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Permit CITY OF TIGARD ELECTRICAL PERMIT - RESTRICTED ENERGY ‘ Aiir DEVELOPMENT SERVICES PERMIT #: ELR2004 -00289 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/10/2004 SITE ADDRESS: 09585 SW WASHINGTON SQUARE RD MGMT PARCEL: 1S12600 -00300 SUBDIVISION: OMSBENGTON SQUARE ZONING: C -G BLOCK: LOT: JURISDICTION: TIG Project Description: CO2 sensor. 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: PROTECTIVE SIGNAL: INSTRUMENTATION: OTHER: CO2 SENSOR X TOTAL # OF SYSTEMS: 1 Owner: Contractor: PPR WASHINGTON SQUARE LLC BY MACERICH COMPANY 9585 SW WASHINGTON SQUARE RD TIGARD, OR 97223 Phone: Phone: 692 - 1565 Reg #: FEES Required Inspections Description Date Amount Low Voltage Inspection [ELPRMT] ELR Permit 9/10/2004 $75.00 Elect'I Service [TAX] 8% State Surchart 9/10/2004 $6.00 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 may obtain copies of these rules or direct questions to OUNC - .03) 246 -6699. Issued by s ` Kr E � Permittee Signatu - 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 639 -4175 by 7:00 P.M. for an inspection needed the next business day Electrical Permit Application • I FOR . OFFICE USE o1L1': . City of Tigard Received ,. _ ' _ 13125 SW Hall Blvd., Tigard, OR 97223 Date/B �y A /�✓ �� �Q Plan Review I/ Phone: 503.639.4171 Fax: 503.598.1960 1 Date/B Other Permit Inspection Line: 503.639.4175 ,,,g. ^'' 4p Dale Ready/By runs' H See Page 2 for Internet: www.ci.tigardor.us Notrlied/Method � Supplemental Information i � .�*,in•t- .mow #t. a_ - .•s.a _ ifie ii�`at.t ti • E• OF �'(: t�:;a i t:' `' nil , t' iizi` ;�'.- t . • .- , . .. , -" - �' °� i'••rt ?.: ' �'•� -. -'! �o i�?:§ F�:: �.•• �. .�Ia'y�FiltE„V (. ^t•{ � . ..., .. - - • t� •f�.'i�I?:3�•,+�.r:,,.�;ai�..tl le New construction - ❑ Addition/alteration/replacement Please check all that apply: ❑ Demolition ❑ Other: ❑Service over 225 amps, comm'I 0 Hazardous location : • t3 I ❑Service over 320 amps Buildng over 10, sq. ft.. `.� ! - 1:,t:�c%" v ux:,u. ;:,n s � c- ., w s: PS - rating ❑ 000 > i , % ftt.T;a ;'r:: i�. ACIWN:0- T 4,0. � �c r r'iaV F 'trt of I- and 2- family dwellings 4 or more new residential 0 1- and 2- family dwelling al Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure 0 Building over three stories ❑ Feeders, 400 amps or more ❑ Multi - family 0 Master builder Other: . : ,:.� ), ri y - ���I�iFOR14 �., 0 Oc upant load over 99 persons 0 Manufactured structures or •,.�F' -�i` .,#'sA.a�� - �; S :. ..,.• , T�`�'IdNND: J(+OCATIQl11� �� .>z ,_ Egress/lighting RV ic ... A , r y� • . „�•...,F� -. , ..•4°3}t >� :T� =s7�? ❑ Plan park Job no.: Job site address: I S O s �� ❑ Health -care facility ❑Other: �� [ `� FIrSI Ir S�i I / W $ Submit 2 sets of plans with any of the above. City /State/ZIP: / / &ha \ I !, n The above are not applicable to temporary construction service. Suite/bldg. /apt no: 1 Project name: R•u f' e � ^� t t' t I a''n !x?f ?�^i s w '' . , 0 0TH Prto e /,1 /h- 51211crt z ' � �, - Qty. Fee Total tee:. y :�'r Q7. 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 1 7.i �' ttiap/pari el no.: Limited energy, residential 75.00 2 . , ";:r. .DSCRIPTION WORi� _ :;s r Limited energy, non - residential 75 00 2 • E - .. � =I ?• „• , Each manufactured or modular C /� L ! S dwelling, service and/or feeder _ 90.90 2 V J Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 • l: PRO PERTY OWNER : ' I • ❑ TENANT ..: . .... . . 201 amps to 400 amps 106.85 2 P 401 amps to 600 amps 160.60 2 nc Nae' { 6 k LV1 N _ 500 A-a L5 t- ( G 601 amps to 1.000 amps 240 60 _ 2 clrsss ,5 F3 563 GJ » sit/ H6 -7-ml _5('-()6--14(e- 2� -1 O`er Reconnect nl' or volts 454.65 2 •\d Reconnect onl }� GG RS 2 City /State/ZIP 'l/ t ia. t 0d/ ' 722 3 Temporary scrtict•s or feeders installation, alteration, and /or Phone ( ) F \ • ( ) relocation 200 amps or less 66 85 1 O.∎ ncr installation: This installation is being made on property that I own which is not 201 amps to 400 amps 1 1 100 30 1 2 I ntended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133 75 2 l >wner signature: Date: Branch circuits - new, alteration, or extension, per panel - •-:? © •APPLICANT• - I ® •CONTACT' PERSON • - A. Fee for branch circuits with :;useless name: //�) ^'U n service or feeder tee. each G GS 2 Mato tcH Ali I c i L Co 0J P CTc25 branch circuit B Fee for branch circuits Contact IL11t1C: ' bon R O A f, N without service or feeder fee. 46.85 2 \ddress ( O t / each branch circuit c l WI-LI TZt'_`t 1 . 0 Each add'I branch circuit I 6 65 2 City/State/ZIP - rio.Lg_n ,vF / Oil p1 (P 7 o / Z- Miscellaneous (service or feeder not included) I' Z / Pum p _ or imgahon circle 53 40 2 Phone. (St ) 69Z . -/ 7o Fax (53 ) (Ai -/ G - 7q / / i': mail: Sign or outline lighting 53 40 I 2 2 Signal circuit(s) or limited- . .. • . . . CONTRACTOR'... . - ' . ` ! energy panel, alteration, or 13lisiness name: stension. Describe• ` Page 2 2 Rta26IA) MgCHAa trig CONT J - cTortS ( Z 5 i5o32 • Address: / 6330 S L) fT to `M ?/ n /C G •, Each additional inspection over allowable In any of the above 1 Per Inspection 1 62.50 City /State/ZIP: ¶ L q Tl nl f a _ 7 a G Z Investigation per hour (I hr min) 62.50 ('hone: (56 3) ( la,- 1 - 6,5 - I Fax: (S 63) 699 ( — ($ 19 Industrial plant per hour 73.75 (:C13 LTC.. s"'t 3 3 Electrical LIC.:3 7� p Su ry IC.25'4 l / �� • =.t•: `sY;; :::.NrailE E;C: rRtG/1.(1 ltk l�tlT�rg _ �ik,'t ie ?:'.1,: [!' • lL'L L Subtotal Ira- Supry Electrician signature, required Plan review (25% of permit fee) 2 2 Print name: J L C L'' t State surcharge (8% of penult fee) (' t Dal e:9 /� _� TOTAL PERMIT FEE eL) Authorized Signature: This permit application expires If a �� ` Pe PP P permit is not obtained within 180 Print name. J days after It has been accepted as complete • M �� 17fI v'ec��(�Z Date 9/070,4_ • Fee methodology set by Tri- County Building Industry Service Board CITY OF TIGARD 24-Hour BUILDING i Inspection Line: .(503) 639 -4175 MST INSPECTION DIVISION Business Line: (503) 639 - 4171 j . / BUP Received Date Requested / 6 ✓ Z Z AM v PM BUP Location q 5 5 U) A S 65, Suite MEC Contact Person 9 ll Ph ( )6/ F 7? PLM Contractor OPY Ph ( ) s 3 - / 5-4 � ' SWR BUILDING Tenant/Owner ELC Footing Foundation ELC Ftg Drain Access: ELR 13 1 6 4 1 ---66 2 1 ? Crawl Drain Slab Inspection Notes: S SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Rrewall Fire Sprinkler Fire Alarm 1114. Susp'd Ceiling Roof Other: Final PASS PART FAIL C./ 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 T FAIL ESTRICA Servi e Rough -In' UG/Slab Low oltage Fire Ala • T PART FAIL El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. SITE 0 Please call for inspectio E: 1=1 Unable to inspect — no access Fire Supply Line ADA � D Approach/Sidewalk Date Inspector Ext Other: Final DO NOT REMOVE this Inspection record from the Job site. PASS PART FAIL