Permit CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
PERMIT #: ELR2005 -00338
DEVELOPMENT SERVICES DATE ISSUED: 10/12/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 1S12600 -00300
SITE ADDRESS: 09374 SW WASHINGTON SQUARE RD ZONING: C -G
SUBDIVISION: WASHINGTON SQUARE LOT: JURISDICTION: TIG
Project Description: HVAC.
j' c=►\p ki
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 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 10/12/200E $75.00
[TAX] 8% State Surchart 10/12/200E $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 q esti n to O C t 503 - 246 -6699.
Issued By: L,Gi Permittee Signature:
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.
•Electrical Permit Application 1.0R m 01.1 I t l : I S I: t) w 1.,
•
City of Tigard Received — , ., A 6) :MON
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 ��," . - .k• '` D�/B : other Permit.
Inspection Line: 503.639.4175 '1 I„ Date Ready/By: El See Page 2 for
Internet www.ci.tigard.or.us Notified/Method: I= Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ❑ Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑Other; OService over 225 amps, comm'l ❑Hazardous location
❑Service over 320 amps — rating DBuildn over 10,000 sq ft.,
CATEGORY OF • CONSTRUCTION • of 1- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
❑Building over three stories 0 Feeders, 400 amps or more
❑ Multi- family 0 Master builder 0 Other:
JOB SITE INFORMATION AND LOCATION ❑Occupant load over 99 persons ❑KVu pied structures or
❑Egress/lighting plan park
Job no.: I Job site address: I 1 \ -- (j,, facility ❑Other:
�� / �^' Q S ` S P �� 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.: I Project name: (? FEE* SCHEDULE
v- P 'f 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: I Lot no.: Ea. add'I 500 sq. R or portion 33.40 I
Limited energy, residential 75 00 2
Tax map /parcel no.: Limited energy, non-residential
•''' ' . • • DESCRIPTION OF WORK Each manuf red orr modu err 75 00 2
` v O dwelling, service and/or feeder 90 90 2
r, ) 'r1 Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
'13' 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: ( ) 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: 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 , . energy panel, alteration, or
extension. Describe: Page 2 2
Business name: oetotgy Me G (y1Gin i Cot ( 5 yc ewL S
Address: 7Q / / NE_ 3 3rd 56,0-.e._ 'j. 5 O Each additional inspection over allowable in any of the above
/ Per inspection 62.50
City/ State/ZIP: Por,filci LA 4 02 C 1 - 7 2 ( Investigation per hour (I hr min) 62.50
b Phone: (5•25) ( 2.( - $ c(o to I Fax: (503) 61-1 - Ca 3 4 8 Industrial plant per hour 73.75
Elec trical Lie.- ELECTRICAL PERMIT FEES!
I CCB Lic.:
63 /S$ y I •3391x Suprv. ic.: 145LE Subtotal
Suprv. Electrician signature, required: f Plan review (25% of permit fee)
Print name: 0 ot i d s Le I D
State surcharge (8% of permit fee)
Y • t o -!l - 05 TOTAL PERMIT FEE
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: 20 a 1, o f 0 eW t I Date: 1 p _i t _05 • Fee methodology set by Tri County Building Industry Service Board
•• Number of inspections per permit allowed
i• tBuilding1PermitssELC- PamitApp.doe 12/03 440.4615T(l0/07lCOM/WEB
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2005 -00338
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/12/2005
Phone: (503) 639 -4171 A
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 11/9/2005 TIME: 7:09AM PAGE: 31
SITE ADDRESS: 09374 SW WASHINGTON SQUARE RD CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE:
PROJECT NAME: PAPYRUS
DESCRIPTION: HVAC.
OWNER: WASHINGTON SQUARE LLC, PHONE #: 503- 639 -8865
CONTRACTOR: BEWLEY MECHANICAL SYSTEMS PHONE #: 503 - 626 -8986
Inspection Request Scheduled For: Date: 11/9/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
195N Misc. inspection 020839 -01 360.907 -0718 Y
Corrections/Comments/Instructions:
v
•
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PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: l/ r/r Phone #: (503) 718-
.