Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00367
DEVELOPMENT SERVICES DATE ISSUED: 6/22/2004
111 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S135BA-00102
SITE ADDRESS: 10124 SW WASHINGTON SQUARE RD
SUBDIVISION: bRkfttURG ZONING: C -G
BLOCK: LOT : 001 JURISDICTION: TIG
Project Description: Electrical TI, (36) branch circuits.
Job No. A24115
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: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 35 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 SQUARE TOO LLC CURRENT ELECTRIC
BY MACERICH COMPANY PO BOX 19652
9585 SW WASHINGTON SQUARE RD PORTLAND, OR 97280
TIGARD, OR 97223
Phone: 503 - 639 -8865 Phone: 245 -5997
Reg #: SUP 3689S
LIC 46994
FEES ELE 26 -471C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 6/22/2004 $279.60
[TAX] 8% State Surcharge 6/22/2004 $22.37 Rough -in
Elect'I Final
Total $301.97
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
suspen• :: • • - . -n 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
rulz are set forth in OA 152- 001 -001 S , u• • • • . 952 - 001 -0100. You may obtain copies of these rules or direct questions t O (503)
-6 -6699 or 1 -800- 332 -23 • • /
Issued By: , %/MMA / /� // 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 INST •.LLATION ONLY
SIGNATURE OF SUPR. ELEC'N: allO
Q� � � ! .% DATE:
/
LICENSE NO: (,(��/
Call 639 -4175 by 7:00pm for an inspection the next business day
Electricui Permit Application FOR OFFICE lCF USE ONLY
j .-
City of Tigard L.
Date/By Li - 0 ,J� , Permit No' LFGL �-� '7
13125 SW Hall Blvd., Ti ard, OR 97223 y
g Plan Review Other Permit
Phone: 503.639.4171 Fax 503 598 1960 4111
w �Mlli' Date/By:
Inspection Line: 503 639 4175 _ Dat Ready/By tam El See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method (/P Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ® Addition/alteration/replacement Please check all that apply.
❑ Demolition ❑ Other: ❑Service over 225 amps, comm'l ❑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
❑ 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑Budding over three stories ❑Feeders, 400 amps or more
❑ Multi- family ❑ Master builder 0 Other: ❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park
❑Health -care facility ❑Other:
Job no.: A24115 Job site address: 10124 SW Washington Square Road Submit 2 sets of plans with any of the above.
City/State /ZIP: Tigard, OR 97223 The above are not applicable to temporary construction service
Suite/bldg. /apt. no.: Project name: Kinko's Tigard 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. ft. 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
dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80 30 2
201 amps to 400 amps 106.85 2
P O RTY OWNER ❑ TENANT
� 401 amps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps 240.60 2
t�CO s J ,) / / 1 .4.c, � Over 1,000 amps or volts 454.65 2
Address: V..J D
Reconnect only 66.85 2
City/State /ZIP: �co eV__ services or feeders installation, alteration, and/or
P hone: (1Z L67 _, t Fax: ( ) relocation
` 200 amps or less 66.85 I
caner 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 /
Business name: branch circuit 35 6.65 232.75 2
B. Fee for
Contact name: without service or feeder fee, / Q
2
each branch circuit I 46.85 /� . T/
Address: Each add'I branch circuit 6.65 2
City/State /ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation 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
extension. Describe: Page 2 2
Business name: Current Electrical Construction Company
Address: PO Box 19652 Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State /ZIP: Portland, OR 97280 Investigation per hour (I hr mm) 62.50
Phone: (503) 245 -5997 Fax: (503) 245 -599 Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: 46994 ElectricaL `ic.: 26-471 C Suprv. Lic.: 3689S Subtotal gyl bb
Suprv. Electrician signature, requi r \ — .14=i,, ,_ Plan review (25% of permit fee)
Print name: W � ' � ' � ' ��� T Date: 6/21/04
I State surcharge (8% of permit fee) /� 3 7
oenPAS AJDF...4c,� TOTAL PERMIT FEE 301 r2
Authorized signature: / ��_� This permit application expires if a permit is not obtained within 180
6 days after it has been accepted as complete
Print name: il 1 A j i..k M ps 0 J Date: 6/21/04 • � Fee methodology set by Tn -County Building Industry Service Board
Number of Inspections per permit allowed.
i\Building\Permas\ELC- PemiitApp doe 12/03 440 -461 ST(I0 /07/COM/WEB
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received � / G . Date Requeste ' / t AM PM BUP
Location /0 / OZ So) MEC
Contact Person �i1,A / Ph ( ) `ri 0 9'cz,/ PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner I -i N ELC 4- 6'036 7
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 p RIP ' V 9 PDX--
Drywall Nailing (/ 1TT I r'fv
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
�ECTRIC.
Service
Rough -In
UG/Slab
Low Voltage
• larm
El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
S El Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date 1 1 1 0 If Inspector ( ' 1 , E Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL