Permit CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
A DEVELOPMENT SERVICES PERMIT #: ELR2005 -00341
^-`' ..� -' 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/12/2005
PARCEL: 1S12600-00300
SITE ADDRESS: 09359 SW WASHINGTON SQUARE RD ZONING: C -G
SUBDIVISION: WASHINGTON SQUARE LOT: JURISDICTION: TIG
Project Description: HVAC low voltage.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATAITELE 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 BEWLEY MECHANICAL SYSTEMS
BY THE MACERICH COMPANY 7911 NE 33RD DR #250
9585 SW WASHINGTON SQUARE RD PORTLAND, OR 97211 "
TIGARD, OR 97223
Phone: 503- 639 -8865 Phone: 503- 626 -8986
Reg #: LIC 63582
ELE 34- 339CLE
FEES SUP 145LEB
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 10/12/200: $75.00
[TAX] 8% State Surchart 10/12/200: $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 ckuestio s to 09C - 13 46 -6699.
1 IN
Issued By: fj.. Permittee Signature:,
OWNER INSTALLATION ONLY r
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.
L ' t d c t r i c a l Permit Application 1 Olt OF[I( I I "SI: 0\1.1
City of Tigar t is. E1\ h' � 4� • Permit No ' . I / — 6
13125 SW Hall Blvd., i . 97223 I
Phone: 503.639.4171 Fax: 503.598.1 y A uJ t " . Da Review
1>ffiem Other Permit
Inspection Line: 503.639.417, f� 1 z 2O . i 1 _. Date Ready/By: loin Id See Page 2 for
Internet www.citigard.or.ustAJ ' Notified/Method Supplemental Information
(;(CY OF TIGAR D
dYJtelRK PLAN REVIEW
❑ New construction - -1 1.341k1Addition /alteration/replacement Please check all that apply:
['Service over 225 amps, comm'I ❑Flazardous location
❑ Demolition 0 Other:
- ❑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
❑Building over three stories ['Feeders, 400 amps or more
❑ Multi - family 0 Master builder ❑Other;
DOccupant load over 99 persons ['Manufactured structures or
JOB SITE INFORMATION AND LOCATION ['Egress/lighting plan RV park
❑Health -care facility ['Other
Job no.: I Job site address: Submit 2 sets of plans with any of the above.
City/State/ZIP: The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: ‘ ,- -y r._ FEE" SCHEDULE
'� - \ i rm li•t Description I Qtr. I Fee. I 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: I Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 I
Limited energy, residential 75.00 2
Tax map /parcel no.: Limited energy, non - residential 75.00 2
Each manufactured or modular
3 417 // \ dwelling, service and /or feeder 90.90 2
C� / l `f�.t� �JZ ...I-- C2 Cc-4 -3 alt s' Services or feeders installation, alteration, and/or relocation
ff7i A4- 200 amps or less 80.30 2
El PROPERTY OWNER ❑ 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
Phone: ( ) I Fax: ( ) relocation
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: branch circuit
B. Fee for branch circuits
Contact name: wrrhour service or feeder fee, 46 85 2
Address: each branch circuit
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
E -mail: Sign or outline lighting 53.40 2
Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
extension. Describe: Page 2 2
Business name: I3ew(.2Y t c (y{an t ca ( 5 yST.ei.t. S
Address: 7Q I / Nr. 3 3 rd r D r- sV l 7'-c 7. S O Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State/ZIP: Po „ft ct to c( O2 Q7 9.(( Investigation per hour (I hr min) 62.50
( 3) 6,7_ (o - g po lo (503) 6 4 1 - 6. 3 4 8 I p l an t per hour 73.75
Phone: 5o Fax ELECTRICAL PERMIT FEES*
CCB Lic.: (03 SS y I Electrical Lic.: • 33gct,i Suprv. ic.: 1 45LE1 3 Subtotal
Suprv. Electrician signature, required: 6, Plan review (25% of permit fee)
Print name: 'e h ot (d sew Ley V Da , t o _ 1( _ 0 5
State surcharge (8% of permit fee)
I TOTAL PERMIT FEE I .06
Authorized signature: This rmit application expires if a
pe pp p permit is not obtained within 180
days after it has been accepted as complete
Print name: 120 t iti t ®( /3 e L.J Lt? / I Date: I o _ 1 t - 05 • Fee methodology set by Tri County Building Industry Service Board
•• Number of inspections per permit allowed.
i. lBuiidina \Pertnits.ELC- PcxmitAppdoe 12/03 4404615T(10/07/COM/WEB
CITY OF TIGARD
BUILDING DIVISION ,. PERMIT #: ELR2005.00341
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/12/2005
Phone: (503) 639-4171
Requests (24 Hrs.): (503) 639 -4175
4
INSPECTION WORKSHEET FOR DATE: 11/15/2005 TIME: 7:02AM PAGE: 35
SITE ADDRESS: 09359 SW WASHINGTON SQUARE RD CLASS OF WORK:
SUBDIVISION: W SHINGTON SQUARE LOT #: TYPE OF USE:
PROJECT NAME: ST/" TUCKS
DESCRIPTION: HVAC voltage.
OWNER: WASHINGT ` SQUARE LLC, PHONE #: 503- 639 -6865
CONTRACTOR: BEWLEY ME ` , ANICAL SYSTEMS PHONE #: 503- 6266986
Inspection Request Scheduled For: Date: 11/15/2005 Pour Time:
Code # i . - on Description Confirm # Contact # Message
199 Electrical final 021299-01 360 -601 -7930 N
Corrections /Comments /Ins ructions:
A PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: R- Me) Date: I Q5 Phone #: (503) 718 - 2 ���'