Permit C ITY O F TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00193
dr DEVELOPMENT SERVICES DATE ISSUED: 4/16/04
Al. 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S135BA-00102
SITE ADDRESS: 10246 SW WASHINGTON SQUARE RD C^ I ce ZONING: C G
SUBDIVISION: 0
BLOCK: LOT : 001 JURISDICTION: TIG
Project Description: Installation of (6) branch circuits.
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: 5 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:
BY THE MACERICH COMPANY DICKINSONS ELECTRIC
9585 SW WASHINGTON SQUARE RD 8449 SW BARBUR BLVD
TIGARD, OR 97223 PORTLAND, OR 97217
Phone: Phone: 246 - 3550
Reg #: LIC 65534
SUP 3100S
FEES ELE 26 -140C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 4/16/04 $80.10
[TAX] 8% State Surcharge 4/16/04 $6.41 Rough -in
Elect'I Final
Total $86.51
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 may obtain copies of these rules or direct questions to OU ► • :t (x. . 246 -6699 or
1- 800 - 332 -2344.
t
Issued By: Permit Signature: e
f ,
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:
CO - TO • TALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: /� DATE: y / /
LICENSE NO: 4-3/425
Call 639 -4175 by 7:00pm for an inspection the next business day
Electrical per m '1'`I - 0 FOR OFFICE USE ONLY
I .
City of Tigard Received / Permit No� 4
D '/9_3
13125 SW Hall Blvd., Tigard, OR i ij 3 2UU4
Paine . y a O �%
�C�
�: Plan Review
Phone: 503.639.4171 Fax: 503 �:.' '60� ' / �e t4 ,' Date/B • other Pernu Awa ..O0 /0
■
Inspection Line: 503.639.4175 OF TIGARD I
^ � w
� F _ I Date Ready/By plal H1 See Page 2 for
Internet: www.ci tigard.or.us Nonfied/Method Supplemental Information
t DUILDING DIVISION
TYPE OF WORK . ' , - ' ` ' PLAN REVIEW '
❑ New construction 'ditton/alteration/replacement Please check all that apply
❑ Demolition ❑Other: ['Service ['Hazardous over 225 amps, com'I 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 ,ommercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑Building over three stories ['Feeders, 400 amps or more
❑ Multi - family 0 Master builder 0 Other:
❑Occupant load over 99 persons ['Manufactured structures or
, JOB SITE•'INFORMATION AND LOCATION ❑Egress/lighting plan RV park
•
Job no.: Job site address /b, 7� ❑Health -care facility ['Other: Slt� Submit 2 sets of plans with any of the above
City/ State/ZIP: 7�tiG JO, The above are not applicable to temporary construction service
Suite/bldg. /apt. no I Project name: 46 9l4� 44q-SSLF ,-/2„---6-- Description SCHEDULE -• •
Description I Qry, I Fee. I Total �^
Cross street/directions to job site: /fEges 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'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK - Limited energy, non - residential 75.00 2
Each manufactured or modular
/'�� 7,- dwelling, service and/or feeder 90.90 2
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
401 amps to 600 amps 160.60 2
Name: 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
Phone: ( ) I Fax: ( ) relocation
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 . • _ , ❑ CONTACT PERSON A. Fee for branch circuits with
Business name: service or feeder fee, each 6.65 2
branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee, /�
Address: each branch circuit / 46.85 y�i 2
Each add'l branch circuit _ S 6.65 j 7, ;Z3 2
City /State /ZIP: Miscellaneous (service or feeder not included)
Pump or imgation circle 53 40 2
Phone: ( ) I Fax:: ( )
Sign or outline lighting 53 40 2
E - mail: Signal circuit(s) or limited-
- CONTRACTOR , , energy panel, alteration, or
Business name: Ai `� b n Y � /l �,a �� .. extension Describe Page 2 2
Address: go ry �s,� z _ gz,i Each additional inspection over allowable in any of the above
'�e'K Per inspection 62 50
City/State /ZIP: 499--p��� O#_ 9" 7 l 9 Investigation per hour (1 hr min) 62 50
Phone: (02) 5 5 - 2c 2 Fax: (5 a/ 3 —0 otf 99 Industrial plant per hour 73.75
'ELECTRICAL PERMIT FEES* ' . _
CCB Lic.) Electrical Lic.;,,?644/O , Suprv. Lic.: v j Subtotal Pe , /a
Suprv. Electrician signature, r -•,.-. � Plan review (25% of permit fee)
rf/ i/ A State surcharge (8% of permit fee)
Print name: /ti�y, Date: 406 �• yl
TOTAL PERMIT FEE PC, , 5
Authorized signature_ �� This permit application expires if a permit is not obtained within 180
/ days after it has been accepted as complete
Print name: ate �r Date: ,JO 4 • Fee methodology set by Tn- County Building industry Service Board
' • Number of inspections per permit allowed.
i \Buildmg\Persmts\ELC- PernutApp doc I - 3 440- 4615T(10/02/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
. RESIDENTIAL WORK ONLY: ' t
Fee for all residential systems combined .. $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
El Burglar Alarm
El Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
El Vacuum Systems*
El Other:
COMIVIERCL ii WORK ONLYi
Fee for each commercial system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
El Audio and Stereo Systems
❑ Boiler Controls
•
El Clock Systems
El Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
El Landscape Irrigation Control*
El 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 \Buildmg\Permits\ELC- PemutApp doc 00/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISIQN Business Line: (503) 639 -4171 MST
�a = rZ _ BUP
Received Date Requested 5 - 2 V D SAM PM BUP
Location /D 2 4/00 GL/4 _ Rd' Suite C--Hr MEC
Contact Person Ph ( ) PLM
Contractor Ph ( Cl57 5/ z ^27 a Z SWR
BUILDING Tenant/Owner 64 (ko ELC2 / 93
Footing
Foundation ELC
Access:
Ftg Drain D ^ ELR
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
Rough -In
UG/Slab
Low Voltage
` sarm
�'�� ❑ 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 �`
ADA Approach/Sidewalk Date J� ` Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL