Permit -- CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00021
�I� DEVELOPMENT SERVICES DATE ISSUED: 1/12/2005
„� �! 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
ezii- PARCEL: 1512600 -00 300
SITE ADDRESS: 09714 SW WASHINGTON SQUARE RD F -4 ZONING: C -G
SUBDIVISION: WASHINGTON SQUARE
BLOCK: LOT : JURISDICTION: TIG
Project Description: Relocating (2) branch circuits.
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:
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: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 1 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:
WASHINGTON SQUARE LLC MOUNTIAN VIEW ELECTRIC INC
BY THE MACERICH COMPANY 4305 NE 50TH AVE
9585 SW WASHINGTON SQUARE RD VANCOUVER, WA 98661
TIGARD, OR 97223
Phone: Phone: 360 - 695 - 8439
Reg #: LIC 159093
FEES
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 1/12/2005 $53.50
[TAX] 8% State Surcharge 1/12/2005 $4 Rough -
Elect'I Final
Total $57.78 Lo w V 01-7146-
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 Notific "enter. 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 OU t t (503)
246 -0699 or 1-800-332-2344. -
Issued By: Permit Signature' �1r
OWNER INSTALLATI •• • • NLY
The installation is being made on property I own which is not intended for sale, lease, or - • .
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
•
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
Electrical. iermit :,- Ill G 1 V FOR OFFICE USE ONLY
City of Tigard
972tAN g /.... kilhl., , Received
Date/By / - 774 d 5" Y1t..- (.
Plan Review Permit No..c c _2 (5 - 7 0...
6-
i c)
200
13125 SW Hall Blvd., Tigard, OR 5
Phone 503.639.4171 Fax. 503.598.1 60 -- N-49116 , Date/By Other Permit.
Inspection Line: 503.639.4175 GA" • ll Date Ready/By. Ions RI See Page 2 for
Internet: www.ci.tigard.or.us CITY OF Notified/Method 7 Supplemental information
N
TI 'AA- ,___.,
,i: ,.:, ,}4}001X-•'f;,,,+41: W?:-.4-4.:_;635;01-am140 --,...:-.', .
0 New construction ,12(Addition/alteration/replacement Please check all that apply:
['Service over 225 amps, comm'l P Hazardous location
0 Demolition El Other
OService over 320 amps - rating 0Buildng over 10,000 sq ft.,
CAlfiGOiWOiz O:OISStitteT1014iV.-',3:;.:,FAKW-1 of 1- and 2-family dwellings 4 or more new residential
El 1- and 2-family dwelling jatommercial/industrial D Accessory building CISystem over 600 volts nominal units in one structure
:Mudding over three stones C1Feeders, 400 amps or more
0 Multi-family 0 Master builder 0 Other:
DOccupant load over 99 persons I:Manufactured structures or
'.:46iV-Si'M .IlsiRiZiktiON : AN]) • Likkriell;1 S ' ..- -- .' 0Egress/lighting Plan RV park
0Health-care facility 00ther.
Job no.: Job ite address: 17) Li Lk , . 12,1) Submit 2 sets of plans with any of the above.
---- N.:
City/State/ZIP: \ \ c. 0 ( '9 --azz:, The above are not applicable to temporary construction service
1
Suite/bldg./apt. no.: r Project name:. !-":".;;" 4.0
•ree;\ KatiAtir npeAe. Description Qty. I Fee. I Total ..
% ■
Cross street/directions to job site: uc ‘ Ak 0 A v q ■
...1 New residential single- or multi-family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: I Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map/parcel no.:
Limited energy, non-residential 75 00 2
., :CT. :5Y.ORK,...'.: 4AYt,';‘ Each manufactured or modular
dwelling, service and/or feeder 90.90 2
k5 Pr \ ‘c (4, 0 4\ Services or feeders installation, alteration, and/or relocation
200 amps or less 80 30 2
.' - :.,, t 4 oVVNili ". '' '' l• ' ' ' c "- .: ' ; C ' '' 0 TE '-:` -''.." ' ' ' :' 'i: 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: ( ) I 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
; ':- `: f =‘::'-.‘!),,--gl. m.,R.OcANT: -,,:', 7 - '-,; `: .;. I ,7 ;. , - ,[71:coNT4cr ygRAON,: , A. Fee for branch circuits with
service or feeder fee, each
6.65 2
Business name: branch circuit
B Fee for branch circuits
Contact name: without service or feeder fee,
46.85 ci se LI 2
each branch circuit
Address:
Each add'I branch circuit I 6 65 6.6
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 Signal circuit(s) or limited-
-:; ; ;-§;,', .:;: ,==i7; .
t :: - ;. ,z r "*"05N:Otik,C - ' "Q: 1 — , 7 an
. ,ff' 'Av energy panel alteration, or
extension Describe Page 2 2
.
Business name: N\ 0 - I II\ 0 IN
Address: ( r\D E. .S0-tN" Each additional inspection over allowable in any of the above
-
Per inspection 62.50
City/State/ZIP: k coNctik,3ex. (,0 I'l Investigation per hour (I hr min) 62 50
J ' 73 75
Phone: 60) LC\ 5 — Li 31 I Fax: (0) 735-t(-131 Industrial plant per hour
,.. _,. 1 . \ ' "?‘4
t
S CCB Lic.: 6 013 Electrical Lic.:6 le , IC Suprv. ic .337 F 0 , .,3
,
, Suprv. Electrician signature, required - --
- 1 ,..ae. Ar.i Plan review (25% of permit fee)
(N1 .■■•11
" 7 State surcharge (8% of permit fee) . z e
Print name: F 0, v c i
II k Date: ) — 17---0 4 TOTAL PERMIT FEE ■laZt
Authorized signature: ki
_ - NM This permit application expires if a permit is not obtaineglin up
Print nam • 'flOIRKL 0,1FAINI11111 Date: _ 6 days after it has been accepted as complete
methodology set by Tn-County Building Industry Service Board
45
** Fee Number of inspections per pennit allowed
IAButlding\Perrnits‘ELC-PermitApp doe 2/03 440-4615T(10/02/COM/WEB
Electrical Permit Application City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
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* r '
❑ Vacuum Systems*
❑ Other:
GO,�IYI GI RCWW7O,MOYANntakliegnal
Fee for each commercial system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
El Clock Systems
El Data Telecommunication Installation
❑ Fire Alarm Installation
❑HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
El Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling •
El Other i
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations ,
I \Building\Pcnnits\ELC- PernutApp doc 04/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested / ( AM PM BUP
Location f 7/ 1/_)/9 S Q . k D . Suite MEC
Contact Person � Ph (3/011) 6 q S - g 3 ? PLM
Contractor Ph (' ) SWR
BUILDING Tenant/Owner . A ar % ELC a
Footing
Foundation ELC
Access:
Ftg Drain LR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors ='�J q , c _
Ext Sheath/Shear ` � JL/
Int Sheath/Shear t _
Framing & ' / � ° �¢�
Insulation ailed v f ,, ,, Gt-u t xr cdyi / /a D �d
Drywall Nailing /�- �'"'�
Firewall UUU
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof L- .v , P t
Other:
Final
PASS PART FAIL
PLUMBING
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
PASS PART FAIL
ELECTRICAL
Service
r.
0
F ; Alarm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
S El Please call for reinspection RE: El Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date ( �� 6 Inspector P Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL