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Permit C IIY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT A tik DEVELOPMENT SERVICES PERMIT #: ELR2005 -00246 13125 SW U II Blvd., Tigard, OR 97223 503 - 6394171 DATE ISSUED: 8/24/2005 PARCEL: 1S12600-00300 SITE ADDRESS: 09312 SW WASHINGTON SQUARE RD ZONING: C -G SUBDIVISION: WASHINGTON SQUARE LOT: JURISDICTION: TIG Project Description: Limited energy for HVAC wiring. 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 ARROW MECHANICAL BY THE MACERICH COMPANY 10330 SW TUALATIN RD 9585 SW WASHINGTON SQUARE RD TUALATIN, OR 97062 TIGARD, OR 97223 Phone: 503- 639 -8865 Phone: 503- 692 -1565 Reg #: LIC 5193 ELE 34 -47CLE FEES Description Date Amount REQUIRED ITEMS AND REPORTS [ELPRMT] ELR Permit 8/24/2005 $75.00 [TAX] 8% State Surchart 8/24/2005 $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 f w rules opted by e Oregon Utility Notification Center. Those rules are set orth in OAR 952 - 001 -0010 throu OAR 952 -001 I 10. •u may obtain copies of these rules or direct questi•,;• ; C . NC at 503 - 246 -6699. / 1 O • Permittee Signature: Issu d By: _ / � � ��� 9 7 I 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. Electrical_ l •mit Application FOR OFFICE USE ONLY City, do-Tigard Dat Received . „ F� � Permit No / 4405 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phiine: 503.639.4171 Fax: 503.598.1960 � l ' :1/ : -„' f `' Date/B Other Permit -r Inspection Line: 503.639.4175 _-.„ �' I �„ Date Ready/By: 11 RI See Page 2 for Internet: www.ci.tigard.or.us Notified/Method Supplemental Information TYPE OF WORK PLAN REVIEW ® New construction • ❑ Addition/alteration /replacement Please check all that apply: . Demolition 0 Other: ['Service over 225 amps, comet ❑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 A Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure ❑ Multi - family ❑Master builder ❑Other: ❑Building over three stories ['Feeders, 400 amps or more ❑Occupant load over 99 persons ❑Manufactured structures or JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park Job no.: Job site address: 4�5 -7 w4 S� Qo ❑Health -care facility ❑mar Submit 2 sets of plans with any of the above. City/ State/ZIP: I , AA l Qg.. 97 z Z3 The above are not applicable to temporary construction service. Suite/bldg. /apt. no.: Project name: FEE* SCHEDULE Description I Qty. I Fee. I Twat 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 Tax map /parcel no.: Limited energy, residential 75.00 2 Limited energy, non - residential 75.00 2 • DESCRIPTION OF WORK Each manufactured or modular v1,J tJOL'r_ �3r>�r / 5 1,-, 1,-, Ong C' 7-e;zrp}L dwelling, service and/or feeder 90.90 2 L 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: k- - s 1 2S 601 amps to 1,000 amps 240.60 2 Address: 9 75 WA 50 K,© Over 1,000 amps or volts 454.65 2 Reconnect only 66.85 2 City /State/ZIP: f , 1,130_0 9 �. z _ 2.. 3 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 [m APPLICANT I ❑ CONTACT PERSON A. Fee for branch circuits with j / service or feeder fee, each 6 65 2 Business n e: A A`jv, gn ge branch circuit / B. Fee for branch circuits Contact name: 7/2 P/ LL-Al2 without service or feeder fee, 46.85 2 Address: )n y, �1 each branch circuit 17 ) s t. P. i U�'�� V / L Each add'I branch circuit 6.65 2 City / State/ZIP: / 4 . 4 4 , r-/ h i Or b y Miscellaneous (service or feeder not included) Phone: C� Pump or irrigation circle 53.40 2 ( � ��') J q /5 y Fax: : ( ) Sign or outline lighting 53.40 2 E - mail: Signal circuit(s) or limited- . CONTRACTOR energy panel, alteration, or extension. Describe: Page 2 2 Business name: 4/2-42,71,, • Address: Each additional inspection over allowable in any of the above City / State/ZIP: :i �' � s A IfC Per inspection 62.50 Investigation per hour (1 hr mm) 62.50 Phone: ( ) Fax: ( ) Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES* CCB Lic.: �� 9 . Electrical Lic.: 34 _ 47. Suprv. Lic.: Subtotal Suprv. Electrician signature, required: Plan review (25% of permit fee) State surcharge (8% of permit fee) Print name: Date: ( TOTAL PERMIT FEE Authorized signature: /. This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete Print name: zit 0 _ ; ,. Date: • Fee methodology set by Tn- County Building Industry Service Board •• Number of inspections per permit allowed. is \Building\Pennits\ELC- PennitApp doe 12/03 440- 4615T(10/02/COM/WlB . tt Electrical Permit Application - City of Tigard Aka Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: I' RESIDENTIAL Fee for all residential systems combined $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* • El Burglar Alarm ❑ Garage Door Opener* • El Heating, Ventilation and Air Conditioning . • System* • ❑ Vacuum Systems* ❑ Other: 1' COMMERCIAL WORK ONLY: Fee for each commercial system $75.00 (SEE OAR 918- 260 -260) Check Type of Work Involved: El Audio and Stereo Systems El Boiler Controls ❑ Clock Systems El Data Telecommunication Installation El Fire Alarm Installation El HVAC El I nstrumentation ❑ Intercom and Paging Systems El Landscape Irrigation Control* El Medical El Nurse Calls El Outdoor Landscape Lighting* ❑ Protective Signaling . El Other • Total number of commercial systems: *No licenses are required. Licenses are required for all other installations i• \Building\Permits\ELC- PermitApp doc 04/03 CITY OF TIGARD BUILDING DIVISION PERMIT #: ELR2005.00246 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/24/2005 Phone: (503) 639 -4171 . 11j �`a' Inspection Requests (24 Hrs.): (503) 639 -4175 .'!� 1L INSPECTION WORKSHEET FOR DATE: 11 /9/2005 TIME: 7:09AM PAGE: 26 SITE ADDRESS: 09312 SW WASHINGTON SQUARE RD CLASS OF WORK: SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE: PROJECT NAME: KAY JEWELERS DESCRIPTION: Limited energy for HVAC wiring. OWNER: WASHINGTON SQUARE LLC, PHONE #: 503- 639.8865 CONTRACTOR: ARROW MECHANICAL PHONE #: 503- 692-1565 Inspection Request Scheduled For: Date: 11/9/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 199N Electrical final 020839.07 360 -907 -0718 N Corrections /Comments /Instructions: • P-A,.N, \\A � , \A) \ \V() \-\\ T v •tym\_, To s) kicz QOM , r l b \ 1(a G O D 1,.b G 4 10 a • ❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector:jZ �C Date: ' /J 7 Phone #: (503) 718- ��� � • CITY OF TIGARD BUILDING DIVISION A\ PERMIT #: ELR200S -00246 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/24/2005 Phone: (503) 639- 4171 A N91' Inspection Requests (24 Hrs.): (503) 639 -4175 I �.. INSPECTION WORKSHEET OR DATE: 11/16/2005 TIME: 7 :03AM PAGE: 67 SITE ADDRESS: 09312 SW WA: INGTON SQUARE RI) CLASS OF WORK: SUBDIVISION: WASHINGTON S UARE LOT #: TYPE OF USE: PROJECT NAME: A JEWEEERS - DESCRIPTION: i ni ed energy fr5r H C wiring. • OWNER: WASHINGTON SQUAR: LLC, PHONE #: 503- 639 -8865 CONTRACTOR: ARROW MECHANICAL PHONE #: 503- 692 -1565 Inspection Request Scheduled For: Date: 11/16/2005 • Pour Time: Code # Inspection Description Confirm # Contact # Message 135 Low voltage 021. 18-01 603- 692 -1565 N Corrections /Comments /Instructions: 0•�� P ►Ex- ftts, - c`ccL .wii Cst.ab It 0 ttc,"173,116 tfi_ 01) A PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: ' � Date: 1A1 It1 Phone #: (503) 718- •