Permit CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
PERMIT #: ELR2006 -00186
2,V DATE SERVICES DATE ISSUED: 8/4/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 1S135BA-00100
SITE ADDRESS: 10145 SW WASHINGTON SQUARE RD TGI ZONING: C -G
SUBDIVISION: WASHINGTON SQUARE TOO LOT: JURISDICTION: TIG
Project Description: Reconnect 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:
WASHINGTON SQUARE LLC WILLAMETTE HVAC
BY THE MACERICH COMPANY 27655 SW LEPLEY LN
9585 SW WASHINGTON SQUARE RD HILLSBORO, OR 97123
TIGARD, OR 97223
Phone: Contact #: PRI 628 -6841
FEES Reg #: ELE 34- 346CRE
LIC 56951
Description Date Amount
[ELPRMT] ELR Permit 8/4/2006 $75.00
[TAX] 8% State Surcha 8/4/2006 $6.00 REQUIRED ITEMS AND REPORTS
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 -0100. You m/ obtain copies of these
rules or direct questions to OUNC at 503 - 246 -6699.
Issued By: y � (j � � , � � Permittee 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:
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.
EleQtrical Permit Application FoR 01:1 ..icy usl.: ONLY
g R ECC�,HVE® y ►. J — G�l ` d
City of Tigard Received Permi No. •L
u 13125 SW Hall Blvd., Ti �� � � 1
Bard, OR 97223 Plan Re
o Phone: 503.639.4171 Fax: 503.598.1A60 G 4 2006 Date/B , Other Permit
• TIGARD Inspection Line: 503.639.4175 H 11 Date Ready/By. liMil B1 See Page 2 for
Internet: www.tigard - or.gov CITY OF TIGARD Non fied/Mtethod Supplemental Information
TYPE OF RING DIVISION PLAN REVIEW
❑ New construction XAddit ion /alteration/replacement Please check all that apply (submit 2 sets of plans wfitems checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stones
❑ Demolition ❑ Other: where the available fault current ❑ Mannas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agncultural
El 1 -and 2- family dwelling CommerciaUindustrial 0 Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fur pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system
❑ Addition of new motor load of ❑ "A ", "E ". "1 -2 ". "1 -3
Job no.: 1 Job site address:
/0/ S 5.6.) G� C 100HP or more upo
�S1A� btu Six or more residential amts. ❑ Recreational vehicle parks.
City/State/ZIP: D LC Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal:
Suite/bldg. /apt. no.: I Project name: 7 z r l Service � ❑ Service or feeder 600 amps or more
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. ft or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
1, / Limited energy, multi - family 75.00 2
J 1 r C 01" L ,c e (t4 C 4 G c Ck residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I 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 599 amps 133.75 2
Owner signature: Branch circuits - new, alteration, or extension, r panel
A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
without service or feeder fee, 46.85 2
Contact name: first branch circuit
Address: Each add'l branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/ State/ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) V Fax::( ) Reconnect only 66.85 2
E - mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: ‘,.t.1 M.../AC Signal circuit(s) or limited
A,t.✓► c e . energy panel, alteration, or
Address: f )y )^3 O x - 3 3 r/ extension. Describe: Page 2 2
City/State/ZIP: - L 4>~,c / q /, Q V Each additional inspection over allowable in any of the above
/ Per inspection 62.50
Phone: ( ) 4r - C8 c ( t I Fax: ( ) Investigation per hour (I hr min) 62.50
CCB Lic.: $'"G'q,S' — 1 Electrical Lic.: ' Suprvv. Lic.: xE /3 ro25 Industrial plant per hour 73.75
�� � Subtotal:
ELECTRICAL PERMIT FEES
i; '
Suprv. Electrician signature, required: im
Print name: ,fl'(t / i SI tC v - rDate: a _ (1... O 6 Plan review (25%ofpermit fee):
1 State surcharge (8% of permit fee):
Authorized signature: ;%5 .„,e4a TOTAL PERMIT FEE: ) - w
Print name: Date • This permit application expires if a permit is not obtained within 180
days after It has been accepted as complete.
• Number of Inspections allowed per permit.
1 :\Bwlding\Pennits\ELC- PatnitApp dos 05/23/06 440- 4615T(1I /05 /COM/WEB
Electrical Permit Application - City of Tigard
yr
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.
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(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
Iaaulding ermits \ELC- PemitApp.d« 03/23/06
CITY OF TIGARD
BUILDING DIVISION - PERMIT #: ELR200G -0018G
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/4/2006
Phone: (503) 639 -4171 1 � rl
Inspection Requests (24 Hrs.): (503) 639 -4175 'I I ..
INSPECTION WORKSHEET FOR DATE: 8/16/2006 TIME: 7:05AM PAGE:
SITE ADDRESS: 10145 SW WASHINGTON SQUARE RD TGI CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE TOO LOT #: TYPE OF USE:
PROJECT NAME: TGI FRIDAYS
DESCRIPTION: Reconnect HVAC.
OWNER: WASHINGTON SQUARE LLC, PHONE #:
CONTRACTOR: WILLAMETTE HVAC PHONE #: 628-6841
Inspection Request Scheduled For: Date: 8/16/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 035092 -02 503-752 -4985 N
Corrections /Comments /Instructions:
N Z %
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Ins Inspector: 6@�
p 1" � Date: % ' Phone #: (503) 718- 24