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Permit CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT ° COMMUNITY DEVELOPMENT PERMIT #: ELR2007 - 00350 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 9/14/2007 PARCEL: 1S12600-00300 SITE ADDRESS: 09504 SW WASHINGTON SQUARE RD J02 ZONING: C -G SUBDIVISION: WASHINGTON SQUARE LOT: JURISDICTION: TIG PROJECT: DAIRY QUEEN /ORANGE JULIUS Project Description: TI - low voltage wiring and control for VAV box. Job NO. 3812. 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: PROTECTIVE SIGNAL: INSTRUMENTATION: OTHER: VAV X TOTAL # OF SYSTEMS: 1 Owner: Contractor: WASHINGTON SQUARE LLC HVAC INC BY THE MACERICH COMPANY 5188 SE INTERNATIONAL WAY 9585 SW WASHINGTON SQUARE RD MILWAUKIE, OR 97222 TIGARD, OR 97223 Phone: Contact #: PRI 503- 462 -4822 FAX 503- 462 -6555 FEES Reg #: ELE 26 -571 CLE LIC 50897 Description Date Amount SUP 605LEA [ELPRMT] ELR Permit 9/14/2007 $75.00 [TAX] 8% State Surcha 9/14/2007 $6.00 REQUIRED ITEMS AND REPORTS 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 - 001 -0100. You may obtain copies of these rules or direct q : ions to OUNC a - i ' • 6.6699 .r 1.800.332.2344. Issued /// / , Permittee Signature: A AA 0 en t -i& _ .. • r 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. Electrical Permit ADD;,.: " 1VED I OR Of Flc h: t SE() \ 1.1 City of Tigard Received l� �' Permit No. E` I 2,0O7 - to • 13125 SW Hall Blvd., Tigard, OR 97223 S E P 1 4 2007. Plan Review Phone. 503.639.4171 Fax. 503.598.1960 y •'" - - , Date/B Other Permit. Inspection Line: 503.639.4175 CLTYOF ii , .. 4 '' 'I �L Dale Ready/By. RI See Paget for Internet: www.ci.tigard.or.us BUILDIG ®I Notified/Method Supplemental Information I 111�9 TYPE OF WORK - . • - _ - " .PLAN REVIEW.:-;. `- ; ; i `:,_ .,_ c _. - ❑ New construction gi Addition teratio placement 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 Commercia industrial ❑ Accessory building OSystem over 600 volts nominal units in one structure ❑ Multi - family ❑Master builder El Other: ❑Building over three stories ❑Feeders, 400 amps or more DOccupant load over 99 persons ❑Manufactured structures or ' - JOB SITE INFORMATION AND LOCATION ❑ Egress/lighting plan RV park ❑Health -care facility ❑lei: Job no.: 3J 2 Job site address: c sa ‘afsit, 9 2<0 Submit 2 sets of plans with any of the above. City/ State/ZIP: vr Cj c . The above are not applicable to temporary construction service. Project name: `� I' ` t - • • - • : FEE*- SCHEDULE Suite/bldg /apt no. 3 0a J /I, q, 0-1 tUas N S Description I Qty. I Fee. I Tad .. 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 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 LA/ cuurvni 4 Cow y n /� , / 1 , g dwelling, service and/or feeder 90.90 2 `{�l' p� '�jy� V ( Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 . ❑ PROPERTY OWNER ' I Wi TENANT 201 amps to 400 amps 106.85 2 401 amps to 600 amps 160.60 2 Name: O rc,tkey- -3-tii6 r O Q 7"�p044 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 l 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 g � , � / � n service or feeder fee, each 6.65 2 Business name: ,v� A c ..... _, branch circuit _ ` B. Fee for branch circuits Contact name: Wirt ( 3 � �, r -� �, i 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) Pump or irrigation circle 53.40 2 Phone: ( ) i Fax: : ( ) Sign or outline lighting 53.40 2 E - mail: Signal circuit(s) or limited- - . CONTRACTOR - energy panel, alteration, or extension. Describe: / Page 2 2 Business name: 1._t Vg Inc_ Address: SI 8‘ SE / n (,v __. Each additional inspection over allowable in any of the above Per inspection _ 62.50 City/State/ZIP: M ` up atkit u / Ore CrY1 Investigation per hour (I hr min) 62.50 Industrial plant per hour 73.75 Phone: (s� (to__ (f & Fax: - 2) ti(Q).'(OSSS . -. . - • ELECTRICAL PERMIT -FEES' _ c_ • - CCB Lic.: 5084 Electrical Lica&$57 /CC& Suprv. Lic.:6057 Subtotal Suprv. Electrician signature, required: �� ld /!1d f/ Plan review (25% of permit fee) Print name: A- a S Cola at'L I Date: -r/1I167 State surcharge (8% of permit fee) TOTAL PERMIT FEE Authorized signature: S� � J�Th This permit application expires if a permit is not obtained within 180 p � days after it has been accepted as complete Print name: S I e-rr I I vrtS CY1 Date: R / i Z/ 0 7 • Fee methodology set by Tri- County Building Industry Service Board •• Number of inspections per permit allowed i.\ Budding \ Pennies \ELC.Pam,tApp doe 12/03 410- 4615T(10101/COMIWEE CITY OF TIGARD BUILDING DIVISION PERMIT #: E -00350 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/14/2007 Phone: (503) 639 -4171 � Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 11/13/7007 TIME: 7:01AM PAGE: 45 SITE ADDRESS: 09604 SW WASHINGTON SQUARE RD J02 CLASS OF WORK: SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE: PROJECT NAME: [AI QUEEN /ORANGE: JULIUS DESCRIPTION: TI - low voltage wiring and control for VAV box. Job NO. 3812, OWNER: WASHINGTON SQUARE LLC, PHONE #: CONTRACTOR: HVAC INC PHONE #: 503462.4822 Inspection Request Scheduled For: Date: 11/13/2007 Pour Time: Code # • - - on Description - # Contact # Message 199 Eloctiical final 059527 -01 503- 702-3686 Y orrec ions ommen s Instructions: \ 1 r \\ \ vv 7 0 PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Cr N VO Date: VO W 1 Phone #: (503) 718- 1-114o CITY OF TIGARD , BUILDING DIVISION PERMIT #: EL.R2007- 00350 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/14/21107 Phone: (503) 639 -4171 Inspection Requests (24 Hrs.): (503) 639 -4175 ��Zttit INSPECTION WORKSHEET FOR DATE: 10,2122007 TIME: 7:04AM PAGE: 61 SITE ADDRESS: 09604 SW WASHINGTON SQUARE RD J02 CLASS OF WORK: SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE: PROJECT NAME: DAIRY QUEEN /ORANGE JULIUS DESCRIPTION: TI - low voltage wiring and control for VAV box. Job NO. 3812. OWNER: WASHINGTON SQUARE LLC, PHONE #: CONTRACTOR: HVAC INC • PHONE #: W3.461 - Inspection Request Scheduled For: Date: 10/2J2007 Pour Time: Co. - • Inspe • Description Confirm # Contact # Message • 135 Low voltage 056758-01 503-462-4822 \ Y Corrections /Comme ii- - - •ctions: 9 2.M) PASS n PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Z - ' Ltd Date: tOJ 1-j' f 7 Phone #: (503) 718- _62_____