Permit r . , 0 CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00203
e. u�rin DEVELOPMENT SERVICES DATE ISSUED: 4/21/04
13125 SW Hall Blvd.. Tioard. OR 97223 (503) 639 -4171
PARCEL: 1S135BA-00102
SITE ADDRESS: 10124 SW WASHINGTON SQUARE RD
SUBDIVISION: MlitURG ZONING: C -G
BLOCK: LOT : 001 JURISDICTION: TIG
Project Description: (1) ea. sign lighting.
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: 1
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: 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 RAMSAY SIGNS
BY THE MACERICH COMPANY 9160 SE 74TH AVE
9585 SW WASHINGTON SQUARE RD PORTLAND, OR 97206
TIGARD, OR 97223
Phone: Phone: 777 - 4555
Reg #: LIC 63422
ELE 26- 106CLS
FEES SUP 493SIG
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 4/21/04 $53.40
[TAX] 8% State Surcharge 4/21/04 $4 Rough -
Elect'I Final
Total $57.68
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: �C€if7t.. 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: -05 S t 4,
Call 639 -4175 by 7:00pm for an inspection the next business day
/I ( .
Elect ical Permit Application FOR OFFICE USE ONLY
qty of Tigard �p4 Da te/B: c ea 2-( 0 Permit No �oL/ -p d
13125 SW Hall Blvd., Tigard, OR 97223 2 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 I" 4 "Itry I Date/B : Other Permit:
Inspection Line: 503 639.4175 �� - �'� I Date Ready/By. lurss ® See Page 2 for
Internet: www.cl.tigard.or.us Notified/Method Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction J, Addition/alteration/replacement Please check all that apply:
❑ Demolition Other: �j /laNi9C�L� ['Service over 225 amps, comm'l ['Hazardous location
['Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft ,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling ®,Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi family ❑ Master builder Othe . ❑Building over three stones :Weeders, 400 amps or more
® i f C�M�f1E
['Occupant load over 99 persons ['Manufactured structures or
JOB SITE INFORMATION AND LOCATION ['Egress/lighting plan RV park
❑Health -care facility ❑Other:
Job no.: 5, 3o 3 60 Job site address: I U i a 4 SIX' 1 1b'V SC. Submit 2 sets of plans with any of the above.
City /State/ZIP: TI &I A e , D R. The above arc not applicable to tcmporary construction service.
FEE* SCHEDULE
Suite/bldg. /apt. no.: Project name: K 1 },1 K D is 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.
DIA/ VU j4.5f}/ 7Dn( SQ Geile4 - 1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'I 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
%ttOVG R'XIS71N4 Th.u4v b1SPLi4VS R1° I4ctr w,TUNtrL) Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
❑ PROPERTY OWNER EENANT
401 amps to 600 amps 160.60 2
Name: g f N K 0 ' S 601 amps to 1,000 amps 240.60 2
Address: /' Over 1,000 amps or volts 454.65 2
1.d 1a4 1.r/ W riS 14 /NATDN Sly Reconnect only 66.85 2
City /State /ZIP: 1 , C� 2 9 r t� (7 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
f, APPLICANT ® CONTACT PERSON A Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: R A0 , 15 AS ' 5 / 6 N s branch circuit
B. Fee for branch circuits
Contact name: L -14t.A .2 1.4- (-v=1-N to without service or feeder fee,
•
r each branch circuit 46.85 2
Address: q lB 0 SL ? y t= {avr Each add'I branch circuit 6.65 2
City /State /ZIP: ` 7c, (ZT I-l4N I- , v, iZ. C - 2 2 - 0 (o Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: (5 ) 777 -1+5-55 Fax: : ( 533 ) 777 - -02-2- 0 Sign or outline lighting I 53.40 61. y 2
E -mail: I r .� I t/ i vt C v '.t..ky 5-(554 )• co h- Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
extension. Descnbe: Page 2 2
Business name:Z4v,,1 SO 56NS . LIS/ C.
Address: SL 7� d U Each additional inspection over allowable in any of the above
Per inspection 62.50
City / State/ZIP: I_TZ. jo-N 0 (Z 1 4 Investigation per hour (i hr min) 62.50
Industrial plant per hour 73.75
Phone: (5 777- Cf s ( Fax: 5 777- 5/..S3-1- ELECTRICAL PERMIT FEES*
CCB Lic.: . Suprv. Lic.: (.4Q 5 3 if)
(��3 �'� Electrical Lic.: •- 0 , S p C subtotal
Suprv. Electrician signature, required: ITIL . Plan review (25% of permit fee)
State surcharge (8% of permit fee) 17 •d.t
Print name: P I 1 I L S 7-8-16-7=,(2- f Date: 9-- 2Pt
TOTAL PERMIT FEE j 7 (/
Authorized signature: �S f � 7� • I This permit application expires if a permit is not obtained within Igo
) days after it has been accepted as complete
Print name: / a /9 - Z Date: ,L - ' .4/ a . • Fee methodology set by Tri -County Building Industry Service Board
Number of inspections per permit allowed.
i\ Buildmg\Pemuts \ELC- PemiitApp.doc 12/03 440- 461ST(10 /02/COM/WEB
•
CITY OF TIGARD 24 -Hour
BUILDING Inspection (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested AM PM BUP
Location / G l a1 y (AM-- - S 6 ). Suite MEC
Contact Person .dt� Ph ( ) 7 77- Crcr PLM
Ftr - ._D O
Contractor Ph ( SWR
BUILDING Tenant/Owner 16 ELC .76 03
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 -t & Ali) o v ED t" — Fl N
Drywall Nailing /�T�
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
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage Milt)
Fire Alarm �a
PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SI 0 Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA ;,�
Approach/Sidewalk Date v ¢ 0 Inspector � //n ri tdX �( Merti � Ext
Other: tll / `
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL