Permit CITY OF TIGARD:., ELECTRICAL PERMIT
PERMIT #: ELC2005 -00910
,� DEVELOPMENT SERVICES DATE ISSUED: 11/21/2005
I Iai 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1S12600-00300
SITE ADDRESS: 09785 SW WASHINGTON SQUARE RD D -12 ZONING: C -G
SUBDIVISION: WASHINGTON SQUARE LOT : JURISDICTION: TIG
Project Description: Radio Shack, replace panel. Job #9408.
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: SIGNAUPANEL:
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: 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:
WASHINGTON SQUARE LLC DAN CORRELL ELECTRIC INC
BY THE MACERICH COMPANY PO BOX 16785
9585 SW WASHINGTON SQUARE RD PORTLAND, OR 97292
TIGARD, OR 97223
Phone: Phone: 503 - 761 -7299
FEES Reg #: SUP 4686S
Description Date Amount LIE 67336
ELE 26 -103C
[ELPRMT] ELC Permit 1 1/21/200: $80.30
[TAX] 8% State Surcharge 11/21/200: $6.42 REQUIRED ITEMS AND REPORTS
Total $86.72
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 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: 5.j o_ Permittee Signature: S ?1,1,c
OWNER 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 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
NOV 21 2001 3I y KP LRSERJET 3200 5032016833 p.1
': Electrical Per it it Appljatii}�� 1(112 i)rrl('t: 1 Sl: t)\l.I
I G, I Z y Hall BlvdTi an d OR 972 3 1� O
N ' a I/ - 3 i _ m - 1 PermitNo.:6C,C ��g /
3
5 SW g �+ b 11 _ Plan Renew
Phone: 503.639.4171 Fax: 503.59p8i� A \ . * •""iii ? 1 ' • Date/By. • - other Permit' Inspection Line: 503.639.4175 0 �� I" - ' - � - Date ReadyReady/By tuns RI See Page 2 far
Internet: www.ci.tigard.orus Q V ' �)1 Noti edtMethod• I Supplemeotallnforrnatioa
y TYPE OF WORK PLAN REVIEW
❑ New construction Addition/alteration/replacement Please check all that apply.
❑ Demolition ❑Other: ❑Vice over 225 amps, comm ❑Hazardous location
❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft ,
CATEGORY OF CONSTRUCTION of I- and 2- family dwellings 4 or more new residential
❑ I - and 2- family dwelling 'Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
El Multi- family ❑Master builder ❑Other: ❑Building over three stories :Weeders, 400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION
'�� ��"" l ❑Egress/ltghtingpian park
Job no.:�9 (:)1 Job site address: S ski /dasrjrjiy ❑Health -care facility ❑
`` Submit / sets of plans with any of the above.
City / State/ZIP: t b Jerre ,: el j g y c e p)'r The above are not applicable to temporary construction service.
FEE* SCHEDULE
Suite/bldg./apt. no.: ai'roject name: ' `�"
m
Description I Qty. I Fee. I Total I
Cross street/directions to job site: New residential single- or multi- family dwelling unit.
Includes attached garage.
1,000 sq. R. or less 145.15 4
Subdivision: I 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
de/Aif t- Services or feeders installation, alteration, and/or relocation
200 amps or less I/ I 80.30 26,3,6 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
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: ( ) I Fax: ( ) 200 amps or less 66.85 1 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 1 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 I ❑ 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 tee,
• each branch circuit 46.85 2
Address: Each add'l branch circuit 6 65 _ 2
City/ State/ZIP: Miscellaneous (service or feeder not Included)
Phone: ( ) ! Fax: : ( ) Pump or irrigation circle 53 40 . 2.
1 Sign or outline lighting 53 40 2
E -mail: Signal circuit(s) or limited-
• CONTRACTOR energy panel, alteration, or
Address: / p
Business name: , 4',- re dysi�O .��' , JG + ,
extension. Descnbe: Page 2 2
R e . � 1 ® J y t Each additional inspection over allowable In any of the above
Per inspection 62 50
City/State./ZIP: / 4 0 4 0/ - /law' C/` l'7 g2.1 P... Investigation per hour(1 hr min) 62 50
I Phone: �s3 76/- ?294 l l Fax: 5 3 74, 4 2' 7 industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*'
C'‘ CCB Lic.:4 7jAg, Electrical '• , 0034, Suprv. U ' $� Subtotal I 30 , ,$upry Electrician signature, requir =+
V4 J Plan review (25% of permit fee) 1
el; Print name: l .h _`r Date: / !/z/�5�� State surcharge (8% of permit fee)
TOTAL PERMIT FEE 5 0""
Authorized signature:
This permit application expires If a permit is not obtained within ISO
days after it has been accepted as complete
Print name: Date: a Fee methodology sd by TriCotmty Building Industry Service Board
r• Number of i nsoections per permit allowed.
- i
CITY OF TIGARD _ .
• BUILDING DIVISION � r PERMIT #:
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 d I
Inspection Requests (24 Hrs.): (503) 639 -4175 _..
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: 6 7 7.4pS q=ty' Gyiebidt SC f j CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: Rciclik0 ..Citot 4tr
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: ,.. e 9-Y 4/ PHONE #: SO3 - -7295
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
/99 E[, N Ora 8 ( f/ - 5 z.0/ - Ccf:' 33
Corrections /Comments / Instructions:
ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
LI FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: ` L 2 'S Phone #: (503) 718 -
r.
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2005 -00910
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/21/2005
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 �-
INSPECTION WORKSHEET FOR DATE: 12/21/2005 TIME: 7:01AM PAGE: 56
SITE ADDRESS: 09785 SW WASHINGTON SQUARE RD D-12 CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE:
PROJECT NAME: RADIO SHACK
DESCRIPTION: Radio Shack, replace panel. Job #9408.
OWNER: WASHINGTON SQUARE LLC, PHONE #:
CONTRACTOR: DAN CORRELL ELECTRIC INC PHONE #: 503-761-7299
Inspection Request Scheduled For: Date: 12/21/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 023841 -01 503.201 -6833 N
Corrections /Comments /Instructions:
(tzT4 px vs k i A`]' sa-axi . t
cztAt
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
1K FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: T O v Date: _` Phone #: (503) 718- Al,
f
`'' CiTY OF TIGARD r
I ;''.' G DIVISION - PERMIT #: ELC2005 -00910
13125 SW .Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/21/2005
..Phone: (503) 639- 4171�jj't
Inspection Requests (24 Hrs.): (503) 639 -4175 -�
INSPECTION WORKSHEET FOR DATE: 11/28/2005 TIME: 7:05AM PAGE: 40
SITE ADDRESS: 09785 SW WASHINGTON SQUARE RD D-12 CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE:
PROJECT NAME: RADIO SHACK
DESCRIPTION: Radio Shack, replace panel. Job #9408.
OWNER: WASHINGTON SQUARE LLC, PHONE #:
CONTRACTOR: DAN CORRELL ELECTRIC INC PHONE #: 503. 761 -7299
Inspection Request Scheduled For: Date: 11/28/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 022388 -01 503-201-7138 Y
Corrections /Comments /Instructions:
- P tkovl et Rset, vit1S•fl w aa.V. it3 s p.m
be- 11 kta. OLA kao
Oa t10 41/3 WA - c.,-
1•9�o�c = 3 6" stt%C. ; A K
30 wt Q11 1,044ia s(A ^.
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 1 M L Date: 14 I O Phone #: (503) 718- UHL •