Permit CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
i DEVELOPMENT SERVICES PERMIT #: ELR2006 - 10036
��� I � 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 6/28/2006
PARCEL: 1512600 -00300
SITE ADDRESS: 09589 SW WASHINGTON SQUARE RD B9 ZONING: C - G
SUBDIVISION: WASHINGTON SQUARE LOT: JURISDICTION: TIG
Project Description: Low voltage for HVAC. Job No. 3497
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:
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: 503- 639 -8865 Contact #: PRI 503- 462 -4822
FEES Reg #: ELE 26- 571CLE
LIC 50897
Description Date Amount
[ELPRMT] ELR Permit 6/28/2006 $75.00
[TAX] 8% State Surcha 6/28/2006 $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 rect questibns to OUNC at 503 - 246 -6699.
ci)
Issue By: ' hh 07\--x Permittee Signature: I`� cw07\--x Y
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 Application 1=01z (Irr1( t:1 sl, ()M.) City of Tigard 1 e p , Permit No.: E /4.#0,_/20.50
Daten3
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Other Permit:
_
Phone: 503.639.4171 Fax 503.598.1960 Date/B .
Inspection Line: 503.639.4175 x l,l 'I, 1 Date Ready/By. 3uris. ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: � a, Supplemental Information
- - - - 'TYPE OF 'WORK ' - - - : c. - ' ; + - a r, ..--, PLAN- R EVIEW r' ; H zi
s ' ,j, t-r r
❑ New construction AAdditio alteratio placement Please check all that apply:
❑ Demolition ❑Other: ❑Service over 225 amps, comrn'l ❑Hazardous location
❑Service over 320 amps - rating ❑ Buildn over 10,000 sq. ft,
CATEGORY_ OF CONSTRUCTION • of 1 and 2 family dwellings 4 or more new residential
❑ I - and 2 family dwelling Wommercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi - family ❑Master builder ❑Other: ❑Building over three stories 0 Feeders, 400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or
. ' : • JOB SITE INFORMATION "AND LOCATION - - • RV
❑Egress/lighting plan park
Job no.:&l/9 7 Job site address: 95 s 9 , 0,0-5-# . , + ❑Health -care facility ❑ cr.
Submit 2 sets of plans with any of the above.
City/State/ZIP: � O l r g yy The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: :) / ' Project n e: /l44- )IU OnE60/v " " ' - s FEE* SCHE L E - :. _ _; , ?" ; : .
Description I Qty. I Pee. I Taal 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
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
: •:..7 `` ; t_' CL , --:,=..-• ,DESCRIPTION OF WORK r Each manufactured or modular
_ UO ( / 0- ( / v 6 S () Services service and/or feeder 90.90 2
/
(, �w � � '(� Servervices es or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
`,, ❑ PROPERTY .OWNER • - _ I - _ - - ❑ 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
"R APPLICANT - - I ❑ CONTACT PERSON • - A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: k,Q(1 , `4,, , branch circuit
Contact name: > 11 � 6 B. Fee for branch circuits
without service or feeder fee, 46.85 2
Address: — �jl//1 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'-: -.-="; z. ' - • _ , energy panel, alteration, or
extension. Describe: / Page 2 2
Business name: pi j 4 l C..
.\ Address: Sl $ g . E, 'F--Y 1A.. Each additional inspection over allowable in any of the above
Per inspection 62.50
•
1 ' �-
t i City/ State/ZIP: L- C ,, j ,,,, or efii tyl 9 1;_D____ Investigation per hour (1 hr min) 62.50
Phone: ( ) "[ -
�7 !w_ oZ� �2 lax: ( 'ft0�� '!/_, � �s � p Industrial plant per hour 73.75
i �
U .. • :ELECTRICALPER
- PERMIT C. �t , � � ° - - "
CCB Lic.: 50 Ci 7 Electrical Lic.,_57/ ' Suprv. Lic.: or
Subtotal 7S OO
Suprv. Electrician signature, required: /` 7'/ 040.1'
l Plan review (25% of permit fee) `_
Print name: 44, Ep k C Date: (p / A f O F� State surcharge (8% of permit fee) (0 . OU
TOTAL PERMIT FEE 87 ��
Authorized signatureLS i t7, Cti(.Q U- This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: S c eXYu �____. Date: 6, / Q(p • Fee methodology set by Tri-County Building Industry Service Board
•• Number of inspections per permit allowed.
i\&oldmg\Permiafl.C- PamitAppdoe 12/03 440-4615T(I0132/COMIWFB
CITY OF TIGARD
BUILDING DIVISION `R PERMIT #: ELR2006.10036
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/20/2006
Phone: (503) 639 -4171 i;i r
Inspection Requests (24 Hrs.): (503) 639 -4175 '!+�jll�
INSPECTION WORKSHEET FOR DATE: 8/1/2006 TIME: 7:02AM PAGE: 19
SITE ADDRESS: 09589 SW WASHINGTON SQUARE RD B9 CLASS OF WORK:
SUBDIVISION: WASHINGTON' SQUARE LOT #: TYPE OF USE:
PROJECT NAME: MADE IN OREGON
DESCRIPTION: Low voltage for HVAC. Job No. 3497
OWNER: WASHINGTON SQUARE LLC, PHONE #: 503
CONTRACTOR: HVAC INC PHONE #: 503 -467 -4822
Inspection Request Scheduled For: Date: 811/2006 Pour Time:
Code #- Inspection Description Confirm # Contact # Message
199 ' Electrical final 034169 -01 503 - 462 -4822 Y
\NN , .
Corrections /Comments/ Instructions:
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F. PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL . ❑ CALL FOR INSPECTION • ❑ ADDITIONAL FEES ASSESSED
Inspector: 0% " .Date: 1 ` (5 k) Phone #: (503) 718- -"1
•