Permit CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
1A DEVELOPMENT SERVICES PERMIT #: ELR2005 -00384
' " III 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 11/1/2005
PARCEL: 1S12600-00300
SITE ADDRESS: 09315 SW WASHINGTON SQUARE RD ZONING: C -G
SUBDIVISION: WASHINGTON SQUARE LOT: JURISDICTION: TIG
Project Description: LV for Fire Alarm.
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: X OUTDOOR LANDSC LITE:
OTHER: : HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
WASHINGTON SQUARE LLC OREGON ELECTRIC GROUP
BY THE MACERICH COMPANY 1010 SE 11TH AVE
9585 SW WASHINGTON SQUARE RD PORTLAND, OR 97214
•
TIGARD, OR 97223
Phone: 503 639 - 8865 Phone: 503 234 - 9900
Reg #: LIC 203
SUP 4460S
FEES ELE 26 -95C
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 11/1/2005 $75.00
[TAX] 8% State Surchari 11/1/2005 $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 95,401-'100. You . y obtain copies of these rules or direct questions to OUNC at 503 - 246 - 6699.
Issued By: • /`_ /j i 4 � ` Permittee S i gnature: A /// / _ / di
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.
•
E.'_.ectrical Permit Application '' FOR OFFICE USE ONLY
Cit o: Tigard Date (� 5 B Permit No , J _ 0 0
13125 SW Hall Blvd., Tigard, OR 97223 n Plan Revte
Phone: 503.639.4171 Fax: 503.598.1960 U l, 1 i 1U ' + � "`� Date/By: Other Permit:
Inspection Line: 503.639.4175 e' ' I Date Ready/By. i it Si See Page 2 for
Internet: www.ci.tigard.or.us w Notified/Method: Supplemental Information
-- 1311FEntivemtvlsioN PLAN REVIEW
❑ New construction ® Addition/alteration/replacement Please check all that apply:
El Demolition ❑ Other: ❑Service over 225 amps, comm'I ['Hazardous locat4i
['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 ® Commercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
El Multi - family ❑Master builder ❑ Other: ❑Buildin over three stories ❑Feeders, 400 amps or more
['Occupant load over 99 persons ['Manufactured structures or
JOB SITE INFORMATION AND LOCATION DEgress/lighting plan RV park
Job no.: 13353 Job site ad 6/3 / SW Washington Square Rd ❑Health -care facility ['Other:
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.
FEE* SCHEDULE
Suite/bldg. /apt. no.: T3 Project name: Teavana
Description I Qty . Fee. 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 1
Limited energy, residential 75.00 2
Tax map/parcel no.: Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
Install low voltage wiring and cabling for Fire Alarm 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: Washington Square LLC 601 amps to 1,000 amps 240 60 2
Address: 9585 SW Washington Square Rd Over 1,000 amps or volts 454 65 2
Reconnect only 66 85 2
City /State /ZIP: Tigard, OR 97223 Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) 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 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 6.65 2
Business name: Oregon Electric Group, Inc. branch circuit
B. Fee for branch circuits
Contact name: Loni Martin without service or feeder fee, 46.85 2
Address: 1010 SE 11 Ave each branch circuit
Each add'I branch circuit 6.65 2
City /State /ZIP: Portland, OR 97214 Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: (503) 234 -9900 Fax: : (503) 535 -2620
Sign or outline lighting 53.40 2
E -mail: loni @oregon - electric.com Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or /
Business name: Oregon Electric Group, Inc. extension Describe: Page 2 - 2
Address: 1010 SE 11 Ave Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State/ZIP: Portland, OR 97223 Investigation per hour (I hr min) 62.50
Phone: (503) 234 - 9900 Fax: (503) 535 - 2620 Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: 203 Electrical Lie. Suprv. Lic.:28 1/5 Subtotal 75--"'
Suprv. Electrician signature, required: Plan review (25% of permit fee)
Print name: �i 94 5� A- Date: 10/28/05 State surcharge (8% of permit fee)
• / TOTAL PERMIT FEE 9/ Oi
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: 10/28/05 * Fee methodology set by Tn- County Building Industry Service Board
•• Number of inspections per permit allowed.
is \ ButldingTemuts\El .C- PermrtApp.doc I7J03 440- 4615r(10/02/COM/WEB -----7----, A y / —
CITY OF TIGARD .
BUILDING DIVISION PERMIT #: ELR2005 -00384
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/1/2005
Phone: (503) 639 -4171 A 16,
Inspection Requests (24 Hrs.): (503) 639 -4175 J "'/
INSPECTION WORKSHEET FOR DATE: 11/ 005 TIME: 7:04AM PAGE: 1
SITE ADDRESS: 09315 SW WASHINGTON SQUARE `•D CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE:
PROJECT NAME: TEAVANA
DESCRIPTION: LV for Fire Alarm.
OWNER: WASHINGTON SQUARE LLC, PHONE #: 503 - 639.8865
CONTRACTOR: OREGON ELECTRIC GROUP PHONE #: 503 - 2349900
•
Inspection Request Scheduled For: Date: 11/21:005 Pour Time:
Code # 'on Description Confirm # Contact # Message
135 ..ors voltage 020154 -01 503.793.7177 N
Corrections /Comments /Instructions:
•
•
A PASS PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G ►2, WS Date: 1,`' 1—' Phone #: (503) 718- 2AL\ 10-
.
CITY OF TIGARD
BUILDING DI I N PERMIT #:'EIA.20)6"' 403
13125 SW Hall Blvd., Tigar., OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 ill
Ake
Inspection Requests (24 Hrs.): 03) 639 -4175 R __..
INSPECTION WORKSHEET FOR DATE: \% n, . � TIME: PAGE:
SITE ADDRESS: CLASS OF WORK:
. SUBDIVISION: LOT - #: TYPE OF USE:
PROJECT NAME.
DESCRIPTION: °DE , 0v lP
OWNER: PHONE #:
CONTRACTOR: tia,lay -\ PHONE #:
4t1
Inspection Request Scheduled For: Bate: U • I ` t • O Pour Time:
Code # Inspection Description C•nfirm # Contact # Message
F
� NL(�
• Corrections /Comments /Instructions: U
- a �\ + \Mt �+
K PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
G IqcSia L- Date: IA 4 0 Phone #: (503) 718- t