Permit CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
i� DEVELOPMENT SERVICES PERMIT #: ELR2005 -00210
— 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 7/28/2005
PARCEL: 1S12600-00300
SITE ADDRESS: 09367 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 7/28/2005 $75.00
[TAX] 8% State Surchart 7/28/2005 $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 f. : • : adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -001 -0010
thro OAR 952 -b S 1 -t You may obtain copies of these rules or direct questions to OUNC at 503 - 246 -6699.
Iss ed By: ' k �1 J _�_ Permittee Signature:)C , ,b,,,,,�: ‘"‘",q.vti1
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.
Electltikal Permit Application FOR OFFICE USE ONLY
City of Tigard Date/B • Received / ;� /
Z ' ,.. •m- o
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598 1960 A'' 1'
• 1 1 Date/B Other Permit.
Inspection Line 503 639.4175 0 7 e•' Date Ready/By HI See Page 2 for
Internet: www ci.tigard or us Notified/Method Supplemental Information
x ■ :• =, - - ,- . TYPE; O WORK: ' - . - ?,. „ ' ' •- ; : •• ,_ -, - PLAN.-REVIEW
few construction ❑ Addition/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 ,
-. s'• • w•'CATEGOltY .OF .CONSTRUCTION:' t' ='x —' of 1- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling Wtommercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi family ❑Master builder ❑Other: ❑Building over three stones ❑Feeders, 400 amps or more
['Occupant load over 99 persons ❑Manufactured structures or
• ` > Ti p . = - ❑ Egress/hghting plan RV park
• ': . r } o '�dOB S E IIYFORMA ON Ai�iD LOCATION ' ' 4
❑Health -care facility ['Other.
Job no.: Job site address: p `� () I
L 3 to 1 au i z1 S, K dI Submit 2 sets of plans with any of the above.
`Tk City/State/ZIP: na,rok (} The above are not applicable to temporary construction service
3 ` "
IA
. ;- ` ..;'•.• s'� E *
:FE_ <S:CH DULE's:-
Suite/bldg. /apt. no.: Project name / �) ^ a
/- X.- l.Ltit.•�Wl S — B"WLD�- Description . 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
r :'. ,,. z :' `. . •fy: ; ';■E OF WO M ' 4: ii - . ; . ::'. Ai' rr ; _ : : Each manufactured or modular
f ^ �- � { dwelling, service and /or feeder 90 90 2
(-- V1-l.) 1 (. bQ Q IU..) vY � c Tin 4 t - ' - ' 7s. 4 Services or feeders installation, alteration, and/or relocation
200 amps or less 80 30 2
• - _ - , i,...•'• 201 amps to 400 amps 10685 2
• ID PROPERTY OWNER " <= 0 TENAI!IT" _ .
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
a'` 1 -"! - D APPLICANT'•' `'' r`' v h l ; ' 111 CoNTACr PE1StSO V ' k = - 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: without service or feeder fee,
46.85 2
each branch circuit
Address.
Each add'l branch circuit 6.65 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Pump or imgation circle 53.40 2
Phone: ( ) Fax:: ( )
Sign or outline lighting 53 40 2
E -mail: Signal circuit(s) or limited-
Y 4 . CONTRACTOR " -. f'1,; " . energy panel, alteration, or 75.0D
Business name: � \ \Aa `:7.:.,..; " ' extension Describe / Page 2 2
.
Address: ( 8g ..SE -i' I Each additional inspection over allowable in any of the above
Nu) � Per inspection 62.50
City /State/ZIP: I VL J O J' (j 1 (7y - 7 as a_ Investigation per hour (I hr min) 62.50
Phone: 6b3) 1 4(02 - 4 $ax ax: o3) ` CO 55 5 Industrial plant per hour 73.75
;'ELECTRICAL'.PERMIT •FEES' '
CCB Lic.: 50897 Electrical Lic.a(p.. .-// CLt1 Suprv. Lic.: a I Lzs Subtotal
Suprv. Electrician signature, required: 6,(j Plan review (25% of permit fee)
� � 2$ , D3 State surcharge (8% of permit fee)
Prutt name: "—Milk V l I �Yl Date 1 . ,
TOTAL PERMIT FEE
Authorized signature: S1412.-44.A..0—.., Nlbla , rv1 This permit application expires if a permit is not obtained within 180
i 111777 days after it has been accepted as complete
Print name: ` 7 V.ceXv\Z4 , S tSY1 Date: 1(2$'(0 S • Fee methodology set by Tn- County Building Industry Service Board
t
•• Number of =peewits per permit allowed -
i \Building\Pertruts\ELC- PemntApp dot 12/03 440 -46I ST( I 0/02/COM/WEB
Electrical Permit Application - City of Tigard '
Page 2 -Supplemental Information
LIMITED ENERGY PERMIT FEES:
vs- r+veu+we. . ; a*.s. 3 � ...� ,. �w.tr. t• �.., �'_
PRESID E_Ntra_W ITT E:�' R.W. <`` AUM
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:
ran.. `-° R lic.O I A : ,,,T E A
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
,AVIIVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
•
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems: I
*No licenses are required. Licenses are required
for all other installations
i \Building\Pemuu\ELC- PernmApp doc 04/03
i
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2005-00210
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/28/2005
Phone: (503) 639- 4171
Inspection Requests (24 Hrs.): (503) 639 -4175 __..
INSPECTION WORKSHEET FOR DATE: 11/15/2005 TIME: 7:02AM PAGE: 82
SITE ADDRESS: 09367 SW WASHINGTON SQUARE RD CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE:
PROJECT NAME: WILLIAMS- SONOMA
DESCRIPTION: Limited energy for HVAC.
OWNER: WASHINGTON SQUARE LLC, PHONE #: 503-639-8865
CONTRACTOR: VAC INC PHONE #: 503 - 462-4822
Inspection Request Sche• . led For: • Date: 11/15/2005 Pour Time:
Code # Inspection Des. iption Confirm # Contact # Message
199 Electrical fins 021274 -02 503. 462 -4822 N
Corrections/Comments/Instructions:
C. 1 N 6F1 e44.4 't S nil 661Nq
fi , \ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Wtb Date: lI I Q Phone #: (503) 718- Zttitb•