Permit -_-‘,CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00050
'/A DEVELOPMENT I r d 97223 DATE ISSUED: 2/3/04 Hall 13125 (503) 639 -4171
PARCEL: 1S126C0-01107
SITE ADDRESS: 09693 SW WASHINGTON SQUARE RD
SUBDIVISION: �13� INGTON SQUARE ZONING: C -G
Gy
BLOCK: LOT : JURISDICTION: TIG
Project Description: Job #10303 (1) 200 amp service and 15 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: 1 W /SERVICE OR FEEDER: 15 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 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:
PPR WASHINGTON SQUARE LLC COHO ELECTRIC INC
BY THE MACERICH COMPANY PO BOX 40
9585 SW WASHINGTON SQ. RD. WILSONVILLE, OR 97070
PORTLAND, OR 97223
Phone: Phone: 503 - 582 -9774
Reg #: L1C 157169
ELE 3 -575C
FEES SUP 3483S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 2/3/04 $180.05
[TAX] 8% State Surcharge 2/3/04 $14.40 Elect'I Service
Rough -in
Total $194.45 Elect'I Final
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Spedalty 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 rf 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- 2 -23
Issued By: OP (,gjL4_, Permit Signature: /
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: C3'7
Call 639 -4175 by 7:00pm for an inspection the next business day
Jan 30 04 02:46p p,2
FOR OFFICE USE ONLY
t hi tr y. Ma Received r J Electrical ,
Date/By:.4 ---7 -o ? Permit No.: 0 r a7052)
Planning Approval Sign
ir- 3 u 2004 Plan Review Permit No.:
City
131 SW of T i ga Ha l l Bl4�d`� Plan evtcw Other
Date/By: Permit No..
Tigard, Orego j F IGARD Post - Review Land Use
Phone: 503- ! I�8 1960 4„,,,,,.. • (<� Date/By: Case No..
Internet: w us • y c I Contact J n .: 1:81 See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 `"- Name/Method 176 I Supplemental Information.
TYPE OF WORK PLAN REVIEW (Please check all that apply)
n ❑Demolition
El over 225 amps- _ El
facility COIIStrUCtlOri commercial ❑Hazardous location
Addition /alteration/replacement ❑Other: ❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet,
CATEGORY OF CONSTRUCTION 1 & 2 family dwellings four or more residential units in
❑ 1 & 2- Family dwelling
❑ System over 600 volts nominal one structure
Commercial/Industrial ❑ Building over three stories ❑ Feeders, 400 amps or more
n Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder _ ❑Other:
E] Egress/lighting plan ❑ Other:
Submit sets of plans with any of the above.
JOB SITE IIVFORMATION and LOCATION The above are not applicable to temporary construction service.
Job site address: "\i- ? 3 `J\n. \tom `- v i\5A 'N Sq FEE* SCHEDULE '
Suite #: CC '
c� "► I Bldg. /Ae t. #: - Number of inspections per permit allowed
Qty Fee (ca.) Total I
+ Description 1
Project Name: �1�� + l New residential - single or multi- family per
Cross street/Directions to job site: dwelling unit. Includes attached garage.
Service included:
1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft or ponron thereof 33.40 1 I
Limited energy, residential 75.00 - 2
Subdivision: L Lot #• Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling 90 9D 2
service and/or feeder
t DESCRIPTION OF WORK Services or feeders - installation,
��C'4A—r , , C_.RCG(k_e.1 alteration or relocation: ` 80.30 Z�- Q •3L 2
200 amps or less
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
N. 601 amps to 1000 amps 240.60 _
Over 2
PROPERTY OWNER ❑ TENANT s 454.65 2
amps
amps or volts 2
� „ t ,. 41 Reconnect only 66.85
Name: ^;�,�4�,-v `=7r L A
1 Temporary services or feeders - installation,
Address: �->„� � � ✓ � ( alteration, or relocation:
��
City /State /Zip: — sc,: — ; C:-- � —I 200 amps or less 66.85 1
201 amps to 400 amps 100.30 2
Phone: Fax: 401to600amps 133.75 2
[1] APPLICANT " El CONTACT PERSON Branch circuits - new, altcration,or
extension per panel:
Name: extension
Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit \.-7 6.65 �� %' 2
B. Fee for branch circuits without purchase of 46.85 2
City /State /Zip: service or feeder fee, first branch circuit 2
Phone:
I Fax: Each additional branch circuit 6.65
Misc.(Service or feeder not included): 53.40 2
E-mail: Each pump or irrigation circle
CONTRACTOR Each sign or outline lighting 53.40 2
Job No: \( ` :) Signal circuit(s) or a limited energy panel, Page 2 2
1 , g ` `.' , alteration, or extension
Business Name: CoA ` � -mi l ' - Description:
�i,
Address: \ 7C�, , -1Q, Each additional inspection over the allowable in any of the above:
City /State /Zip: \\ `S Y1 l ,. ' t ' \ - o R c' L1L Per inspection per hour (min. 1 hour) I I 62.50 I
via Investigation fee: I If I Phone: 1 - 1�k Fax: • �i�r.t• Other.
CCB Lic. #: \:=,"11 ■n , Lip. #: O' Electrical Permit ,Fees*
Supervising electrici Subtotal $ % V c
s ignature required:
v . - / � Plan Review (25% of Permit Fee) $
l y`� c # 3`� State Surcharge (8% of Permit Fee) S , ...s--k 0
Print Name: ■—�.1�_ �v� rt TOTAL PERMIT FEE $ \` . 4` 5
Authorized � r Notice: This permit application expires if a permit is not obtained within
Signature: • � ,c) CV.' Date: \— 3Ll - C-1 180 days after it has been accepted as complete.
` l *Fee methodology set by Tri -County Building Industry Service Board.
P`M 0 IK t 4
(Please print name)
i s \Dsts\Permit Forms\ElcPermitApp.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
22,. ,, // BUP
Received 3.3 7 D ate Requested 3 -- /q <AM PM BUP
Location _�. __.�. Gf_ �-tr — etse. . Suite C 9 MEC
Contact Perscl+b,( Ph ( --4 7 7 PLM
Contractor X-0 Ph ( SWR
BUILDING Tenant/Owner .5S tJ / �' ELC (� i2
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
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
P _ PART FAIL
L
Service
Rough -In
UG /Slab
Low Voltage
.i;,� rm
��� PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SIT ❑ Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line /�
ADA
Approach/Sidewalk Date /7 ° CT Inspector 03 �
Other:
Final DO NOT REMOVE this Inspection record fro the Job =1te.
PASS PART FAIL