Permit CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
I DEVELOPMENT SERVICES PERMIT #: ELR2003 -00228
,,� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/29/03
SITE ADDRESS: 09493 SW WASHINGTON SQUARE RD A -3 PARCEL: 1S126C0 -01107
SUBDIVISION: WASHINGTON SQUARE ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
Project Description: Low voltage system to HVAC thermostats.
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:
PPR WASHINGTON SQUARE LLC HVAC INC
BY THE MACERICH COMPANY 5188 SE INTERNATIONAL WAY
9585 SW WASHINGTON SQ. RD. MILWAUKIE, OR 97222
PORTLAND, OR 97223
Phone: Phone: 503 462 - 4822
Reg #: LIC 50897
ELE 26- 571CLE
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 7/29/03 $75.00 Elect'I Final
[TAX] 8% State'Tax 7/29/03 $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 follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 throuc
Issued by 7 ��� Permittee Signature j 4(
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
h. Electrical Permit Application
RECEIVED Date received: ej_'3 Permitno.: / exo3 -t04 !;
J , :a i City of Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard 2 97223. Date issued: By: .6 Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
CITY OF TIGARD
Land use approval: B .i Dlnlr4 nIVISION
• �---- ��""TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory QCQ ❑ Multi- family ❑ Tenant improvement
❑ New construction (lA Additio .40 terati • r eplacement ❑ Other: ❑ Partial
. • JOB SITE INFORMATION '
Job address: (7J3 3ce W S ei Bldg. no.: Suite no.:4 Tax map /tax lot/account no.:
Lot: I Block: 'Subdivision:
Project name: rn0 t4 t knad 11/6117 yru I Description and location of work on premises: rn@cc,nf h'&,v ,e,„, mo Cam.I
Estimated date of completion/inspection:
CONTRACTOR APPLICATION' FEE SCIIEDl.1LE
Job no: Fee Max
Business name: 4.11/4J4e Description Qty. (ea.) Total no. insp
New residential - single or multi- family per
Address: S\ 5e ±4_34 dwelling
City:Ma /4jQ-tacie. I Jtate:Q I ZIP: q7 a',.. Serviceincluded:
Phone: LI (o),(i F;-�a I Fax: / - t,555 I E -mail: 1000 sq. ft. or less 4
CCB no.: 502C) -' I Elec. bus. lic. no: 0(0 — 571 C.A.--t., _
Each additional eny 500 si sq. ft or portion thereof
no.: Limited energy, residential 2
City /metro lic. no.: ,D._‘ �q Limited ener
gy, non-residential 2
�.6_il4 t_ C`ryL-- .7 J30l0 Each manufactured home or modular dwelling
Signature of supervising electrician (required) Date t Service and/or feeder 2
Sup. elect. name (print):' r , VI License no: ` :, _..:;,/ Services or feeders — installation,
alteration or relocation:
PROPERTY OWNER . 200 amps or less 2
• Name (print): 201 amps to 400 amps 2
Mailing address: 401 amps to 600 amps 2
601 amps to 1000 amps 2
City: I State: I ZIP: Over 1000 amps or volts 2
Phone: I Fax: I E -mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services or feeders -
which is not intended for sale, lease, rent, or exchange according to Installation, alteration, or relocation:
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 amps 2
ENGINEER • Branch circuits - new, alteration,
or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: I State: - I ZIP: B. Fee for branch circuits without purchase
Phone: Fax: E -mail: of service or feeder fee, first branch circuit: 2
Each additional branch circuit:
I'LAN REVIEW (Please check all that apply) Misc. (Service or feeder not lncluded):
❑ Service over 225 amps- commercial ❑ Health-care facility Each pump or irrigation circle 2
O Service over 320 amps -rating of 1 &2 0 Hazardous location Each sign or outline lighting 2
family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
O System over 600 volts nominal more residential units in one structure alteration, or extensions 2
O Building over three stories O Feeders, 400 amps or more *Description: _
O Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional Inspection over the allowable In any of the above:
O Egress/lighting plan , O Other.
Per inspection I I I I
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application
Permit fee $ 7s -O
O Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number. / / within 180 days after it has been State surcharge (8 %) .... $ b. OO
Expires accepted as complete. TOTAL $ I .0 0
Name of cardholder as shown on credit card
Cardholder signature Amount 440 - 4615 (6.00(COM)
Electrical Permit Fees : Limited Energy Fees: ,
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
p Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total 4, Check Type of Work Involved:
Residential - per unit
1000 sq. ft or less $145.15 4 ❑ Audio and Stereo Systems
Each additional 500 sq. ft. or
portion thereof $33.40 1 ❑ Burglar Alarm
Limited Energy $75.00
Each Manuf'd Home or Modular
Dwelling Service or Feeder $90.90 2 ❑ Garage Door Opener*
Services or Feeders ❑ Heating, Ventilation and Air Conditioning System'
Installation, alteration, or relocation
200 amps or less $80.30 2
201 amps to 400 amps $106.85 2 ❑ Vacuum Systems
401 amps to 600 amps $160.60 2
601 amps to 1000 amps $240.60 2 ❑ Other
Over 1000 amps or volts $454.65 2 '
Reconnect only $66.85 2
Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY
Installation, alteration, or relocation Fee for each system $75.00
200 amps or less $66.85 2 (SEE OAR 918-260 -260)
201 amps to 400 amps $100.30 2
401 amps to 600 amps $133.75 2 Check Type of Work Involved:
Over 600 amps to 1000 volts,
see "b" above. n Audio and Stereo Systems
Branch Circuits
New, alteration or extension per panel n Boiler Controls
a) The fee for branch circuits
with purchase of service or ❑ Clock Systems
feeder fee.
Each branch circuit $6.65 2 n Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service ❑
or feeder fee. Fire Alarm Installation
First branch circuit $46.85 HVAC
Each additional branch circuit $6.65
Miscellaneous ❑ Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40
Each sign or outline lighting $53.40 ❑ Intercom and Paging Systems
Signal circuit(s) or a limited energy
panel, alteration or extension $75.00 ❑ Landscape Irrigation Control`
Minor Labels (10) $125.00 I -- 1
Each additional Inspection over I I Medical
the allowable in any of the above
Per inspection $62.50 ❑ Nurse Calls
Per hour $62.50
In Plant $73.75 ❑ Outdoor Landscape Lighting
Fees: ❑ Protective Signaling
Enter total of above fees $ n Other
8% State Surcharge $
Number of Systems
25% Plan Review Fee'
See "Plan Review" section on $ *. No licenses are required Licenses are required for all other installations
front of application.
Fees:
Total Balance Due $
Enter total of above fees $
i
❑ Trust Account # 8% State Surcharge $
Total Balance Due $
i:\dsts\fomis\elc- fees.doc 10/09/00
CITY OF TIGARD 24 -Hour
BUILDING Inspection -Line: 503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
Q BUP
•
Received�j Lt Date Requested o �a \ pp AM PM BUP
`
Location ` a 3 �-C> f" 3(' • (ot • Suite Ac 3 MEC
Contact Person Ph ( ) ( 46 Z - �' 2 �-' PLM
Contractor Ph ( ) f SWR
BUILDING Tenant/Owner o t ELC
Footing ELC .
Foundation Access:
Ftg Drain ELR 3 -- e.v a'
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
• Framing
Insulation
Drywall Nailing J` / / ,�
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
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab -
Low Voltage .
Fire Alarm
PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE EI Please call for reinspaction RE: Unable to inspect — no access
Fire Supply Line
ADA - 0
Approach /Sidewalk Date o Inspe o, Ext
Other: '
Final DO NOT REMOVE this Inspection record fr m the jo site.
PASS PART FAIL