Permit CITY OF TIGARb RE TRIC EDPERMIT
ENERGY
r DEVELOPMENT SERVICES PERMIT #: ELR2002 -00023
t -� 13125 SW Hall Blvd., Tiqard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/27/02
SITE ADDRESS: 10145 SW WASHINGTON SQUARE RD TGI PARCEL: 1S135BA-00100
SUBDIVISION: OAKBURG ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
Project Description: Low voltage to HVAC.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: • HVAC: X PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
PPR SQUARE TOO LLC AMERICAN HEATING
BY MACERICH COMPANY 1339 SW GIDEON ST
ATTN: JANET FISHER, ASSET MGMT PORTLAND, OR 97202
SANTA MONICA, CA 90407
Phone: Phone: 239 -4600
Reg #: LIC 33135
ELE 26- 683CLE
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT CTR 2/27/02 $75.00 2720020000 Elect'I Final
5PCT CTR 2/27/02 $6.00 2720020000
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 follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 -0010 through OAR 952 - 001 -0080. You may obtain copies of these rules or dir t questions • ! - NC at (503)
246 -1987. // K�
Issued by �G/ti�2.(�t t,GL & A) Permittee Signature) �j/
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: p DATE:
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Electrical Permit Application
Date received: a.-I 0 Permit no.: GL; , op, — Apo G 3
,�.K .
j :. i , City of Tigard Project/appl. no.: Expire date: Il
City ofTigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Dateissued: �� Receiptno.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
TY OF PERMIT
0 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family 0 Tenant improvement
0 New construction GI4 ►ddition/alteration/replacement O Other: ❑ Partial
JOB SITE INFORMATION
Job address: /0/ NS $ k1e3t+iNq..al -"
tbl Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: I Block: I S ubdivision: S\JJ
Project name: Fria ; Al s er tanlagr I Description and location of work on premises: iv C/R PC104,3 r &PMi/er
Estimated date of comtion/inspection: 3 20 0 2
CONTRACTOR APPLICATION FEE SCHEDULE
Job no: Fee Max
Description Qty. (ea.) Total no. insp
Business name: A
me jraP Fea tiivj , Ire_ New residential - single or multi -family per
Address: 1'1"19 Sr. Gi rlarn Girl Si- dwelling unit. Includes attached garage.
City: Port 1and I State: nR I ZIP:g77n7 -741 R Service included:
Phone: 239 -4600 I Fax: 239 -7038 I E-mail: 1000 sq. ft. or less 4
3 3135 I Each additional 500 sq. ft. or portion thereof
Elec. bus. lic. no: 2 6- 683CLE
CCB no.: Limited energy, residential 2
City/metw lic. no.: 60114 Limited energy, non- residential 2
�"�,,,` Each manufactured home or modular dwelling
Signature of supervising el%trici(required) Date Service and/or feeder 2 .
am3 `
Services n r feeders — installation,
Sup. elect. name (print): Th S S. Yours• License no:
2640_' � alterationorreocation:
PROPERTY OWNER 200 amps or less 2
Name (print): 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address: 601 amps to 1000 amps 2
City: I State: I ZIP: Over 1000 amps or volts 2
Phone: I Fax: I E -mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services or feeders -
which is not intended for sale, lease, rent, or exchange according to hnstallation ,alteration,orrelocation:
200 amps or less 2
20
ORS 447, 455, 479, 670, 701. 201 1 amps to 400 amps 2
Owner's signature: Date: 401 to 600 am s 2
Branch circuits - new, alteration,
or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: I State: • I ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: 2
Phone: Fax: E-mail: Each additional branch circuit:
PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included):
O Service over 225 amps - commercial 0 Health -care facility Each pump or irrigation circle 2
O Service over 320 amps- rating of 1&2 O Hazardous location Each sign or outline lighting 2
family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
O System over 600 volts nominal more residential units in one structure alteration, or extensions 1 2
O Building over three stories ❑ Feeders, 400 amps or more *Description:
O Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable In any of the above:
O Egress/lighting plan ❑ Other: Per inspection I I I
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Not all jurisdictions accept information. ept credit cards, please call jurisdiction for more infoation. Notice: This permit application
Permit fee $ 75 -0
❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ (.' •C 6
Name of cardholder as shown on credit card Expires accepted as complete. TOTAL $ I. OG
$
Cardholder signature Amount 440.4615 (6100ICOM)
■
•
Electrical Permit Fees: ' Limited Energy Fees: -
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total y Check Type of Work Involved:
Residential - per unit
1000 sq. ft. or less $145 15 4 ❑ Audio and Stereo Systems
Each additional 500 sq. ft. or
portion thereof $33 40 1 ❑ Burglar Alarm
Limited Energy $75.00
Each Manufd Home or Modular Garage Door Opener
Dwelling Service or Feeder $90.90 2 El
Services or Feeders 0 Heating, Ventilation and Air Conditioning System`
Installation, alteration, or relocation
200 amps or less $80.30 2 i Vacuum Systems 201 amps to 400 amps $106.85 2 .
401 amps to 600 amps $160.60 2 Other
. 601 amps to 1000 amps . $240.60 2
Over 1000 amps or volts $454.65 2 , . . .
•
Reconnect only $66.85 2
Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY
Installation, alteration, or relocation Fee for each system $75.00
200 amps or less $66.85 2 (SEE OAR 918-260 -260)
201 amps to 400 amps $100.30 2
401 amps to 600 amps $133.75 2 Check Type of Work Involved:
Over 600 amps to 1000 volts, ❑
see "b" above. Audio and Stereo Systems
Branch Circuits , Boiler Controls
New, alteration or extension per' panel
'a) The fee for branch circuits ❑
with purchase of service or Clock Systems
feeder fee.
Each branch circuit $6.65 2 n Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service ❑ Fire Alarm Installation
or feeder fee. 0 First branch circuit $46.85 HVAC
Each additional branch circuit $6.65
Miscellaneous ❑ Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40 and Paging Systems
Each sign or outline lighting $53.40
Signal circuit(s) or a limited energy
panel, alteration or extension $75.00 ❑ Landscape Irrigation Control
Minor Labels (10) $125.00 ❑
Medical
Each additional inspection over
the allowable in any of the above Calls
Per inspection $62.50
Per hour $62.50 El Plant $73.75 Outdoor Landscape Lighting
Fees: ❑ Protective Signaling
Enter total of above fees $ n Other
8% State Surcharge $ Number of Systems
25% Plan Review Fee
See "Plan Review" section on $ * No licenses are required. Licenses are required for all other installations
front of application.
Fees:
Total Balance Due $
Enter total of above fees $
❑ Trust Account # 8% State Surcharge $
Total Balance Due $
•
i:\dsts \fomu\elc- fees.doc 10/09/00
N
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 _
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received - / Date Requested AM PM BUP
<
Location /
- - p_1), Suite _MEC
Contact Person 't / Ph ( ) 5 7 8 7 GAS PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner � P ELC
Footing
Foundation ELC
A te •
Ftg Drain ELR " 2 3
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear ,
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
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 e i t ,,
Rough -In
UG/Slab
Low Voltage
Alarm
*ART FAIL
E Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SI ❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line / /
ADA
Approach/Sidewalk Date ` j 3 — C)) Inspector 44 Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL