Permit CITY OF TI GARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
, DEVELOPMENT SERVICES PERMIT #: ELR2003 -00192
A 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/7/03
SITE ADDRESS: 09491 SW WASHINGTON SQUARE RD A -4 PARCEL: 1S126C0-01107
SUBDIVISION: WASHINGTON SQUARE ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
Project Description: Installation of (5) telephone props.
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:
PPR WASHINGTON SQUARE LLC LOW VOLTAGE SPECIALTIES LLC
BY THE MACERICH COMPANY 13556 SE CLAYBORNE ST
9585 SW WASHINGTON SQ. RD. PORTLAND, OR 97236
PORTLAND, OR 97223
Phone: Phone: 503 - 720 - 1881
Reg #: ELE 26 -I 155CEA
LIC 154341
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 7/7/03 $75.00 Elect'I Final
[TAX] 8% State Tax 7/7/03 $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 les adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 throuc
•
sued by `% ,0 Permittee Signat
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 639 -4175 by 7:00 P.M. for an inspection needed the next business day
ElectFlea4 Permit Application FOR OFFICE USE ONLY
Received 2 Electrical C o2-
Date/By: 7 7 � J Permit No.: 3 -0 , / 7
Cit of Ti and Planning Approval Sign
y g Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By Permit No.
Phone: 503- 639 -4171 Fax: 503 -598 -1960 A Post - Review Land Use
� Date/By. Case No.:
Internet: www.ci.tigard.or.us . V Contact _Jt os:. ® See Page 2 for
` ^
24 -hour Inspection Request: 503- 639 -4175 " Name /Method. / / _ Supplemental Information.
TYPE OF WORK PLAN REVIEW (Plea se check all that apply)
] New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
❑ Addition/alteration/replacement ❑ Other: ❑ Service over 320 amps - rating of ❑ Building over 10,000 square feet,
CATEGORY OF CONSTRUCTION 1 & 2 family dwellings four or more residential units in
LI 1 & 2- Family dwelling TA Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stones ❑ Feeders, 400 amps or more
❑ Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
JOB SITE INFORMATION and LOCATION Submit sets of plans with any of the above.
n The above are not applicable to temporary construction service.
Job site address: 9 i/ .3 sa W & IN I � -t .5 n J FEE* SCHEDULE
Suite #: 4 -0 y I Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: Z u wt 1 eL $= 3 1 Description Qty Fee (ea.) Total
Cross street/Directions to job site: New residential - single or multi - family per
l dwelling unit. Includes attached garage.
Service included:
1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 1
Limited energy, residential 75.00 2
Subdivision: Lot #: Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
DESCRIPTION OF WORK service and/or feeder 90.90 2
Services or feeders - installation,
7NS '4 ( t Cc. I S 7 /l (9 aai to alteration or relocation:
200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
❑ PROPERTY OWNER I TENANT 601 amps to 1000 amps 240.60 2
C/ � Over 1000 amps or volts 454.65 2
Name: /4'J/4. W - e S Reconnect only 66.85 2
Address: Temporary services or feeders - installation,
alteration, or relocation:
City /State /Zip: 200 amps or less 66.85 1
Phone: Fax: 201 amps to 400 amps 100 30 2
❑ APPLICANT ❑ CONTACT PERSON Branch n h circuits amps 133.75 2
Branch circuits -new, alteration, or
Name: extension per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 6.65 2
City /State /Zip: B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46.85 2
Phone: I Fax: Each additional branch circuit 6.65 2
E -mail: Misc.(Service or feeder not included):
CONTRACTOR Each pump or Irrigation circle 53.40 2
) / 1 Each sign or outline lighting 53.40 2
) Job No: 2 - / Signal circuit(s) or a limited energy panel,
alteration, or extension Page I Pa 75 Oe
Business Name: L ow \/o / -49, 5v- y Gr / L, LL C. 2 / 2
Description:
Address: (3 s6,6 5E- CIr9 Gov �-t. 5 a' +
Y Each additional inspection over the allowable in any of the above:
n City /State /Zip: Pp.r -. (9 IL 9 1 Per inspection per hour (min. 1 hour) 62.50
\ Phone:503- 720 - /6 6/ Fax: Sad - No -* 7P69 Investigation fee
Other.
CCB Lic. #: /FV,3�/ Lic. #• C -/
Electrical Permit Fees*
Supervising electrician `ol 11041 Subtotal $ 7� db
signature required: — b Plan Review (25% of Permit Fee) $
Print Name: p.ii tiEL • • Lic. #: /0 FeL C4 State Surcharge (8% of Permit Fee) $ 6.
TOTAL PERMIT FEE $ 4 O�
Authorized . 7 / 7 / 0 3 Notice: This permit application expires if a permit is not obtained within
Signs / % Date: 180 days after it has been accepted as complete.
��w.,-- *Fee methodology set by Tri- County Building Industry Service Board.
,O/9V / EC 5C t/ 5
(Please print name)
i:\Dsts\Permit Fotms\ElcPermitApp.doc 01/03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved:
r7 Audio and Stereo Systems
Burglar Alarm
Garage Door Opener
• Heating, Ventilation and Air Conditioning System
Vacuum Systems
n Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved: -
D Audio and Stereo Systems
Boiler Controls
❑ Clock Systems
gi Data Telecommunication Installation
Fire Alarm Installation
HVAC
n Instrumentation
Intercom and Paging Systems
▪ Landscape Imgation Control
❑ Medical
Nurse Calls
▪ Outdoor Landscape Lighting
n Protective Signaling
n Other
J Number of Systems
* No licenses are required. Licenses are required for all
other installations
i:\Dsts\Permit Forms \ElcPermitAppPg2.doc 01/03
CITY � F TIGARD- 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received o [ Date Requested Ti — 1 AM PM �'d1 T BUP
Location L -[ g ( .1) Suite MEC
Contact Person Ph (',' I ) – 7 !,O ? PLM
Contractor - Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access:
Ftg Drain • ELR ° ' 4
Crawl Drain
Slab Inspection Notes: SIT ) '7'
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing �r
Firewall
Fire Sprinkler -
Fire Alarm
Susp'd Ceiling
Roof
Other: -
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers -
Final � 6 3 — G G /7
PASS PART FAIL
ELECTRICAL
Service
Rough -In
ow Voltage .
Fire arm
PAS RT FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE ❑ Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date 3 Inspector i / , ..�—
Other:
Final DO NOT REMOVE this inspection record fr th ob alts.
PASS PART FAIL