Permit i.
,CITY OF TIGARD
4 it ELECTRICAL PERMIT
PERMIT #: ELC2004 - 00191
'� DEVELOPMENT SERVICES DATE ISSUED: 4/15/04 „' 13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171
PARCEL: 1S12600-00300
SITE ADDRESS: 09718 SW WASHINGTON SQUARE RD F -5
SUBDIVISION: WASHINGTON SQUARE ZONING. C -G
BLOCK: LOT : JURISDICTION: TIG
Project Description: 1 amp, (31) 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: 31 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 RIVER CITY ELEC LLC
BY THE MACE RICH COMPANY 535 NW BROOKWOOD AVE.
9585 SW WASHINGTON SQ. RD. HILLSBOR, OR 97124
PORTLAND, OR 97223
Phone: Phone: 503 - 201 - 9687
Reg #: ELE 34 -656C
LIC 156612
FEES SUP 4943S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 4/15/04 $286.45 •
[TAX] 8% State Surcharge 4/15/04 $22.92 Elect'I Service
Rough -in
Total $309.37 Elect'l Final
This Permit is issued subject to the regulations contained in the Tigard Muniapal 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 or
1- 800 - 332 -2344.
Issued By: Permit Signature: t VO Z /A
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 Permit Application FOR OFFICE USE ONLY
City T`i g and Received / / n,� I /
131 of SW Hall Blvd., Tigard, OR 97223 DateB . -1 ®� Permit No. =j C./�7 �U`gl
Plan Review
Phone 503.639.4171 Fax 503 598.1960 A � `� Date/B Other Permit.
Inspection Line 503 639.4175 .1 n I! Date ReadyBy. . L
] ® See Page 2 for
Internet www.ci.tigard.or.us Nohfied/Method I (\ Supplemental Information
ui° . ;..1' ^ r ': „ h- ° ;TY'PEOF.WORK... ' r i'l " ".:;': �' _.'.' _ ` :PliAN,REVIEW;
❑ New construction ❑ Addition�eratior replacement Please check all that apply.
❑ Demolition ❑Other: ❑Service over 225 amps, comm'l ❑Hazardous location
::,A C ❑Service over 320 amps — rating ❑ Buildng over 10,000 sq ft ,
ATEGORY, "OF CONSTRUCTION 1` ` ':, of 1- and 2- family dwellings 4 or more new residential
❑ 1 and 2 family dwelling Tgl Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑Building over three stones ❑Feeders, 400 amps or more
❑ Multi family 0 Master builder 0 Other:
❑Occupant load over 99 persons ❑Manufactured structures or
, ,_g '.; - _ AND LOCATION - .- _ El Egress/lighting plan RV park
Job no.: Job site address: 97/8 SW W4 s'l - Il /Jb►a,v p„ ❑Health -care facility ❑Other
U� Subrrut 2 sets of plans with any of the above
City /State /ZIP: T GArw 023cn/ The above are not applicable to temporary construction service.
' . : _ _ *:.LE:,.
Suite/bldg. /apt. no.: F u Project name: � va F EE SCHEDU
D esc ri p ti on 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'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
_ , ; DESCRIPTION OF WORK ` ;- Each manufactured or modular
/ dwelling, service and /or feeder 90 90 2
/ ex'� 4""_'. . Services or feeders installation, alteration, and/or relocation
200 amps or less / 80 30 g 3 .:1 2
;Nf',. 201 amps to 400 amps 106 85 2
PROPERTY OWNER � ; :• ° � ,, �� - °iC■ TENANT .' ' ' - - � �
401 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: ( ) 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
v C r. - ',..',r.; ' ..i, .
- '-; -�; r ❑ °-APPLICANT'.;��' -:_ " : _ ' '. ❑• CONTACT PERSON - " -''.', A. Fee for branch circuits with
service or feeder fee, each is" Business name:
branch circuit 3 6.65
! ,e,` 2
Contact name: B. Fee for branch circuits
without service or feeder fee, 46 85 2
Address: each branch circuit
Each add'I branch circuit 6 65 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-
f" , -: -- -- ' -.', z , J' "e ' CONTRACTOR = ' :.4 ..- : energy panel, alteration, or
1 4) Business name:
µ extension Descnbe Page 2 2
n ^ _ , Each additional inspection over allowable in any of the above
Address: S .7 11.0E 4/000 4 . L , Per inspection 62 50
1 City/State /ZIP: j...\ 41 - ruo
0&720 4-2 1.76W Investigation per hour (1 hr tin) 62 50
Phone: 1 b` ax; Industrial plant per hour 73 75
l
(sD. > 742 l �6 B"] O /\ (�3 6 yo j'. SO ' .ELECTRICAL PERMIT FEES * -', ,'..'' '
CCB Lic.: / Z Electrical t,ic.:5y_s-66 Supry
Lic../!/y'[J/ Subtotal g( LtS
Suprv. Electrician signature, required: /7 �G [ 'O Plan review (25% of permit fee) t
l � ` State surcharge (8% of permit fee)
Print name: i G 7 Date: 1,�� �1�
TOTAL PERMIT FEE G Oil
Authorized signature: c
This permit application expires if a permit is not obtained within ISO
i days after it has been accepted as complete
Print name OA b 1 2 c.5'41 e — e Date: / * Fee methodology set by Tn- County Building Industry Service Board
** Number of inspections per permit allowed
I \Bwlding\Pernuts\ELC- PermnApp doc 12/03 440- 4615T(10 /O2JCOM/WEB
Electrical Permit Application - City of Tigard 4.
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
,IW§ffirkRtiatiT*45140WiTO5MMigiSit,
Fee for all residential systems combined... $75.00
Check Type of Work Involved:
0 Audio and Stereo Systems* •
O Burglar Alarm
E Garage Door Opener*
• Heating, Ventilation and Air Conditioning
System*
Vacuum Systems*
E Other:
reittit:W7.0,
Fee for each commercial system $75.00
(SEE OAR 918-260-260)
Check Type of Work Involved:
E Audio and Stereo Systems
O Boiler Controls
• Clock Systems
• Data Telecommunication Installation
fl Fire Alarm Installation
HVAC
O Instrumentation
• Intercom and Paging Systems
▪ Landscape Irrigation Control*
LI Medical
El Nurse Calls , .
0 Outdoor Landscape Lighting* • ,
•
El Protective Signaling •
O Other
Total number of commercial systems:
*No licenses are required. Licenses are required ;. •
for all other installations • -
,
V3uildingTerrrutAELC-PermitApp doc 04/03
CITY OF TIGARD 24 -Hour
BUILDING Inspectio ) e: (503) 639 -4175 MST
INSPECTION DIVISION Busine Line: (503) 639 -4171
BUP
Received Date Requested /v AM �PM BUP
Location 7 • ,, - ,W Suite S MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) C / — q4' 8 7 SWR 1 c�
BUILDING Tenant/Owner ELC od `
d 7 e /
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
Fire wall
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
UG /Slab
Low Voltage
Fire Alarm
PART FAIL ❑ 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 N I �c f
Approach/Sidewalk Date � vJ o q Inspector N ( L-G Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site. .
PASS PART FAIL