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Permit A ~ • CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT PERMIT #: ELR2006 -00091 DEVELOPMENT SERVICES DATE ISSUED: 4/24/2006 '- 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 1512600 -00300 SITE ADDRESS: 09610 SW WASHINGTON SQUARE RD G -1 ZONING: C -G SUBDIVISION: WASHINGTON SQUARE LOT: JURISDICTION: TIG Project Description: HVAC. 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 ARROW MECHANICAL BY THE MACERICH COMPANY 10330 SW TUALATIN RD 9585 SW WASHINGTON SQUARE RD TUALATIN, OR 97062 TIGARD, OR 97223 Phone: Contact #: PRl 503- 692 -1565 FEES Reg #: ELE 34 -47CLE LIC 5193 Description Date Amount [ELPRMT] ELR Permit 4/24/2006 $75.00 [TAX] 8% State Surcha 4/24/2006 $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 direct questions to OUNC at 503-246-6699. Issued By: L ~ %� Permittee Signature: 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. . Patric Permit A licat 'fir FoR (FFlCr: l sr oNl,,, . . . City of Tigard 10 k_.} Received -0 6 13125 SW Hall Blvd., Ti_: 012\ -97223 �� Permit No. �� . , _ / PI-, ,one: 503.639.4171 Fax 503 598.1960 Fax. ; 10 i4 I - ,I.\, P Review Other Permit. T�nspection Line' 503.639.4175 p . / J . ' �-, Date Ready/By El See Page 2 for P Internet: www.ci.tigard.or.us N? 1\ Notified/Method. �a Supplemental Information e "Veg. OF' WOR� R� PLAN REVIEW ❑ New construction '- { l d'ttori/altera tion/replacement Please check all that apply: ' -' ❑Service over 225 amps, comm'I ['Hazardous location ❑ Demolition PALI Other: OService over 320 amps - rating ❑Bulldog over 10,000 sq. ft., CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential ❑ 1 - and 2 family dwelling ❑ Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure ❑ Multi - family ❑Master builder ❑Other' ❑Building over three stories ['Feeders, 400 amps or more ❑Occupant load over 99 persons ❑Manufactured structures or JOB SITE INFORMATION AND LOCATION . ❑Egress/lighting plan RV park Job no.: Job site address: %9 /' t j�J ,J 4e-e..1- ❑Health -care facility ❑Other: � j Submit 2 sets of plans with any of the above. City /State/ZIP: 7/, j _ � .. g 7 �2 3 The above are not applicable to temporary construction service. , f FEE* SCHEDULE Suite/bldg. /apt. no.: / Project name: I/ /,a'''' / ��/ �1 ! �4.� • Description I Qty. I Fee. I Total 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 f la / z Y y c �� - �_ dwelling, service and/or feeder 90.90 2 Services 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 4; 600 amps 133.75 2 Owner signature: Date: Branch circuits - new, alteration, or extension, per panel ❑ APPLICANT ❑ CONTACT PERSON A. Fee for branch circuits with service or feeder fee, each 6.65 2 Business name: /cr oc.e /ee4�,/ //� , mo o _ 4 .� branch circuit / B. Fee for branch circuits Contact name: /iiA zip P ,,- without service or feeder fee, 46.85 2 Address: /O I ?'� 0 5 Ca 72 �� j each branch circuit j/e/ `� ! ( Each add'I branch circuit 6.65 2 City / State/ZIP: j ✓/, � �� r �� )C Z Miscellaneous (service or feeder not included) Phone: ‘ �..)--° Fax: :G c f _ ? � Pump or irrigation circle 53.40 2 S'_ • o 53.40 2 E - mail: ignal circuit(s) or limited - CONTRACTOR energy panel, alteration, or ■ extension. Describe: Page 2 2 Business name: Waee,ep4 - 6 ,c�l ,5 l�� Address: A% C /' t S', L W. Zi;i1(47/ /t1tecE Each additional inspection over allowable in any of the above Per inspection 62.50 City/ State/ZIP: ✓v4. /T ` /2; (9, 9 ‘e--- Investigation per hour (I hr min) 62.50 /' `r �� Industrial plant per hour 73.75 Phone: ��� �Z J i7 Fax: c5:23) ‘q(....._ /�� ELECTRICAL PERMIT FEES* CCB Lic.: 051F3 Electrical Lic.: 34--it ? ( Suprv. Lic.: Subtotal Suprv. Electrician signature, required: Plan review (25% of permit fee) Print name: 3 eiJj. c•'( P - k p Date: 4_24_06 State surcharge (8% of permit fee) TOTAL PERMIT FEE Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete Print name: Date: • Fee methodology set by Tn- County Building Industry Service Board •• Number of inspections per permit allowed. i:\ Budding\Permits\ELC- PermitAppdoe 12/03 440-4615T(10/02/COM/WFB Electrical Permit Application - City of Tigard • Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: • RESIDENTIAL WORK ONLY: Fee for all residential systems combined .. $75.00 Check Type of Work Involved: El Audio and Stereo Systems* ❑ Burglar Alarm El Garage Door Opener* • ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* El Other: 11 CONIlVIERCIAL WORK ONLY:. Fee for each commercial system $75.00 (SEE OAR 918- 260 -260) Check Type of Work Involved: ❑ 'Audio and Stereo Systems El Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation El Fire Alarm Installation HVAC El Instrumentation El Intercom and Paging Systems ❑ Landscape Irrigation Control* El Medical El Nurse Calls ❑ Outdoor Landscape Lighting* El Protective Signaling El Other Total number of commercial systems: • *No licenses are required. Licenses are required for all other installations \BuddmgTermtts\ELC- Perm itApp doc 04/03 CITY OF TIGARD r BUILDING DIVISION PERMIT #g.IZ1Oot 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 00 °I 1 Phone: (503) 639 -4171 404 7, Inspection' ReqUests (24 Hrs.): (503) 639 -4175 "'_ INSPECTION WORKSHEET FOR DATE: 31 I b 106 TIME: PAGE: SITE ADDRESS:e\ 61 st5 v..)6,6W CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: DESCRIPTION: OWNER: N` �a� C-0`N • PHONE #: CONTRACTOR: PHONE #: Inspection Request Scheduled For: Date:3 j � (� a 6 Pour Time: Code # Inspection Description Confirm # Contact # Message \CV\ "T- g 147 1- ►VAC--. 02:019 -DI Corrections /Comments / Instructions: 672C3 • PASS ❑ PARTIAL APPROVAL ❑ CANCEL ' ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: ' � V 1,E. Date: fUf 6 Phone #: (503) 718 - L1414