Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00404
DEVELOPMENT SERVICES DATE ISSUED: 7/3/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 13126C0-01107
SITE ADDRESS: 09493 SW WASHINGTON SQUARE RD A -3 ZONING: C-G
SUBDIVISION: WASHINGTON SQUARE
BLOCK: LOT : JURISDICTION: TIG
Project Description: (1) ea. sign lighting.
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:
PPR WASHINGTON SQUARE LLC MULTI -LIGHT SIGN CO.
BY THE MACERICH COMPANY 809 N E LOMBARD
9585 SW WASHINGTON SQ. RD. PORTLAND, OR 97211
PORTLAND, OR 97223
Phone: Phone: 281 - 3083
Reg #: LIC 64107
SUP 343SIG
FEES ELE 26 -90CLS
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 7/3/03 $53.40
[TAX] 8% State Tax 7/3/03 - $4.27 Rough -
Elect'I Final
Total $57.67
This Permit is issued subject to the regulations contained in the Tigard Munidpal 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 (503) 246 -6699 or
1- 800 - 332 -2344.
Issued By: 4110 - � � _ Permit Signature: t
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: 5
Call 639 -4175 by 7:00pm for an inspection the next business day
l
N.
A. ._
Electrical Permit Application
Date received. - .p 6 i Permit no.: ( - yam _ () O 1
") I Project/appl. no.: Expire date:
• �� ,y, . City of Tigard � tea- �� 3
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By:Q, i'j Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
TYPE OF PERM1.1 . `'
❑ I & 2 family dwelling or accessory to Commercial/industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Other: ❑ Partial
JOB SITE INFORMATION - •.
Job address: / 33 z . I / (i /q5�,`, 4,7i;t! ., RD, Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: I Block: (Subdivision:
Project nameAftp-r t{nnr (yp and location of work on premises: 140 p,c ( jam -( 6M
Estimated date of t,ompletion /inspection: ll
' CONTRACTOR'. I .FEE SCHEDULE
Job no: Fee Max
Business name: AAA) L. t _ Lie, HT . 6 t C-AN �.cn Description Qty. (ea) Total no. insp
New residential - single or maid-family per
Address:
cq N.1 L . -, An 12>pi t.2 1=7. dwelling unit. Includes attached garage.
City FFo[ZTL I StateniKI ZIP: Cj ZC I Service included:
Phone: zg /-3093 Fax: 1E-mail: 1000 sq. ft. or less 4
0.: EIeC. bUS. liC. n0: q Each additional 500 sq. ft or portion thereof
CCB n
�� (� I zn _ rQCL Limited energy, residential 2
City /metro lic. no.: 24 q9 Limited energy, non - residential 2
�ti $ * _ / Q3 Each manufactured home or modular dwelling
Signature of supervising electncian (required) Date Service and/or feeder 2
Sup. elect. name (print): " i= t , s t 4 , , License no: 4 S(6-- Services or feeders — installation,
alteration or relocation:
- PROPi:RTY OWNER 200 amps or less 2
Name (print): 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address: 601 amps to 1000 amps 2
City: I State: I ZIP: Over 1000 amps or volts 2
Phone: I Fax: 1E-mail: Reconnect only I
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,orrelocation:
200 amps or less 2
ORS 447, 455, 479, 670, 701.
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 amps 2
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: 'State: I ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: 2
Phone: Fax: E -mail:
Each additional branch circuit:
PLAN REVIEW (Please check all that apply) Misc . (Serviceorfeedernotincluded):
O Service over 225 amps- commercial 0 Health -care facility Each pump or irrigation circle 2
0 Service over 320 amps - rating of 1&2 0 Hazardous location Each signor outline lighting / ,33 40 2
family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
0 System over 600 volts nominal more residential units in one structure alteration, or extension* 2
❑ Building over three stones 0 Feeders, 400 amps or more * Descrpuon.
❑ Occupant load over 99 persons O Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
0 Egress/lightingplan O Other: Per inspection
Submit _ sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other L
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $ J . 40
O Visa ❑ MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: I / within 180 days after it has been State surcharge (8 %) $ , Z
Expires accepted as complete. TOTAL $
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440 -4615 (6/00 /COM)
f
Electrical Permit Fees: Limited Energy Fees:
TYPE OF WORK INVOLVED - RESIDENTIAL OILY
Complete Fee Schedule Below: 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 II
1000 sq. ft. I or less $145 15 4 - I 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 Garage Door Opener*
Dwelling Service or Feeder $90.90 2 El
Services or Feeders ❑ Heating, Ventilation and Air Conditioning System*
Installation, alteration, or relocation
200 amps or less $80 30 2 Vacuum Systems -
201 amps to 400 amps $106 85 2 •
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. Audio and Stereo Systems
Branch Circuits n Boiler Controls
New, alteration or extension per panel
- a) The fee for branch circuits �
with purchase of service or i l Clock Systems
feeder fee. •
Each branch circuit $6 65 2 Li Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service n Fire Alarm Installation
or feeder fee.
First branch circuit $46.85 HVAC
Each additional branch circuit $6.65
Miscellaneous n Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40 ❑ Intercom and Paging Systems
Each sign or outline lighting $53.40
Signal circuit(s) or a limited energy
panel, alteration or extension $75.00 H Landscape Irrigation Control
Minor Labels (10) $125.00 ❑
Medical
Each additional inspection over
the allowable in any of the above Calls
Perinsper.tion $62.50 • - -
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
* No licenses are required. Licenses are required for all other installations
See "Plan Review" section on $
front of application.
Fees:
Total Balance Due $
Enter total of above fees $
❑ Trust Account # 8% State Surcharge $
Total Balance Due $
i:\dsts \forms \elc- fees.doc 10/09/00 -
CITY OF TIGARD 24 -hour
BUILDING - Inspect' • ! 503 '639-4175
MST
INSPECTION DIVISION Busin - . 03) 639 -4171
BUP
Received Date Requested � AM PM BUP
Location Suite �3 MEC
Contact Person 7‘19,3 Ph ( ) g PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner rIfkatetallurtar ELC 3 -oe y r•
Footing ELC c - 00 10
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL 4 L �. ( N 0-1--\\A
PLUMBING . — ° 4 I t> I lr N 1)
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
! • T FAIL
RIAL
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
TE D Please call for r -' spection RE: Unable to inspect — no access
Fire Supply Line
ADA Approach/Sidewalk Date A .$ Inspector Gasp
Other:
Final DO NOT REMOVE this inspection record fro the job si e.
PASS PART FAIL