Permit ' w ELECTRICAL PERMIT -
c ITY OF TIGARD RESTRICTED ENERGY
� k DEVELOPMENT SERVICES PERMIT #: ELR2004 -00030
,,�° 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/11/04
SITE ADDRESS: 09800 SW WASHINGTON SQUARE RD SEARS • PARCEL: 1S126C0 -01107
SUBDIVISION: WASHINGTON SQUARE ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
Project Description: Installation of voice & data. •
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 TELDATA SYSTEMS
BY THE MACERICH COMPANY PO BOX 88983
9585 SW WASHINGTON SQ. RD. SEATTLE, WA 98188
PORTLAND, OR 97223
Phone: Phone: 206 - 682 - 8721
Reg #: ELE 37- 706CLE
LIC 114991
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 2/11/04 $75.00 Elect'I Final
[TAX] 8% State Surchart 2/11/04 $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 foil • • -s adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -001 -0010 throuc . i# 0
Iss ed by _ ' � 1 t o! 4 l' • Permittee Signature AD , A. 409, 4 , _
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
Electrical Perm Application FOR OFFICE USE ONLY
City of Tigard Received : A r Nd Permit No.: l / `l/ --a19
13125 SW Hall Blvd., Tigard, OR 97223 Plan Revie
Phone 503 639.4171 Fax: 503.598.1960 � � 1A Other Permit. � -I' I Date/B : il
.
Inspection Line. 503.639.4175 e., Date Ready/By l;:1 See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method• EMI Supplemental Information
TYPE OF WORK PLAN REVIEW
El New construction ❑ Addition/alteration/replacement Please check all that apply
❑ Demolition ❑Other: ❑Service over 225 amps, comm'I ['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
❑ l- 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 ['Feeders, 400 amps or more
['Occupant load over 99 persons ['Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park
Job no.: Job site address: Ci G0 U)S , ❑Health care facility ❑Other
�� "�' Submit 2 sets of plans with any of the above.
City/State/ZIP: `1( 6A-12z ` The above are not applicable to temporary construction service
Suite/bldg. /apt. no.: Project name: S"- f �QS FEE* SCHEDULE
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. ft. or less 145.15 4
Subdivision: Lot no.: Ea add'I 500 sq. fl. or portion 33 40 I
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
Y� 1 c ,, \ , \ CC ` � - ` C br Cal/ dwelling, service and /or feeder 90 90 2
_l \1 v ` ` ` / n` Services or feeders installation, alteration, and/or relocation
R -.4 1 01/4) 014 'L ( D V 0 `C-E /LA ( 11�-/ 200 amps or less 80.30 2
❑ PROPERTY OWNER - " _ ❑ TENANT 201 amps to 400 amps 106.85 2
(� /� 401 amps to 600 amps 160.60 2
Name: , a . 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 I
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 . 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 fee,
each branch circuit 46 85 2
Address: Each add'I branch circuit 6.65 2
City/ State/Z1P: Miscellaneous (service or feeder not included)
Pump or imgation circle 53.40 2
Phone: ( ) Fax:: ( )
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
Business name: `1 A_ti-ji c,,` S�>v40`S extension. Describe:.,. „ / Page 2 /O � 2
Address: C i 9)9 3 Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State/ZIP: 50\. g , q g 1 1 q e Investigation per hour (I hr nun) 62.50
Phone: (20(0 )0 .,g 7 a ( Fax: (2C6) 6 8.2- 67O2-- Industrial plant per hour 73.75
'/ I ELECTRICAL PERMIT FEES*
CCB Lie.: �� 7 99 / ' � lectrical Lic.;' 7 -7p* at Suprv. Lic.: �56LE P Subtotal 7�- 40
P
Su rv. Electrician si BTt atui3'r fired: la / /"'/ Plan review (25% of permit fee)
Print name: Date: State surcharge (8% of permit fee) 4, • .,d
TOTAL PERMIT FEE t f . v 0
Authorized signature: $n Thi permit application expires if a permit is not obtained within 180
days after It has been accepted as complete
)206'2_,..,)
Print name: a Date: lb-- 1— 0S I • Fee methodology set by Tri- County Building Industry Service Board
•• Number of inspections per permit allowed
i \Buiidmg\Permits\ELC- PermitApp doe 12/03 440-4615T( I 0/02/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
COMMERaAi WORK ONLY: _ — —
Fee for each commercial system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
i \BuddmgWcnnits \ELC -Pete itApp doc 04/03
CITY OF TIGARD - 24 -Hour
BUILDING - Inspection Line. 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
,! / BUP
Received 76 /`t' Date Reque i ` AM PM BUP
•
Location ) Suite MEC
Contact Person �E��'2 ((JJ Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner 1 ELC
Footing
ELC
Foundation
g Access:
Ft ELR � Ow 30
Drain
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors '�
Ext Sheath/Shear
Int Sheath/Shear
%
Framing
Insulation V Drywall Nailing J
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling I
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
E( P SS_ PART FAIL
ECTRIC�FL
Service
Rough -In
UG/Slab
ow Voltage
T(- • . rm
ir Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
❑ Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
47 (4411
ADA
Approach/Sidewalk I nspector
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL