Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00775
�i11 DEVELOPMENT SERVICES DATE ISSUED: 10/18/2005
"- 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 - 4171
PARCEL: 1S12600-00300
SITE ADDRESS: 09367 SW WASHINGTON SQUARE RD ZONING: C -G
SUBDIVISION: WASHINGTON SQUARE LOT : JURISDICTION: TIG
Project Description: Sign lighting for (1) sign.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG: 1
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HM/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10):
SERVICE/FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
WASHINGTON SQUARE LLC
BY THE MACERICH COMPANY
9585 SW WASHINGTON SQUARE RD
TIGARD, OR 97223
Phone: 503 - 639 -8865 Phone:
FEES Reg #:
Description Date Amount
[ELPRMT] ELC Permit 10/18/200: $53.40
[TAX] 8% State Surcharge 10/18/200: $4.28 REQUIRED ITEMS AND REPORTS
Total $57.68
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Code nd all ther applicable laws. All
work will be done in accordance with approved plans. This permit will expire if work is not started within 180 day f issuan , or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility tification enter. 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 0 C at 503 - 246 -6699 or
1- 800 - 332 -2344.
Issued By: - , tom 2
Permittee Signature: �����
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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.
5GN aoo5 --ooa.1
'4 F.lectI cal Permit Application FoR OFFICE ust: ONLY
City of Tigard Received e 0 I3 Q5 Permit No.• E , , -0977 •
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 fit" lk.h.sA I e DateB : Other Permit:
Inspection Line: 503.639.4175 ^'I I Date ReadyBy: ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method WreM Supplemental Information
TYPE OF WORK PLAN REVIEW
. 4ew- construction ❑ Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑Other: ❑Service over 225 amps, comm'I ❑Hazardous location
❑Service over 320 amps - rating ❑Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of l- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling etzamercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi- family ❑Master builder ❑Other: ❑Bwlding over three stories ❑Feeders, 400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ( ,G//�/ ❑Egress/lighting plan RV park
Job no.: Job site address: / , � �V' / 5 ❑Health -care facility [Other:
Submit 2 sets of plans with any of the above.
City/ State/ZIP! - / ri ` The above are not applicable to temporary construction service.
�_'! 3 ro name ,,�-/ 1/� FEE SCHEDULE
°
S uit t /bldg. /apt no. AAAI Description I Qty. 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: 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
DESCRIPTION OF WORK Each manufactured or modular
II P /.i _ / - / l/ dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
‹.5"-}-4 200 amps or less I I 80.30 I 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: ( ) l Fax' ( ) 200 amps or less 66.85 l
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 I 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
❑ APPL I ONTACT 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: / C ': i�
f 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: ( ) I Fax: : ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting ' 53.40 2
E -mail: Signal circuit(s) or limited -
CONTRACTOR J energy panel, alteration, or
,ArAJ _ ../
extension. Describe: Page 2 2
Business name:
Address: �� Each additional inspection over allowable in any of the above
Per inspection 62.50
City/ State/ZIP: � � `J i ' / Inv estigation per how (I hr mm) 62.50
Industrial plant per hotu 73.75
Phone �� , 3083 F ).,P- �
- 0 _ ELECTRICAL PERMIT FEES*
/
CCB Lic.: y/0 Electrical Lic �J / _'JD 4 Suprv. Lic.: 7a S Subtotal
Suprv. Electrician signature, r 'red: / a.- -- Plan review (25% of permit fee)
L t�
Print name: Date: State surcharge (8% of permit fee)
�� TOTAL PERMIT FEE
-
Authorized signature: � 'Ibis permit application expires if a permit is not obtained within 180
- days after it has been accepted as complete
Print name: Date: /Z3i ^ Fie m set by Tel-County Rnildinv Indnctry Service Rnani
4 A Aitri,/)
CITY OF TIGARD Ez_6 775
BUILDING DIVISION PERMIT #:
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 �'
Inspection Requests (24 Hrs.): (503) 639 -4175 .. • I I..
INSPECTION WORKSHEET FOR DATE: ` TIME: PAGE:
SITE ADDRESS: ? 3 CQ • IA / < < ,S6 • 1 `li ' CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: LOW/ Y I i 6-yn 0\(\,A,
A-
DESCRIPTION: �(
OWNER: PHONE #:
CONTRACTOR. PHONE #:
Inspection Request Scheduled For: Date: / 1 7 ' Q5 Pour Time:
Code Insp- '•n Description k onfirm # Contact # Message
• I •• • •• - Instructio
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wri EL 'Loo O Oc‘ C
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PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL C LL FO" IN PECTIO ❑ ADDITIONAL FEES ASSESSED
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Inspector: Date: v ! � Phone #: (503) 718- 24`x6