Permit 1
{ CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
1A DEVELOPMENT SERVICES PERMIT #: ELR2000 -00137
I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 06/09/2000
SITE ADDRESS: 09724 SW WASHINGTON SQUARE RD F -6,7 PARCEL: 1S126C0 01107
SUBDIVISION: ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
Project Description: Remote stock room space #DN -1
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: X
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS:
Owner: Contractor:
PPR WASHINGTON SQUARE LLC ADT SECURITY SERVICES, INC
BY THE MACERICH COMPANY 2815 SW 153RD DR
ATTN: JANET FISHER, ASSET MGNT BEAVERTON, OR 97006
SANTA MONICA, CA 90407
Phone: Phone: 503469 -7100
Reg #: LIC 0059944
ELE 26209CLE
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
5PCT JMT 06/09/200C $4.00 0002834
Total $4.00
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 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -1987.
Issued by J 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 639 -4175 by 7:00 P.M. for an inspection needed the next business day
503 598 1960 •,
03/7,700 FRI 12:15 FAX 503 598 1960 CITY OF TIGARD
X1003
CITY OF TIGARD ;' 'REC !
13125 SW HALL BLVD. electrical Permit Application Plan Check #
JUN In Rec'd By
TIGARD OR 97223 N tl Q g 3.../ b7 / Date Recd i/
Phone (503) 639 -4171, x304 //4 Date to P.E.
Inspection (503) 639 -4175 P �IIVf1lNI� Date to DST
Fax (503) 598 -1960 t of T ype Permit # F(AaODV- 0 0 i 37 i
MO G tp ble will not be accepted 1 Called
1. Job Addres PAGe A „big _ +' � � 4. Complete Fee Schedule Below:
Name of Development __ f.l. , k &M N Number of Inspections (or name of bUSln@S pections per permit allowed
Address ; i/ Service included: Items Cost Sum
✓ .
4a. Residential - per unit
_
A
City /State /Zip i [ 3 1000 sq. ft. or less $ 117.75
Each additional 500 sq. ft. or 4
Commercial K Residential r--
portion thereof $ 26.75
Limited Energy
Each Monied Home or Modular 1 $ 60.00 $60.00
2a. Contractor installation only: Dwelling Service or Feeder
(Prior to permit issuance, applicants must provide contractor license $ 72 75 2
information for COT data base). Servlr, alteration rJ Feeders
Electrical Contractor Ai)T Security Services , Inc . 1n200amps ,orrebcatlon
Address 2815 SW 153rd Dr. 201 amps to400amps $ 64.25 2
Ci $ 85.50 2
ty RPavpr State OR Zip 97006 401 amps to 600 amps $ 128.50 2
Phone No. . _ l 601 amps to 1000 amps $ 192.50
2 • Job No. / • N- Over Reconnect or volts $ 363.75 2
Job Cont. Lice. No. Reconnect only $ 53 50 2
26- 209CLE Exp.Date 10/2000 4c.Tem
OR State CCB Reg. No. 59944 Exp.Date 5/07/01 Installation, Temporary
, a o
COT Business Tax or Metro No. xp.Date 200 amps or less
$ 53.50 2
201 amps to 400 amps $ 80.25 2
Signature of Supr. Elec'n �
Over 600 amps amps to 600 amps
2 $ 1 00.00 2
License No. r) �t! .� above.
t 1000 volts,
E xp. Date / 0 ,� s ee " b° above.
Phone No. 4d. Branch Circuits
New, alteration or extension per panel •
2b. For owner installations: a) The fee for branch circuits
with purchase of service or
Print Owner's Name feed f ee
Each branch circuit $ 5.35 2
Address b) The fee for branch circuits
City State Zip
without purchase of service
Phone No. or feeder fee.
First branch circuit $ 37.50
made on property Each additional branch circuit $ 5.35
The installation is being p perty I own which is not 4e. Miscellaneous
intended for sale, lease or rent.
er not induded)
Each (Service pump or feed or irrigation circle $ 42 -75
Owner's Signature Each sign or outline lighting $ 42.75
Signal circuit(s) or a limited energy
3. Plan Review section (if required):* panel, alteration or extension $ 60.00
Minor Labels (10) $ 100.00
Please check appropriate item and enter fee in section 5B. 4f. Each additional ins
4 or more residential units in one structure the allowable In won over
any of the above
Service and feeder 225 amps or more Per inspection $ 50.00
System over 600 volts nominal Per hour $ 50.00
Classified area or structure containing special occupancy as In Plant $ 59.00
described in N.E.C. Chapter 5 5. Fees:
Submit 2 sets of plans with application where any of the above apply Sa. Ester total of above fees $ 6n nn
Not required for temporary construction services. PP Y Surcharge (.OS X total fees)
Subtotal $ ii . 80
S btt
NOTICE 6b. Enter 25% of One Safer
Plan Review if required (Sec. 3) $
'ERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED Subtotal $ 64:80
S NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR
NORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS ❑
\T ANY TIME AFTER WORK IS COMMENCED. Trust Account #
Total balance Due $ 64.80
‘dsts\forms \c lectric. dac
CITY OF TIGARD BUILDING INSPECTION DIVISION . MST -
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 - - „
BUP
Date Requested i `�; AM PM BLD
Location . c?? 2 ( CC() 164 . gee` Suite MEC
Contact Person i Ph e,5- 720 PLM
Contractor IW J Ph SWR
BUILDING TenaniOwner _ .' ELC
Retaining Wall ELR 1.41 —
OD t 7
Footing
Foundation ACC / _ / G�� ��J
Ftg Drain e�l�
ri - a r�1 7/46.> /v 1 � - l
Crawl Drain Inspection Notes: SGN
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
D ywal Insulation g j �O 1 / • ` + l . 4 A ,
D all Nailin c / C-� 4-7v /9- I
Firewall //��
Fire Sprinkler 4/J)7 s S eFi /A /5-4- / (e, /9
Fire Alarm
Susp'd Ceiling 074 I / I / O G0 /A/ /.! �/ T71747Z Roof 1
Misc:— -- Al-P //AJc5 (..J cJ ii`S //✓. C- 7 7-'-u c,-/� .
Final
• A G ,S is ,
PASS PART FAIL � � ,�
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service /4//19- �_,
Sanitary Sewer
Rain Drains
F inal a P
.PASS PART FAIL
MECHANICAL —
Post & Beam
Rough In
Gas Line -
Smoke Dampers
Final
P P FAIL •
ELEC L
ervice
Rough In
UG/Slab .
Low Voltage
Fire Alarm
Tom^) PART FAIL'
SITE
Backfill /Grading
Sanitary Sewer
• Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA a
Other
/
oach /Sidewalk Date .3 / 7 D7 Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the .job site. .