Permit CITY OF TIGARD ELECTRICALPERMI
RESTRICTED ENERGY
DEVELOPMENT SERVICES PERMIT #: ELR2004 -00078
At 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/25/04
SITE ADDRESS: 09653 SW WASHINGTON SQUARE RD M -2A PARCEL: 1S12600 -00300
SUBDIVISION: WASHINGTON SQUARE ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
Project Description: Job No. 12675 Data Cabling
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:
PPR WASHINGTON SQUARE LLC COMMWORLD OF PORTLAND
BY THE MACERICH COMPANY 5711 SW ARCTIC DRIVE
9585 SW WASHINGTON SQ. RD. PO BOX 3675
PORTLAND, OR 97223 BEAVERTON, OR 97005
Phone: Phone: 503 - 520 - 1220
Reg #: L6G6- 023$03916
ELE 26- 890CLE
SUP 3541LEP
FEES Required Inspections
Description Date Amount Ceiling Cover
[ELPRMT] ELR Permit 3/25/04 $75.00 Wall Cover
Elect'I Final
[TAX] 8% State Surchart 3/25/04 $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 throuc
Issued by T Permittee Signature 5,i6Mp
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
Ele Permit Application FOR OFFICE USE ONLY
Received Y i,.. Electrical
DateBy. 3 �/ O h i Permit N 20-b 1
Cl of Ti and Date/ By: Sign
City g Test Form Date/By: PermitNo.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503 - 639 -4171 Fax: 503 - 598 -1960 ,,�, (& Post - Review Land Use
Date/By: Case No.:
Internet: www.ci.tigard.or.us Ave, ��� Contact Juris.: 0 See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name/Method: Supplemental Information.
- TYPE OF WORK ` PLAN REVIEW (Please check all that apply) '
['New construction ['Demolition ❑ Service over 225 amps- ❑ Health-care facility
commercial El ® Addition/alteration/replacement El Other: Hazardous
❑ Service over 320 amps- rating of ❑ Building Building over er 10 10,000 square feet,
'' ::?, , ' , CATEGORY. OF CONSTRUCTION I & 2 family dwellings four or more residential units in
n 1 & 2- Family dwelling ® Commercial/Industrial ❑ System over 600 volts nominal one structure
['Accessory Building n Multi- Family
El Building over three stories ❑ Feeders, 400 amps or more
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
- , JOB SITE INFORMATION and LOCATION - Submit _ sets of plans with any of the above.
The above are not applicable to temporary construction service.
Job site address:9653 SW Washington Sq. Mall RU. FEE* SCHEDULE , .
Suite #: Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: The Picture People Description Qty Fee(ea.) Total
New residential - single or multi - family per
Cross street/Directions to job site: dwelling unit. Includes attached garage.
2nd floor Washington Square Service Included:
1000 sq. ft. or less 145.15 4
Thompson Guide Pg. 655 D -1 Each additional 500 sq. ft. or portion thereof 33.40 1
Subdivision: Lot #: Limited energy, residential 75.00 2
Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
' - DESCRIPTION OF WORK service and/or feeder 90.90 2
Services or feeders - installation,
Data Cabling alteration or relocation:
200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
❑ PROPERTY OWNER I ❑ TENANT 601 amps to 1000 amps 240.60 2
Over 1000 amps or volts 454.65 2
Name: Reconnect only 66.85 2
Address: Temporary services or feeders - installation,
City/State/Zip: alteration, or relocation:
y p 200 amps or less 66.85 I
Phone: Fax: 201 amps to 400 amps 100.30 2
401 to 600 amps 133.75 2
NI 'APPLICANT ❑ CONTACT PERSON Branch circuits - new, alteration, or
Name: Commworld of Portland extension per panel:
Address: 5711 S . W . Arctic Drive
A. Fee for branch circuits with p urchase of
service or feeder fee, each branch circuit 6.65 2
City /State /Zip: Beaverton, OR. 97005 B. Fee for branch circuits without purchase of
Phone:503.520.1220 Fax: 5 0 3.6 4 6.0 2 3 5 service or feeder fee, first branch circuit 46.85 2
Each additional branch circuit 6.65 2
E -mail: Misc.(Service or feeder not included):
CONTRACTOR Each pump or irrigation circle 53.40 2
Each sign or outline lighting 53.40 2
Job No: 12675 Signal circuit(s) or a limited energy panel,
Business Name: CommWorld of Portland alteration, or extension* 1 75.00 75.00 2
*Description:
Address: 5711 S.W. Arctic Drive Data Cabling
City /State /Zip: Beaverton, OR . 97005 Each additional inspection over the allowable in any of the above:
Per inspection (per hour - min. 1 hour) 62.50
Phone:503.520.1220 Fax: 503.646.0235 Investigation fee: .
CCB Lic. #: 103916 Lic. #: 2 6 - 8 9 0 CLE Other:
Electrical Permit•Fees* ., - .
Supervising electrician Metro #5276
Subtotal $ 75_00
signature required: � --- . 4 Plan Review (25% of Per mit F ee) $
Print NameB e r t Alvaro ILie. #: 3541 LE P State Surcharge (8% of Permit Fee) $ 6.00
Authorized TOTAL PERMIT FEE $ 81.00
Notice: This permit application expires if a permit is not obtained within
Signature: Date: 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
(Please print name)
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received40 MMO Date Requested 3 - 29 - 0 1 7 1 AM PM BUP
Location q( 5 3 GU,/ 56 -/( Suite 4f "2- MEC
Contact Person Ph ( ) PLM
Contractor -11( 5 3 5Z0 ZZO SWR
BUILDING Tenant/Owner J '.b. - ELC
Footing -
Foundation ELC Access:
p�
Ftg Drain LR — DAD ��
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
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
G/Slab Q
ow Voltage ��-4 e.
irk /
` ± PART FAIL 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
• SITE ❑ Please call for reinspection RE: • Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date ( : ) X Inspector , — ■ _0! `
Other:
Final
•
DO NOT REMOVE this inspection record fro the job e.
PASS PART FAIL