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Permit %r c� C QTY OF TI GARD ELECTRICAL RESTRICTED ENERGY PERMIT �;� DEVELOPMENT SERVICES PERMIT #: ELR2005 -00240 �� � „ 13125 SW Hall Blvd., T igard, OR 97223 503 - 639 -4171 DATE ISSUED: 8/23/2005 PARCEL: 1S12600-00300 SITE ADDRESS: 09410 SW WASHINGTON SQUARE RD K -11 ZONING: C -G SUBDIVISION: WASHINGTON SQUARE LOT: JURISDICTION: TIG Project Description: Voice /Data 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 LOW VOLTAGE SPECIALTIES LLC - BY THE MACERICH COMPANY 13556 SE CLAYBORNE ST 9585 SW WASHINGTON SQUARE RD PORTLAND, OR 97236 TIGARD, OR 97223 Phone: Phone: 503 720 - 1881 Reg #: ELE 26- 1155CEA LIC 154341 FEES Description Date Amount REQUIRED ITEMS AND REPORTS [ELPRMT] ELR Permit 8/23/2005 $75.00 [TAX] 8% State Surcharl 8/23/2005 $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 -00 0100. You may obtain copies of these rules or direct quest. • _ o,.C....�•! ■:..,99. Issued By: i� lizZ76t Permittee Sig . ,;�-�� 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. r. ti - ,etlectrical Permit Application ED FOR OFFICE USE oNI.v City of Tigard „ ��� j Received Date/B — 1 J Permit No. G 0� / 13125 SW Hall Blvd., Tigard, OR 972fet‘ Plan Review Phone: 503 639.4171 Fax: 503.598.1 9 q � '''N , i I' Per nut: Date/B . Other Peut: Inspection Line: 503.639.4175 0 1-3 ,, 4 . r.-11., Date Ready/By lan El See Page 2 for Internet: www.ci.tigard.or.us WA D Notified/Method Supplemental Informat TYPE ff(Werti�C Vol`-' N PLAN REVIEW . ■ ❑ New construction lkg. o 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., CATEGORY OF CONSTRUCTION of I- and 2- family dwellings 4 or more new residential ❑ I- 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 ❑Feeders, 400 amps or more ❑Occupant load over 99 persons ❑Manufactured structures or JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park Job no.: Job site address: Sp¢4 -4G- I 1 1 � � tn 5 ❑Health care facility ❑Other: k S A. Submit 2 sets of plans with any of the above. City /State/ZIP: ' ` 5 , e .4_ The above are not applicable to temporary construction service. Suite/bldg. /apt. no.: t: te r' Project name: a FEE* SCHEDULE � Description I Qry• 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 I Limited energy, residential 75.00 2 Tax map /parcel no.: Limited energy, non - residential 75.00 2 DESCRIPTION OF WORK Each manufactured or modular l n b L dwelling, service and/or feeder 90.90 2 :Irks 4,4,' ii \• o t 6L a I CA " Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 ❑ PROPERTY OWNER ❑ 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: ( ) 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 ❑ 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: ( ) 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: I Page 2 1 S 0 2 Business name: to W i l 5 p,� t � 4r1_ C Address: / S d T s � �� v �/f'�� s Each additional inspection over allowable in any of the above Per inspection 62 50 City/ State/ZIP: 0 t -4- d /? ' 7 7 L.3 ( Investigation per hour (I hr min) 62.50 r Phone• ( - lie ._ $4- I Fax: ( •----) Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES* S CCB Lic.: I j 39 i9 1 Electrical Lic.:2 ..- • - ic.: b f . L - Subtotal 1 1 b l Si(/V Suprv. Electrician signature, re• ' / _ Plan review (25 % of permit fee) t ('_ 1 . State surcharge (8% of permit fee) r ( p • �`tI A Print name: a.>^ / / J � „ I ) 4 Dat e: L l �\ TOTAL PERMIT FEE rJ� Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete Print name: Date: • Fee methodology set by Tri- County Building Industry Service Board •• Number of inspections per permit allowed. t \ Budding \ Penn its \ELC- PermMop doc 12/03 440- 4615TO0 /02/COM/WEB Electrical Permit Application - City of Tigard i . Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: I RESIDENTIAL WORK ONLY: a.---_ _— _! Fee for all residential systems combined $75.00 Check Type of Work Involved: El Audio and Stereo Systems* El Burglar Alarm El Garage Door Opener* El Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* El Other: • i . COMMERCIAL WORK ONLY: - ; _- 1 Fee for each commercial system $75.00 (SEE OAR 91 8- 260 -260) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems Data Telecommunication Installation El Fire Alarm Installation El HVAC El Instrumentation El Intercom and Paging Systems El Landscape Irrigation Control* El Medical ' El Nurse Calls ❑ Outdoor Landscape Lighting* • ❑ Protective Signaling . El Other Total number of commercial systems: , *No licenses are required. Licenses are required for all other installations i \Building\Permus\ELC- PermitApp doc 04/03 . OF TIGARD BUILDING DIVISION PERMIT #: ELR200S-00240 13125 SW Hall, Blvd., Tigard, OR 97223 DATE ISSUED: 8/2312005 Phone: (503) 639 -4171 Inspection Requests (24 Hrs.): (503) 639 -4175 ,- I INSPECTION WORKSHEET FOR DATE: 8/24/2005 TIME: 7:08AM PAGE: 66 SITE ADDRESS: 04410 SW WASHINGTON SQUARE RD K -11 CLASS OF WORK: SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE: PROJECT NAME: LEGO DESCRIPTION: VoicefData OWNER: WASHINGTON SQUARE LLC, PHONE #: CONTRACTOR: LOW VOLTAGE SPECI A6TIES LLC PHONE #: 503 -720 -1881 Inspection Request Scheduled For: te: 8/24/2005 Pour Time: Code # Ins ection Description - . - Contact # Message 199 Electrical fina�� 0141 _ 01 503 -720 -1881 N Corrections /Comment ructions: • r% N L .E `R 1 ��° — 002 6�. N 1 ‘ 1 • A PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: ©e) Le Date: $' - Phone #: (503) 718 - 2 - 44, •