Permit CITY4OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00803
."1 DEVELOPMENT SERVICES DATE ISSUED: 12/15/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 1S12600-00300
SITE ADDRESS: 09681 SW WASHINGTON SQUARE RD C -6 ZONING: C G
SUBDIVISION: WASHINGTON SQUARE
BLOCK: LOT : JURISDICTION: TIG
Project Description: 13 branch circuits.
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: 12 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 ST JOHNS ELECTRIC INC
BY THE MACERICH COMPANY 4415 NE MINNEHAHA
9585 SW WASHINGTON SQUARE RD VANCOUVER, WA 98661
TIGARD, OR 97223
Phone: Phone: 360 - 693 - 5100
Reg #: LIC 43135
SUP 3024S
FEES ELE 37 -350C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 12/15/200' $126.65
[TAX] 8% State Surcharge 12/15/200' $10.13 Elect'l Final
Total $136.78
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 1-800-33- 2344.
/
Issued By: 14, ` � / � / ,AP ! Permit Signature: ,DA / Li<
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 7:00pm for an inspection the next business day
Electrical PeREGEIMEO FOR OFFICE USE ONLY
City' Of Tigard t Received f1 Permit No.: d
`' 2 ) „L/
13125 SW Hall Blvd., Tigard, t (4723 Fi 2004 Aillko k^ � f Date/By: Plan Rev /p
. Phone: 503.639.4171 Fax; s ., 8 �'' Date/By: Other Permit:
Inspection Line: 503.639.4 If Ut I I(AM) _ a 1, ` I Date Ready /By: lan El See Page 2 for
Internet: www.ci.tigard.SVf' ING mom Notified/Method: Supplemental Information
* �+ TYPE , OF WORK - - 'PLAN REVIEW
New construction ❑ Addition/alteration/replacement Please check all that apply:
Demolition [ Other: REMODEL
❑ Service over 225 amps, comm'l ❑Hazardous location
Service over 320 amps — ratio
❑ p rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of I- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling a Commercial/industrial 0 Accessory building System over 600 volts nominal units in one structure
❑ Building over three stories ❑Feeders, 400 amps or more
❑ Multi - family 0 Master builder 0 Other.
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑ Egress/lighting plan RV park
Job no.: S1M2ICER � Job site address: SW WASHINGTON SQ RD ❑Health -care facility ❑Other:
M/10E Submit 2 sets of plans with any of the above
City/State /ZIP: 90g/ TIGARD, OR 97223 The above are not applicable to temporary construction service.
A gg FEE* SCHEDULE
Suite /bldg. /apt. no.: wFA c 6 Project name: SHARPER IMAGE
Docnption 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'I 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
DESCRIPTION OF WORK Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106 85 2
401 amps to 600 amps 160.60 2
Name: THE SHARPER IMAGE 601 amps to 1,000 amps 240.60 2
Address: 650 DAVIS STREET, 2nd FLOOR Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City /State /ZIP: SAN FRANCISCO, CA 94111 Temporary services or feeders installation, alteration, and /or
Phone: ( ) Fax: relocation
415 445 6097 ( 415 44 5 1537 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
❑ APPLICANT ❑ CONTACT PERSON A Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee,
Address: each branch circuit 1 46 85 46 .85 2
Each add'I branch circuit 12 6.65 79 .80 2
City/State /ZIP Miscellaneous (service or feeder not included)
Phone: ( ) Fax:: ( ) Pump or irrigation circle 53.40 2
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: ST. JOHNS ELECTRIC, INC.
Address: 4415 NE MINNEHAHA STREET Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State /ZIP: VANCOUVER, WA 98661 Investigation per hour (I hr mm) 62.50
Phone: ( Fax:( 360 Industrial plant per hour 73.75
36d 693 - 5100 360 699 - 1345 ELECTRICAL PERMIT FEES*
CCB Lie.: 43135 Electrical Lie • 1 .} • S r v. Lic.: I Subtotal 126.65
• Suprv. Electrician signature, required: f Plan review (25% of permit fee)
Print name: DEAN R. BJ Date 12. 14.04 State surcharge (8% of permit fee) 10.13
TOTAL PERMIT FEE 136.78
Authorized signature: ' .i,e This perm application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: DEAN R. BJUR Date: 12.14.04 • Fee methodology set by Tri -County Building Industry Service Board
•• Number of inspections per permit allowed.
I \Building\Permits\ELC- PermiApp doe 12/03 440 -4615T(IO /02/COM/wEB
•
CITY OF TIGARD - 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION - Business Line: (503) 619 -4171 MST
BUP
Received Date Requested / / AM PM BUP
Location q40, I C011-1, Suite G — "(P MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ND ) 6q3- .' /OCR SWR
BUILDING Tenant/Owner i.i i ELC 4266 7 - DO n v 6 3
Footing
Foundation ELC
Access:
Ftg Drain ELR
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 n,
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
UG/Slab
Low Voltage
Fire Alarm
Reinspection fee of $ • required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
SITE 0 Please call for reinspection RE: 0 Unable to inspect - no access
Fire Supply Line \'` ADA Date \ " 0 $ Ins ector Ext
Approach/Sidewalk P
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL