Permit A - CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
Z oi PERMIT #: ELR2006 -10024
jib DEVELOPMENT Tigard, -639 -4171 DATE ISSUED: 3/22/2006
PARCEL: 1S12600-00300
SITE ADDRESS: 09681 SW WASHINGTON SQUARE RD C6 ZONING: C -G
SUBDIVISION: WASHINGTON SQUARE LOT: JURISDICTION: TIG
Project Description: Limited energy for security.
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: SECURITY. X
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
WASHINGTON SQUARE LLC VISION SECURITY SERVICE
BY THE MACERICH COMPANY 10874 SW ROLAND CT
9585 SW WASHINGTON SQUARE RD WILSONVILLE, OR 97070
TIGARD, OR 97223
Phone: Contact #: PRI 503 682 - 6713
FAX 503 - 582 - 1133
FEES Reg #: ELE 3- 544CLE
LIC 152497
Description Date Amount
[TAX] 8% State Surcharl 4/5/2006 $6.00
[ELPRMT] ELR Permit 4/5/2006 $75.00 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 OA' - -00 -0100. You may obtain copies of these rules or direct • - -lions to OUNC at 5s
Issued B 1 /1I A -G..; Permittee Signature• %e.e_ ,A,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 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 l o USE ° : A'
vb. Received
City oPTigard Date/B / � D(� �� Permit No.: F �loat'o_ ,qp,'t
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503 598.1960
I
Al . p I Other Permit:
_ _
Inspection Line: 503.639.4175 1I ''' Date/B _, Date Ready/By WM VI See Page 2 for
Internet: www.tigard- or.gov Notified/Method. Supplemental Information
' , TYPE OF WORK - . PLAN REVIEW ,
❑ New construction "Addition/alteration/replacement Please check all that apply.
❑ Demolition ❑Other: ['Service over 225 amps, control ❑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
❑ 1 and 2 family dwelling 'Commercial/industrial ❑ Accessory building ❑ System over 600 volts nominal units in one structure
❑ Multi - family ❑Master builder ❑Building over three stories ❑Feeders, 400 amps or more
❑ Other: ❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION 9to 67 ❑Egress/lighting plan RV park
Job no.: Job site address: ea .J0 (A 0.101TQ1.1 ❑Health -care facility ❑mar:
Submit 2 sets of plans with any of the above.
City/ State/ZIP 64 O Oa. (' 7 L3 e-OPC The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: ME. . FEE SCHEDULE .
Description I Qty. I Fee. I Total 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'I 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
, ' DESCRIPTION OF WORK Each manufactured or modular
,5--e/L9-s9
5u) 5 l lam 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 ' '' l ❑, 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
' ❑ APPLICANT I ❑ CONTACT PERSON A. Fee for branch circuits with
,,�, f 1 � �Q
a service or feeder fee, each 6.65 2
Business name: v 15 ((� �J►T� Sl��lC branch circuit
' — _ 1 B. Fee for branch circuits
Contact name: L,�Q�f without service or feeder fee, 46 85 2
Address: first branch circuit
Each add'I branch circuit 6.65 2
-
City / State/ZIP: Miscellaneous (service or feeder not included)
Pump or imgation circle 53.40 2
Phone: ( ) Fax:: ( ) Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited-
. , .
CONTRACTOR energy panel, alteration, or
Business name: \ 5 ) Dil 5Ec a I 5F j1 extension. Describe: I Page 2 2
Address: \ — 12 C C . Each additional inspection over allowable in any of the above
✓" Per inspection 62 50
City /State/ZIP: W' .' '» yuLiF 60 0j0 Investigation per hour (I hr min) 62 50
Phone: (r)s . / 13 Fax: 53 SB.D.. 1 i 33 Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: \ „4.4.1q- Electrical Lic.:3DAIDE Suprv. Lic.z3VCI WA Subtotal
Suprv. Electrician signature, required: &� � Plan review (25% of permit fee)
Print name: Date:5. r "f., 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 Bwlding Industry Service Board
•• Number of inspections per permit allowed.
I \ Building \Permits\ELC- PermitApp doe 12/30/05 4404615T(10/02/COM/WEB
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:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning • - • ,
System *
❑ Vacuum Systems*
❑ Other:
(= COIVIIVIERCIAL WORK ONLY: ---- _
Fee for each commercial system. $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical •
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems: .
*No licenses are required. Licenses are required
for all other installations
1 \Bmldmg\Petmns\ELC- PermnApp doc 12/30/05
CITY OFTIGARD �-Z/Z
BUILDING DIVISION PERMIT #:app 4040 01 ((
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 AhriNth I
Inspection Requests (24 Hrs.): (503) 639 -4175 6- 1 L
INSPECTION WORKSHEET FOR • DATE: TIME: PAGE:
SITE ADDRESS: 96 g SC) . CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 3 - 2- 3 — D Pour Time: MIRO
Code # Inspection De,.9cription Confirm # Contact # Message
qs _ 4 16 3 - 3o r
Corrections /Comments /Instructions: /� •
1/ f'
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ��� 1\i(v)i_tie Date: I 0b Phone #: (503) 718 - 13
— e
1
CITY OF TIGARD
BUILDING DIVISION PERMIT #:S...�
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: I ®01
Phone: (503) 639- 4171i�l
Inspection Requests (24 Hrs.): (503) 639 -4175 _..� __
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS:9 (A W 4" w' N G+� CLASS OF WORK:
• SUBDIVISION: � LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: '4(i 3(0 Pour Time:
• • - # Inspection Description Confirm # Contact # 'Message
Correc . s /Comments /Instructions:
•
•
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 6--042.- N(113tZ Date: L i 13 Ola Phone #: (503) 718- V Y"