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Permit
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT • I � DEVELOPMENT SERVICES PERMIT #: EL /19/20 -00357 ` - II 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/19/2005 PARCEL: 1S12600-00300 SITE ADDRESS: 09330 SW WASHINGTON SQUARE RD ZONING: C -G SUBDIVISION: WASHINGTON SQUARE LOT: JURISDICTION: TIG Project Description: Data /tele. A. RESIDENTIAL B. COMMERCIAL AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING: BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT: GARAGE OPENER: CLOCK: MEDICAL: HVAC: DATA/TELE COMM: X NURSE CALLS: VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE: OTHER: : HVAC: PROTECTIVE SIGNAL: INSTRUMENTATION: OTHER: TOTAL # OF SYSTEMS: 1 Owner: Contractor: WASHINGTON SQUARE LLC VERSATILE CABLING, INC. BY THE MACERICH COMPANY 12606 NE 95TH ST #C -130 9585 SW WASHINGTON SQUARE RD VANCOUVER, WA 98682 TIGARD, OR 97223 Phone: 503- 639 -8865 Phone: 360 -816 -1021 Reg #: LIC 161614 ELE 37- 1048CLE FEES Description Date Amount REQUIRED ITEMS AND REPORTS [ELPRMT] ELR Permit 10/19/200E $75.00 [TAX] 8% State Surcharl 10/19/200E $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 -00 -0100. You may obtain copies of these rules or direct questions to OUNC at 503 - 246 -6699. Issued By: ,45c '`z Permittee Signature: q'�(t 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 le a1 Perlrik r rA ® FOR OFFICE USE ONLY City of Tigard D ived tO ; i Permit No.: � ! 1005 a 0351 13125 SW Hall Blvd., Tigard, OR 97223 C Plan Review Phone: 503.639.4171 Fax: 503530 1 9 2U05 /1 "" ' H i �j�i'I' Date/By: Other Permit: ' Inspection Line: 503.639.4175 -fig- Date Ready/By: I 21 See Page 2 for , Internet: www.ci.tigard.or.us CITY OF TIGARD Notified/Method: Supplemental Information i'V`�yT'FS 1 Q i� I 1ML. ¢' "'*- kw ' L"( N l T. 'h+ :, 2 .. M '" 4 „„ $$ iP � - y i��- Y s' v _� ��y � � Y .t' `. )�'yyy � f y , V• /�D��t ,t.�. `!'�b`7�:!�',�c'C'''',;:,., ♦ S�!" ♦.Y _. l �, y�Jl Mil ?T .v: 14 3. 1rl -Ai N .- e Yt Al2eY a i 4 -ZI •ELI - --471 `�iu8- "" PI-New construction ❑ Addition/alteration/replacement Please check all that apply: El Demolition ❑Other. ['Service over 225 amps, comm'l ['Hazardous location f , ['Service over 320 amps – rating ❑ Buildng over 10,000 sq. ft., E., < j {` IiE' s r ^ © LfC .i;® Z ,fi7Y �` � ) �t of 1- and 2- family dwellings 4 or more new residential ❑ I- and 2- family dwelling c Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure ['Building over three stories ❑Feeders, 400 amps or more ❑ Multi- faintly ❑ Master builder ❑ Other: ['Occupant load over 99 persons ❑Manufactured structures or . . � ° „ � ,P . , © `kT U ' A ` ,' e CAA ° -- 1 t i "� a ['E plan RV park 4 - 1 - _, . t, - -., •z• .' 4 . c1 _ (AA. Job no.: Job site address: y 9 3 �o so v)a.s i'ry 1 , n � � ❑Health care facility ❑�� p Submit 2 sets of plans with any of the above. City/ State/ t ZIP: 9-7 3 sz� U The above are not applicable to temporary construction service. 4.. �`� . '' V ' . rtgV iii �- : _ Y `:,,, Suite/bldg. /apt. no.: I Project name: d– r p v 01 �, .. Deurlptton Qty. Fee Total Cross street/directions to job site: New residential single- or multi - family dwelling unit. wurn � ` / lLlt t � Includes s s a at tached garage. 1,000 or less 145.15 4 Subdivision: I Lot no.: Ea. add'l 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 ,,F.11,-.„ om „ te a . , ” d � 1 r , ,,,, Ea c h manufactured or modular (/ ,, / , / 0 ^ n dwelling, service and/or feeder 90.90 2 W Services or feeders installation, alteration, and/or relocation sf� J' /4..., ` �+ 200 amps or less 80.30 2 l4� 4 r t . t . _ ., c a. ±� � x - g ' °'; 401 amps m 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 1 T�di�,�: ,. d 1 .,; 47,1. } U tT ;, ''..t A. Fee for branch circuits with _ service or feeder fee, each 6.65 2 Business name: l l rd a, /ti eir -( C branch circuit V q � B. Fee for branch circuits Contact name: ` �f'e�GL BA a without service or feeder fee, 46.85 2 Address: / 0 LO pc 9 g /f / n G – `3O each branch circuit mil- / Each add'1 branch circuit 6.65 2 City/ State/ZIP: V f)6,40 U V-e_ A- q 8 & 8 /0P- Miscellaneous (service or feeder not included) Phone: `off 4) 0/6 / e,,zo S I Fax:: 3( 8 / 6 03(oa Pump or irrigation circle 53.40 2 Sign or outline lighting 53.40 2 E -mail: Signal circuits) or limited - I"- 35iff . * rfih a "^yx„s, '` 'i a' !. G, 0 '��,k f iu„i z tt r - ? {l y s 'Cti energy panel, alteration, or s ry ` � y "; " extension. Describe: / Page 2 95 2 Business name: V,e / '' f a . 7 4 - tie /' C Address: Each additional inspection over allowable in any of the above Per inspection 62.50 City/State/ZIP: Investigation per hour (1 hr min) 62.50 Phone: ( ) I Fax: ( ) Industrial plant per hour 73.75 CCB Lic.: /(p /cam/ 9 I Electrical Lic.: 8 d Supry _Li • :, 4a '! Subtotal 7 Suprv. Electrician signature, required: Plan review (25% of permit fee) Print name: CM (f PA i Date: / b / '7 State surcharge (8% of permit fee) TOTAL PERMIT FEE y / o,_:,, 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: • Fee methodology set by Tri -County Building Industry Service Board •• Number of inspections per permit allowed. tlectrical Permit Application - City of Tigard Page 2 = Sapplemental Information • LIMITED ENERGY PERMIT FEES: 1 u WirtIf� �`r' �,'lr � ��_�� ;� s�,:.. s��s�� • :�.�.�F .fi Fee for all residential systems combined........ $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* ❑ 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 ❑ 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 r • lig)F TIGARD „ BUILDING DIVISION - PERMIT #: ELR2005 -00357 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/19/2005 Phone: (503) 639 -4171 Inc w 1 l e'� Inspection Requests (24 Hrs.): (503) 639 -4175 1 �I INSPECTION WORKSHEET FOR DATE: 11/4/2005 TIME: 7:08AM PAGE: 75 SITE ADDRESS: 09330 SW WASHINGTON SQUARE RD CLASS OF WORK: SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE: PROJECT NAME: SOMA DESCRIPTION: Dataltele. OWNER: WASHINGT ` N SQUARE LLC, PHONE #: 503 - 639.8965 CONTRACTOR: VERSATILE *.. BLING, INC. PHONE #: 360-816-1021 Inspection Request Scheduled For: Date: 11/4/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message '., LOW VO 020314 -01 503- 449 -1013 N • , ections /Comments[Instru tions: • A PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL f ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: ` Y " o V -- Date: ` • Phone #: (503) 718 - 1.14410