Permit CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
i �► DEVELOPMENT SERVICES PERMIT #: ELR2005 - 00393
'I I° 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 11/4/2005
PARCEL: 1S 12600 - 00300
SITE ADDRESS: 09367 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. / , �
e /
Issued By: ���� Permittee Signature: , 4 0.)
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.
zs
-' '• Electrical Permit A o WeGiEl V ED FoR OFFICE USE ()NIA
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City of Tigard � ived — 1)./ ►�� Permit No.. ,d 31' i
13125 SW Hall Blvd., Tigard, OR 97223N0 U `] � 4 2005 Plan Review
g'_ - r, Other Pemut:
Phone: 503.639.4171 Fax: 503.5981.960 y I" Dac
Inspection Line: 503.639.4175 V I I Y OF TIGARD �_. ^'I I Date Ready/By ® See Page z for
Internet: www.ci.tigard.or.us BUILDING DIVISION Notified/Method Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction 12-Kddition/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. fl,
CATEGORY OF CONSTRUCTION of I- and 2- family dwellings 4 or more new residential
❑ I - and 2 family dwelling ...g ❑ 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
❑Occupant load over 99 persons OManufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park
L ❑Health -care facility ❑per:
Job no.: Job site address: 936 7 5) ) 4 17M .' ua/[ Submit 2 sets of plans with any of the above.
City/ State/ZIP: T g 0L • of v'` q 7 u 3 The above are not applicable to temporary construction service.
FEE* SCHEDULE
Suite/bldg. /apt. no.: Project name: A3 /'/t, aw.5 ,Sct u o vu A.
Description I Qty,I Fee. Total I ••
Cross street/directions to job site: - 5 , f�Q S j t uY �> A New residential single or multi family dwelling unit.
Includes attached garage.
5-ex. ,.a a /424 1 - 1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 I
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
�� / /� DESCRIPTION OF WORK Each manufactured or modular
1 e' .' /4; /74 ( t-G S (/K •+- eVS Services or feeders installation, feeder _ 90.90 2
Services or feeders installatiom, 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
Phone: ( ) Fax: ( ) relocation ,
200 amps or l ess 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 ...r0- €ONTACT PERSON A. Fee for branch circuits with
n service or feeder fee, each 6.65 2
• Business name: l�✓ /7z D X I lP--/- r/ L branch circuit
B. Fee for branch circuits
Contact name: Armen �Q, (. without service or feeder fee, 46.85 2
Address: _ each branch circuit
ADD /€J45 k c q S Each add'I branch circuit - 6.65 2
City/ State/ZIP: Miscellaneous (service or feeder not included)
t/a ��e t c. v c✓ t u� � 4866 0
Fax: ; Pump or irrigation circle 53.40 2
Phone:
(360) 9� y S/ 7 360 ) 6 �8d Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited-
CONTRACTOR energy panel, alteration, or
S
extension. Describe:
/ Page 2 2
Business name: Z x ' /ecI r, 't Z c.
Address: Each additional inspection over allowable in any of the above
DD e i/ a 3 k , ti �a+„ 51--
Per inspection 62.50
City / State/ZIP: / J a _� Cz �V ate t t,C/A ? ' 6 to & Investigation per hour (I hr min) 62.50
Phone: ( ho ) w 9q - 3 Dn Fax: ( leo ) /9°/ 323 / Industrial plant per hour - 73.75 _ -
El e ctrical Lic.: Suprv. Lic.: ELECTRICAL PERMIT FEES*
CCB Lic.:
/!� 0 / Y/ 37 - / /� p y9/6 5 Subtotal -75
Suprv. Electrician signature, required: -� ��� Plan review (25 %ofpermit fee)
D State surcharge (8% of permit fee)
_ R
Print name: Zu r �f Date: 7 // j /
TOTAL PERMIT FEE
Authorized signature: p This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: A. r , , r Date: ///y/ • Fee methodology set by Tn- County Building Industry Service Board
• • Number of inspections per permit allowed.
1 \Building\Permit\ELC- PamitApp doe 11/03 440- 4615T(I0/02/COM/WIB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
r RESIDENTIAL WORK ONLY:
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 Condi oning
System*
Vacuum Systems*
❑ . ther:
COMMERC •■ WORK ONL :
Fee for each com I. • rcial syste $75.00
(SEE OAR 918-261 60)
Check Type of Work Invo ed:
❑ Audio and Stereo systems
❑ Boiler Controls
❑ Clock Syste s
Data Tele. o mmunication Installation
❑ Fire Al. Installation
❑ HV•
❑ In. • mentation
❑ ntercom 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
\Building\PcnnosELC- PamuApp doc 07/03
I
CITY OF TIGARD
A 4 •
BUILDING DIVISION PERMIT #: ELR 2006 -00393
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/4/2005
Phone: (503) 639 -4171 14 ��I�It I
Inspection Requests (24 Hrs.): (503) 639 -4175 ..' ..
INSPECTION WORKSHEET FOR DATE: 11/10/2005 TIME: 7:02AM PAGE: 105
SITE ADDRESS: 09367 SW , SHINGTON SQUARE RD CLASS OF WORK:
SUBDIVISION: WASHINGTO SQUARE LOT #: TYPE OF USE:
PROJECT NAME: WILLIAMS -SON' A
DESCRIPTION: D3talTelecommuni►. ion.
OWNER: WASHINGTON SQUA LLC, PHONE #: 503 - 639-8865
CONTRACTOR: WILCOX ELECTRIC PHONE #: 360- 694 -3800
Inspection Request Scheduled For: Date: 11/10/2005 Pour Time:
Code # Inspection Description onfirm # Contact # Message
135 Low voltage 0'0885 -01 503-572 -5590 N
Corrections /Comments /Instructions:
A PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 6.-- f\14(13 (_ Date: 11 f i b W Phone #: (503) 718- 2,L11.110