Permit w
CITY C TIGARD
�,•, C I 1 1 O C ELECTRICAL PERMIT
PERMIT #: ELC2005 -00899
DEVELOPMENT SERVICES DATE ISSUED: 11/15/2005
, e.;!
13125 SW Hall Blvd., Tigard, OR 97223 503 PARCEL: 1S12600 - 00300
SITE ADDRESS: 09378 SW WASHINGTON SQUARE RD ZONING: C -
SUBDIVISION: WASHINGTON SQUARE LOT : JURISDICTION: TIG
Project Description: 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 HIGHLIGHT SIGN CORP
BY THE MACERICH COMPANY PO BOX 23667
9585 SW WASHINGTON SQUARE RD TIGARD, OR 97281 -3667
TIGARD, OR 97223
Phone: Phone: 503 - 620 - 8205
FEES Reg #: LIC 104599
Description Date Amount SUP 517SIG
ELE 37- 660CLS
[ELPRMT] ELC Permit 11/15/200' $53.40
[TAX] 8% State Surcharge 11/15/200' $4.27 REQUIRED ITEMS AND REPORTS
Total $57.67
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 .1 246 -6699 or
1- 800 - 332 -2344. i
Issued By: Permittee Signature: : 1`L `��
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.
lectrlcal Permi =g tiVIED . . roR OFFICE. u,SE ()NIA -:
City of Tigard RDeeived , f i C5L ' f- •
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.5984Uto 1 5 2005 d:, 1,h, Date/B Other Permit.
Inspection Line: 503.639.4175 . . = 'f I El See Page 2 for
Internet: www.ci.tigard.or.us CITY OF TIGARD Notified/Method EE's l I
Supplementanformation
BUIL M. iWB Q . PLAN REVIEW
❑ New construction ❑ Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑Other: ['Service ['Hazardous over 225 amps, com'l Hazardous location
['Service over 320 amps – rating ❑ Buildng 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
❑ Multi - family ❑Master builder ❑Other: ['Building over three stories 0 Feeders, 400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION RV
❑Egress/lightingp1an park
❑Health -care facility Elder:
Job no.: Job site address:
3 77 Sw , L.' A! N . SQ. A. . Submit 2 sets of plans with any of the above.
City/State/ZIP: 7 6AR () 0 2 . -I 7 00 7 The above are not applicable to temporary construction service.
v FEE* SCHEDULE
Suite/bldg. /apt. no.: k _Q Project name: D u c ic_ S Ho
P 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: (,../A.3 N * s e. p ...c_ Lot no.: Ea. add'I 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
J1 dwelling, service and/or feeder 90.90 2
J y Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
iii PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
A ,t 401 amps to 600 amps 160.60 2
Name: L.01 ° g/A IDA vQ U to £ V
S V D e,ILD 601 amps to 1,000 amps 240.60 2
Address: 9 0 / Wi Lf Hittia. a t ✓Q . Slit ' D-0 Over 1,000 amps or volts 454.65 2
p� Reconnect only 66.85 2
City/ State/ZIP: S' t A 1u=oN / GA j OA _ q' yD 7 Temporary services or feeders installation, alteration, and/or
Phone: ( , p) 31 4 _ ca-0 0 Fax: ( ) relocation 2000 0 amps
or less 66.85 1
Owner installation: This installation is being made on property that 1 own which is not 201 amps to 400 amps 100.30 2
intended for sale, leas , re or ex ange, rding to ORS 447, 449, 670, d 401 amps to 600 amps 133.75 2
Owner signature' . t► Date: // / �} C Branch circuits – new, alteration, or extension, per panel
• PLICANT I ❑ CONTACT P RSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: j 4 w4..... fr-1 �>I =L,O fie' 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: ( ) p er:: ( ) 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
r � extension. Describe: Page 2 2
Business name: ( pt. S/b a1 S mi t'_ s4) I� ates.2 y
Address: / Each additional inspection over allowable in any of the above
�f Z d INuN ti Kert « - Per inspection 62.50
City/State/ZIP: 7 ) 4 ft n 0 it t 7 z_,-:._ 1 Investigation per hour (1 hr min) 62.50
Phone:
( ) b IO — O Zo f Fax: ( ) Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.:/0 / S$q Electrical Lic.: S // b S (7 Suprv. Lic.:26-'7_ LLI Subtotal
Suprv. Electrician signature, required:04,4A._ Plan review (25 %ofpermit fee)
Print name: 067( Lr L 4 4 y Date: _ State surcharge (8% of permit fee)
/0 3 /�S
TOTAL PERMIT FEE 11, 6 7
Authorized signature: ",/,,Ass„. _ This permit application expires if a permit is not obtained within ISO
days after it has been accepted as complete
Print name: Date: //,f ?/40 /` Fee methodology set by Tn County Building Industry Service Board
Number of inspections per permit allowed.
i \ Building \Pennits\ELC- PermitApp doe 12/03 440- 4615T(10/02JCOM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
-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 Conditioning
System*
❑ Vacuum Systems*
❑ Other:
( •
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. UBuildmg \Permrts\ELC- PermitApp.dot 04/03
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2005 -0089'
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/15/2005
Phone: (503) 639-4171
Requests (24 Hrs.): (503) 639 -41
INSPECTION WORKSHEET FOR DATE: 11/1812005 TIME: 7:17AM PAGE: 110
SITE ADDRESS: 09378 SW WASHINGTON SO ARE RD CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE:
PROJECT NAME: DUCK SHOP
DESCRIPTION: Sign.
OWNER: WASHINGTON SQUARE LLC, PHONE #:
CONTRACTOR: HIGHLIGHT SIGN CORP PHONE #: 503 - 620-8205
Inspection Request Scheduled For: Date: , 1/1812005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
140 _ Si ,. • _ . on — 021762 -01 503- 642 -1464 N
• - - - - /Commen uctions:
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" PAS• ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: c • N "6 L . Date: It `% • OS Phone #: (503) 718- Z LK) •