Permit z, f�
CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
4 11 4, DEVELOPMENT SERVICES PERMIT #: ELR2005 -00272
13125 SW Hall Blvd., T igard, OR 97223 503 - 639 -4171 DATE ISSUED: 9/12/2005
PARCEL: 1S12600-00300
SITE ADDRESS: 09318 SW WASHINGTON SQUARE RD ZONING: C -G
SUBDIVISION: WASHINGTON SQUARE • LOT: JURISDICTION: TIG
Project Description: Low voltage for 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 HVAC INC
BY THE MACERICH COMPANY 5188 SE INTERNATIONAL WAY
9585 SW WASHINGTON SQUARE RD MILWAUKIE, OR 97222
TIGARD, OR 97223
Phone: Phone: 503 462 - 4822
Reg #: LIC 50897
ELE 26 -571 CLE
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 9/12/2005 $75.00
[TAX] 8% State Surchar€ 9/12/2005 $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 w' ; days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires
you t• ollow rules . o •ted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010
thro gh OAR 952 -00 ' r0. Y•u may obtain copies of these rules or direct questions to OUNC at 503 - 246 -6699.
Iss ed By: � P Signature: i
/ I
AAA.cjt� (Qd 6i7A.0 rM
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 - Pti Application FOR OFFICE USE ONLY
City of Tigard Dat ' t/ • O •
13125 SW Hall Blvd , Tigard, OR 97223 Plan Review
Phone. 503 639.4171 Fax. 503 598 1960 -- „_41111‘, :••»ti l''' Date/B Other Permit.
Inspection Line 503 639.4175 „ • a I Date ReadyBy El See Page 2 for
Internet: www ci tigard.or us Notified/Method 111 7 1 E1 Supplemental Information
- <7 _ — -: -, mss=. , -' - � : :.r ; = • r• ' - - *- -- i - - . - • � -
,; :.,.- "- %i._- * -7, :: c ,PE;OF, ORIC .m,; I .a: • .111 _. -: -- ?,._ - : _ ,'. -, V EW
-; PLA RE -
❑ New construction E ;:;. Y - Additio ratio eplacement Please check all that apply:
M1 over 225 amps, comm'l Hazardous location
❑ Demolition ❑ Other:
['Service ❑
['Service over 320 amps — rating ❑Butldng over 10,000 sq ft ,
" -- =` . - ;•- ' . ` .- ..,CAT R ''0E-CONS UCTIONV ;'.' , ',:''. ,, A .. , ---- ` .” of 1- and 2- family dwellings 4 or more new residential
ID 1 - and 2 - family dwelling CommerciajJ'n ❑ Accessory building V ['System over 600 volts nominal units in one structure
['Building ver three stones ❑Feeders, 400 amps or more
❑ Multi - family ❑ Master builder ❑ Other: g
❑Occupant load over 99 persons ['Manufactured structures or
'"A:---_-...1.4..-1 . , 'JOB SITE :INFORMATION, _LOCATION" , 7,,-.., . •.' .' ;',,', - . ❑ Egress/lighting plan RV park
Job no.: 3agj Job site address ?LV Sto (,Oi (.1 S ( 0k ❑Health - care facility ❑Other
Submit 2 sets of plans with any of the above
City/State /ZIP:7 ,, ,,A. e 1 The above are not applicable to temporary construction service
Suite/bldg. /apt. no.: Project name: C `_,' "0.'a FEE *_ S "CFIDi1tE ~.: . .
-? - Description ✓Y I Qty I Fee. l Total
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'l 500 sq ft or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75 00 2
r, * Limited energy, non - residential 75.00 2
r•` :: R _, ; , i _ , ; , "DESC t1PTION OF ,WOR.K . ; ,:; a; — • ' Each manufactured or modular
n n LD J S �� r^t �
dwelling, o deed and/or ers installation, 90.90 2
'T"V V /L- � Services r feedallation, alteration, and/or relocation
200 amps or less 80 30 2
: - ,_ :� ; 201 amps to 400 amps 106 85 2
' - _ ❑' .PROPERTY W,NER ra _- , ' I ..;....... . � . ❑' .. .. ANT•:,, ,� : � :1- -
4 401 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
relocation
Phone: ( ) Fax: ( )
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
'' yQ ' 4 1` • ¢I. iy '-� ; - A Fee for branch circuits with
Jr � . < v: - :a - ; APFLIGAP1T .;r, , ;`f •h -" - r4• " . . ,; ° - - =,--_,-- . ®;CONTACT' PElRSOlV —k n , , • service or feeder fee, each 6.65 2
Business name: branch circuit
B Fee for branch circuits
Contact name: without service or feeder fee,
each branch circuit 46 85 2
Address: Each add'l branch circuit 6 65 2
City /State /ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) Fax : ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53 40 2
E - mail: Signal circuit(s) or limited -
g> , ',' .•' - .., M - ;,cor fRA,L i : ''�,i :. t :' • zrf:...:' i _ ;',; energy panel, alteration, or
extension Descnbe / Page 2 2
Business name ]•( / o� J
Address: �` !� " � ,- P fA , ) , � , ^ Each additional inspection over allowable in any of the above
`' u`�, Per inspection 62 50
City/State/ZIP.MAJAjj 0.tC�GC, ` iS� Investigation per hour (I hr min) 62 50
Industrial plant per hour 73 75
Phone: V r
( ) yc92_ i _,.- — Fax ( ) �•{1G2 - (DSSS
':,t ,'; -:, „" ;':. :EL•ECfRICAI;••PERMIT FEES *
CCB Lic /D 7 Electrical Lic(0~57/ eOE Supry Lic • E4 LC8 Subtotal -7,
Supry Electrician signature, required , eij Plan review (25% of permit fee)
Print name 1 0 Vv An ` f 3 0 ,� Date 91V° S State surcharge (8% of permit fee) LO 'Q�
TOTAL PERMIT FEE $ 1 .
Authorized signature- v
This permit application expires if a permit Is not obtained within 180
�•� days after it has been accepted as complete
Print name: St J 'ZO \ Date. C /-- • Fee methodology set by Tn- County Building Industry Service Board
•• Number of inspections per permit allowed
i i BuildingiPerrrutsiELC- PermitApp doc 12/03 440- 4615T(10 /02/COM/WEB
Electrical Permit Application - City of Tigard
-Page 2 - Supplemental Information
•
LIMITED ENERGY PERMIT FEES:
'RESI i M aiTYQ ONTWAI r;MA --_,s ; -s J
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
El Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
Fee for each commercial system $75.00
(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
El 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
i \Buddmg\Pcrmtt\ELC- PmnzApp doc 04/03
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR200 00272
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/12/2005
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 ' `'II
INSPECTION WORKSHEET FOR DATE: 10/6/2005 TIME: 7:02AM PAGE: 36
•
SITE ADDRESS: 09318 SW WASHINGTON SQUARE RD CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE:
PROJECT NAME: CHICO'S
DESCRIPTION: Low voltage for HVAC
OWNER: WASHINGTON SQUARE LLC, PHONE #:
CONTRACTOR: HVAC INC PHONE #: 503 - 462 -4822
Inspection Request Scheduled For: Date: 10/6/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low voltage 017639 -01 503 -462 -4822 N
Corrections /Comment In'stru tions:
\ , ` 11 %
•
•
•
?►] PASS ❑ PARTIAL APPROVAL • ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: < Date: f ° P hone # : (503) 718- 2 16