Permit CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
DEVELOPMENT SERVICES PERMIT #: ELR2005 - 00392
--- 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 11/4/2005 •
PARCEL: 1512600 -00300
SITE ADDRESS: 09345 SW WASHINGTON SQUARE RD ZONING: C - G
SUBDIVISION: WASHINGTON SQUARE LOT: JURISDICTION: TIG
Project Description: Data /Telecommunication.
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 WILCOX ELECTRIC
BY THE MACERICH COMPANY 300 WASHINGTON ST
9585 SW WASHINGTON SQUARE RD VANCOUVER, WA 98660
TIGARD, OR 97223
Phone: 503- 639 -8865 Phone: 360 - 694 -3800
Reg #: LIC 160141
ELE 37 -1041C
FEES SUP 4916S
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 11/4/2005 $75.00
[TAX] 8% State Surcha 11/4/2005 $6.00
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or direct questions to OUNC at 503 - 246 -6699.
�y
Issued By:� � �/ Permittee Signature: �
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
• /.Elictrical Permit Application FOR OFF USE ONLY .
City of Tigard -- I V c/ /) Permit No. /o - '''Oft/'
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review i,. .
Phone: 503.639.4171 Fax: 503.598.1960 �� • x i . ;' Date/B Other Permit:
Inspection Line: 503.639.4175 NOV 4 - .1 "_1_1_, Date Ready/By. ® See Page for
Internet: www.ci.tigard.or.us CITY OF T 1GARD Noufied/Method ( Supplemental Information
TYFstccEom nIVI$Iori PLAN REVIEW
•
❑ New construction B1dition/alteration/replacement Please check all that apply:
❑ Demolition ❑Other: ['Service over 225 amps, comm'l ['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
❑ I - and 2 family dwelling 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
DOccupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION DEgress/lighting plan RV park
['Health-care facility ❑per:
Job no.: Job site address:
93 5/3 S lt/o,,kh, ....fie re- Submit 2 sets of plans with any of the above.
City/State/ZIP: — 17 141 , 0 ( r FEE* SCHEDULE 9 71 Z 3 nub The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: I Project name: 7 r
D f�eY Y EI Description I Qry• I Fea I Total
Cross street/directions to job site: 7-1,, S New residential single - or multi- family dwelling unit.
P W t h7 Includes attached garage.
S q (-4._U tr c 1124 (7 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
/� dwelling, service and/or feeder 90.90 2
L_C+t, i U® s. f - //h a 1-- .S e... --e'e (rS 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: 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 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: Z / CO k effe'e.,'r, r branch circuit
, B. Fee for branch circuits
Contact name: ,9 re . /7 �G* r , a without service or feeder fee, 46.85 2
Address: each branch circuit
Tee /4/2.$ L- s • - key. -J Each add'I branch circuit 6.65 . 2
City/State/ZIP: Miscellaneous (service or feeder not included)
1/a Pt CDuVes - t .r/ c?S( D
� Pump or irrigation circle 53.40 2
Phone: ( b o) go if-ad/5-7 I Fax: : (UM) 67y _ 'c8 e / Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
/ / extension. Describe: l Page 2 7-s 2
Business name: G ! � r A D( G y /
l
Address: / Each additional inspection over allowable in any of the above
rec. Gc `C r / g Yuri S. Per inspection 62.50
1 v City/ State/ZIP: �A N ce,a, tti, / �" Fg/ ‘ p Investigation per hour (I hr mm) 62.50
Phone: (360 ) G 9� —�8r� Fax: (70 ) 6? —3,0 ( Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES* '
V....CCB Lic.:46 O /5// Electrical Lic.: 77o '/c Suprv. Lic.: 1797 5 Subtotal 7s —
9 Suprv. Electrician signature, required: �" � "; Plan review (25% of permit fee)
Print name: /I 1'77 if �'� c _ Date: /y /S • State surcharge (8% of permit fee)
c ry , ( // d
TOTAL PERMIT FEE
Authorized signature: Qnn 7 ��� This permit application expires if a permit is not obtained within 180 ..___tai6.,... f days after it has been accepted as complete
Print name: //a /tJ7i! Date: 4s U • Fee methodology set by Tn -County Building Industry Service Board
• • Number of inspections per permit allowed.
i \ Building \Petmits\ELC- PemitApp.doc 12/03 440- 4615T(l0/02/COM/WEB
b' TS
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
t • SIDENTIAL.WORK ONLY:
Fe for all residential systems combined $7 :.00
Check • e of Work Involved:
❑ Audio = d Stereo Systems*
❑ Burglar Ala
❑ Garage Door Open- *
El Heating, Ventilation and Conditioning
System *
El Vacuum Systems*
❑ Other:
COMMERCIAL ' ORKONLY: .' - 1
Fee for each co I ercial system $75.00
(SEE OAR 9 8- 260 -260)
Check Ty • • of Work Involved:
❑ udio and Stereo Systems
IA Boiler Controls
❑ Clock Systems
Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
CITY OF TIGARD •
BUILDING DIVISION PERMIT #: ELR2005.00392
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/4/2005
Phone: (503) 639 -4171 ,° -
Inspection•Requests (24 Hrs.): (503) 639 -4175 '!+� 'I
INSPECTION WORKSHEET FOR DATE: 11 /10/2005 TIME: 7:02AM PAGE: 104
SITE ADDRESS: 09345 SW • ' SHINGTON SQUARE RD CLASS OF WORK:
SUBDIVISION: WASHINGTON .OUARE LOT #: TYPE OF USE:
PROJECT NAME: POTTERY BARN DS
DESCRIPTION: Data/Telecommunica 'on.
OWNER: WASHINGTON SOUAR LC, PHONE #: 503 - 639^8865
CONTRACTOR: WILCOX ELECTRIC PHONE #: 360 -694 -3800
Inspection Request Scheduled For: late: 11/10/2005 Pour Time:
Code # Inspection Description C. firm # Contact # Message
13 •,.:• • _.e • 020: t7 -01 503 -572 -5590 N
IS t`►
• ections /Comments/ • = uctions: •
•
•
161 PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
• FAIL , ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ""�" Date: 14 I n elF
Phone #: (503) 718 -QM