "f41•Z * ' : • + a '1,-- ` cf - ..,-;.1.4.. , •-,.,! -,„, ' -.
U New construction ES-Addition/alteration/replacement Please check all that apply
0
['Service over 225 amps, comm'l 0Hazardous location
Demolition 0 Other:
['Service over 320 amps El Buildng over 10,000 sq. ft.,
..F,, - -. ..• , -t.-o: - . 'A: $.`,... s • ' VC ' • - V" 4e., ... • •• g ' - ,,..,- ' • ' ..,1: ..,1 ' ,..1; : : 4 .i.
i' 'S T 7..7 'c {:.■ 4 ''Tg9,94 ., Y91 .t '''''' ' ' 1 '''..:' 'F Z 4 of 1- and 2-family dwellings 4 or more new residential
El 1- and 2-family dwelling laCorrunercial/industrial 0 Accessory building 0System over 600 volts nominal units in one structure
I=IBuilding over three stones ['Feeders, 400 amps or more
0 Multi-family 0 Master builder 0 Other:
, 00ccupant load over 99 persons ElManufactured structures or
;i0jaitii.iiki'60.g1 r ....k • illi :- Zaeg"Fia`r ' ''-'' ;11 "' --; ' '-- 0Egress/lightmg plan RV park
Job no.: Job site address: qi_co s 4_,4,-,/,4,6-0 ..sf 0Health-care facility ['Other:
Submit 2 sets of plans with any of the above.
City/State/ZIP: 6 (1---
2?, Z 3 el Oa" X" if9 47: The above are not applicable to temporary construction service
,, ,- , 1 1 V•z:iSR.V.1:,..Vt.Olt,:4.401.11pTat. , ,;- - : ,, -- ' '
Suite/bldg/apt. no.: Project name: 5,1 f
Descripdon Qty. Fee. 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
Limited energy, residential 75.00 2
Tax map/parcel no.:
Limited energy, non-residential 75.00 2
4fitstitliiloW6i5V61W-i* --- t"" - '''''et-'
• .-: .: t ,, . t-,', -'... '-, . , .:2, ,.',„•: rt.„.;_,_. .. -,., . „ ,, .,, .. ■;:hf 6: ; g .4 . ?1,4Fleit, ' -,'-:1:4 Each manufactured or modular
dwelling, service and/or feeder 90.90 2
ca 0 AZO St/ J f/!
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
t --, __,..to ,_._...•-- • °•••,••• • ntillte="" • 71. ' •`• ','•■••, ' b ' : • .• ' '••• .•... - '...,)17,1' ''..,, C • , .-' •'''...•!•-' 201 amos to 400 amps 106.85 2
utOXIAR.tic.:0WNER:... . ...':': to - .:-‘..r.:' E Ts-DIANJ - -3-:= 'F' ' l■"17.= '
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: ( ) I 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. 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits- new, alteration, or extension, per panel
il tVi 01 -1 - 74- 11$46Vtiefib r fiki." 6 . ',. „ A. Fee for branch circuits with
Business name: /0/1 Z- l e_ branch circuit 6.65 2
•
B. Fee for branch circuits
Contact name: oyd / without service or feeder fee,
46.85 2
Address: 39/r 44 g 0 ,/,-t...v,,, each branch circuit
Each add'I branch circuit 6.65 I 2
City/State/ZIP: fr "-I ; (1.-- SC 2 70 Miscellaneous (service or feeder not included)
Phone: (5'6 Z $ _ 7 (/6 7 I Fax: : ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53 40 2
E-mail: Signal circuit(s) or limited-
k V ., an
/', ....--- energy panel alteration, or
....., ... ,. ...--, . - iL.ii. , -,: -
extension. Descnbe: ( Page 2 2
Business name:
Address: t Each additional inspection over allowable in any of the above
fr
5"Lt ' ***1/ Per inspection 62 50
Investigation per hour (i hr min)
City/State/ZIP: -
62.50
Phone: ( ) Fax: ( ) Industrial plant per hour - 75
iI j . i ,; t;i:.4Z,._;;:-f:4 .a_t$7!?.
CCB Lic.: It-t Z 160 Electrical Um.: ' 6- ()5y GttSue . Lic.. • 0 d 7V4AJ
Subtotal
Suprv. Electrician signature, required:/ / • Plan review (25% of permit fee)
Print name: A, yd /1 I Date: ?_;„) -0 / State surcharge (8% of permit fee)
TOTAL PERMIT FEE
Authorized signature/ ( .4.,....,52___ This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name:
/6 t/t /(1/.4 Date: 1 - 9.7 -d • Fee methodology set by Tn-County Building Industry Service Board
•• Number of inspections per permit allowed.
i \Building \Perrruts \ELC-PermitApp doc 12/03 440 I 0/02/COM/WEB
Electrical Permit Application - City of Tigard
Page .. 2 - Supplemental Information . .
LIMITED ENERGY PERMIT FEES:
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:
. Fee for each commercial system $75.00
(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.\Buildmg\Pe mas\ELC•PemutApp doc 04/03