Permit A !Q
CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
�� DEVELOPMENT SERVICES PERMIT #: ELR2005 -00319
_Ai AI' 13125 SW Hall Blvd., T OR 97223 503 - 639 -4171 DATE ISSUED: 10/4/2005
PARCEL: 1S12600-00300
SITE ADDRESS: 09364 SW WASHINGTON SQUARE RD ZONING: C -G
SUBDIVISION: WASHINGTON SQUARE LOT: JURISDICTION: TIG
Project Description: Limited energy 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: 503 639 - 8865 Phone: 503 462 - 4822
Reg #: LIC 50897
ELE 26 -571 CLE
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 10/3/2005 $75.00
[TAX] 8% State Surchart 10/3/2005 $6.00
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and
all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not
started withinlR0 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires
you t• • ow rules a,'op - •,b he Oregon Utility Notification Center. Those rules are set fo h i OAR 952 - 001 -0010
thr. ugh OAR 952 -00 ; 01 , u may ob in copies of these rules or di red ques u• ns o U C 50 - 246 -6699.
I - sued By: Permittee Signature: V ► 1
OWNER INSTALLATION ONLY '
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N DATE:
LICENSE NO:
Call 503 -639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Eleetric2l Permit Application FOR OFFICE USE ONLY
City of Tigard Received /0 dim Permit No . E i
13125 SW Hall Blvd , Tigard, OR 97223 Plan Review
Phone: 503 639.4171 Fax: 503 598.1960 4 • • °;i l ''� Date/B Other Permit
u
Inspection Line 503 639.4175 � n' I Date Ready/By ® See Page 2 for
Internet: www ci tigard.or us Notified/Method i f Supplemental Information
" ; ', ' - . • -'i:. -TYPEOF'WORIC - - _ , . '.
'v � ='� �� ' -_ ^ ^ , LL a�,� = ; ;. ���•: : :.: PLAN-REVIEW
❑ New construction Addit 7altetation placement Please check all that apply
❑ Demolition ❑Other: ❑Service over 225 amps, comm'l ['Hazardous location
['Service over 320 amps - rating ❑ Buildng over 10,000 sq ft ,
-•_, 7 ; • , ,,!CATEG$R CONSTRUCTION _`_i ?- . .1=:'i' > ' of 1- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling ommercial/ dustrial ❑ Accessory building OSystem over 600 volts nominal units in one structure
❑ Multi- family Master builder ❑Other: ['Building over three stones ❑Feeders, 400 amps or more
M .[ : ; F # ,
DOccupant load over 99 persons ['Manufactured structures or
,
.. : JOB1 AND SITE' LOCATION' y ❑Egress/lighhng plan RV park
� • � y -, ,-' r •,' ' c4Vcif Job no.: Job site address:i9 , 910 0_,Aa.94 ❑Health -care facility ['Other Submit 2 sets of plans with any of the above.
City /State /ZIP: 773 Q/Yj Orej P1 The above are not applicable to temporary construction service
Suite/bldg. /apt. no.: k� Project name / , ,, ! , , / ez -Cob- l ' - ,' S ' t _`: FEE *_ <SCI:t0 E ..
V�-l.,AudA d
/ :'.' Description 1 I Qty. I Fee. I 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
Limited energy, non - residential 75.00 2
y1 . - , , .'' e-1,; D ESCRI R TI O YY , O t ' : • 4 - ' , ;r % r'_ Each manufactured or modular •
11 c�- dwelling, service and /or feeder 90.90 2
ttnA. U O f lei (JtJY( p q1- 4rot.-o 5 k Services or feeders installation, alteration, and/or relocation
200 amps or less 80 30 2
❑ -PRQRI RTY OWNER ' I " ,�]. TENANT •- - K : • 4i; 201 amps to 400 amps 106 85 2
r ,.
401 a mps 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
-' .•a-"' .:".c a APPE;IC c . .
; -,. ?` • "'' �8 • : i9 GON`.CACI A -it8-0 'q A Fee for branch circuits with
to irk• L r - ._ ti .. :
service or feeder fee, each 6 65 2
Business name: branch circuit
Contact name: B. Fee for branch circuits
without service or feeder fee, 46.85 2
Address: each branch circuit
Each add'I branch circuit 6 65 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) Fax:: ( ) Pump or imgation circle 53.40 2
Sign or outline lighting 53 40 2
E -mail: Signal circuit(s) or limited -
K. _,:, ''' . i't : 2 :• - •.'''' : ' , .; - .1 i 4 = :7'.- ,' • i''. - i ener oriel, alteration, or
> ti : . CONT I OR ..� .. gy P
extension. Descnbe� / r Page 2 2
Business name: - A.UA. - '� C (/
Address: j j O O S 6 ' .,, L • Each additional inspection over allowable in any of the above
+-` , Per inspection 62 50
City/State/ZIP: c“, ( r � e ,•Yl Investigation per hour (I hr min) 62 50
( F ax: r� t C Industrial plant per hour 73.75
Phone:
) Li cox_ I $'l ( S D3 ) Lf (02- (p - 5$ . ' .`' . EDECTRICAL' ,PERMI7r' FEES* '-. -�
CCB Lic.: So7CI Electrical Lic a/0 - 57 1 &E Suprv. Lic r1„2y I F--A Subtotal
Suprv. Electrician signature, required: `2 Plan review (25% of permit fee)
Print name: _,yl VV L is 0 ....,, r1 Date i b/ I State surcharge (8% of permit fee)
TOTAL PERMIT FEE
Authorized signature: G�� Rb to _ ) This permit application expires if a permit is not obtained within iSO
/� `� days after it has been accepted as complete
Print name: I „ ,..,.../ e O 6 S � ,, Date: I 0 /Y • Fee methodology set by Tri- County Building Industry Service Board
��V lll��llCCAii ►►► •• Number of usspecnons per perrrut allowed.
i \Buiidmg\Pemuts\ELC- PemutApp doe 12/03 440 - 461 Sr(10 /02/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
Tagf mmaa- ; 1 f WORT r Y:'.Y'WM��"12 t..Tiai'�yl*�+y
�- S - - -- - NI•�' .._.1 .:•� _.�_-1H?t- �,.= �`JSYt"M�W
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
[II Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
CO 1VISMR 7 : ; ' W p O1VLI
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
I \Buddmg\ Permits \ELC•PamdApp doc 04/03
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2005 -00319
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/4/2005
Phone: (503) 639 -4171 - /41 4111
Inspection Requests (24 Hrs.): (503) 639 - 4175
INSPECTION WORKSHEET FOR DATE: 11/16/2005 TIME: 7:03AM PAGE: 79
SITE ADDRESS: 09364 SW WASHINGTON SQ • RE RD CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE:
PROJECT NAME: HIALI DA SOLE
DESCRIPTION: u nited energy for HVAC.
OWNER: WASHINGTON SQUARE LLC, PHONE #: 503 - 639 -8865
CONTRACTOR: HVAC INC PHONE #: 503. 462 -4822
Inspection Request Scheduled For: Date: 11/ 2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
• a • e 021395 -01 503- 462 -4822 N
VA 14
Corrections /Comments /I • = ructions:
•
!A PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: c) N N 68 LI Date: U(j O5 Phone #: (503) 718 - - "1`Vb•