Permit r
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CITY OF TIGARD
ELECTRICAL RESTRICTED ENERGY PERMIT
..,�,rlr, DEVELOPMENT SERVICES
PERMIT #: ELR2006 -00083
�I DATE ISSUED: 4/17/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1S12600-00300
SITE ADDRESS: 09777 SW WASHINGTON SQUARE RD D9,10 ZONING: C - G
SUBDIVISION: WASHINGTON SQUARE LOT: JURISDICTION: TIG
Project Description: Low voltage /burglar alarm.
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: BURGLAR AL X
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
WASHINGTON SQUARE LLC AMERICAN VETERANS
BY THE MACERICH COMPANY 8301 SW 135
9585 SW WASHINGTON SQUARE RD BEAVERTON, OR 97008
TIGARD, OR 97223
Phone: Contact #: PRI 503- 319 -4754
FAX 503- 808 -9018
FEES Reg #: ELE 34 -501 CLE
LIC 135086
Description Date Amount
[ELPRMT] ELR Permit 4/17/2006 $75.00
[TAX] 8% State Surcha 4/17/2006 $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 • )tain copies of these
rules or direct questions to OUNC at 503 - 246 -6699.
Issued By: Permittee Signature: j /
OWNER INSTALLATION ON Y rr
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.
p , 4
Electrical Permit Applicat ������ x012 OFFICE USE ONLY
City of Tigard e g m Dateiv ► b .i i Permit N gO(9 — COO&
13125 SW Hall Blvd., Tigard, OR 97223 Plan Revie
• III ; Phone: 503.639.4171 Fax: 503.598.1n Date/B . Other Pemut:
TIGARD Inspection Line: 503.639.4175 Date Read 1 2006 yBy ®See Page 2 for
Internet: www.tigard- or.gov CITY OF TIGARD Notified/Method: Supplemental Information
TYPE OT M1j )tNG D%VI5ION PLAN REVIEW
❑ New construction ddition/alteration/replacement Please check all that apply:
12 Demolition ❑ Other:
El Service over 225 amps, comm'I ❑Hazardous location
['Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
❑ I- and 2- family dwelling Commercial/industrial ❑ Accessory building 0 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.: HOLLI 5i7 Job site address: S) t ;JxtSFl�iv 5 ❑Health -care facility ❑Other:
0� Submit 2 sets of plans with any of the above.
Ci / State/ZIP: 776 art The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: //O1 L I S / ` 14— e--5// FEE* SCHEDULE
Description I Qty. I Fee I Total I ..
Cross street/directions to job site: /5/ S E� 5 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
//G /A Ciglehe 6 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 ❑ 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
service or feeder fee, each 6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee,
first branch circuit 46.85 2
Address:
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 energy panel, alteration, or
I
extension. Describe: Page 2 2
Business name: A i c„,pAj J/ET£izz,iS 5 E....
Address: 3 3o 4/ se /,3 7,0/d4 Each additional inspection over allowable in any of the above
�,A Cr Per inspection 62.50
City / State/ZIP: EI4 //5�/'�j . / - 77ov 2 Investigation per hour (1 hr min) 62.50
Phone: (50 ) / S _ 7 7 3" Fax: ( ) Industrial plant per hour - - 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: / 3 < 8'6 Electrical Lic.:3y Say cLi_Suprv. Lic.: ZL £ £ kL Subtotal: 7S
Suprv. Electrician signature, required r 1 � � Plan review (25% of permit fee):
Print name: So L is £ Cz Date: G/ f 7 —�� State surcharge (8% of permit fee): ��-
� � TOTAL PERMIT FEE g i 00
Authorized signature: _ y , / This permit application expires if a permit is not obtained within 180
N .. / days after it has been accepted as complete
Print name: iy 4,0 L.L e- Date: c. / 7 p g • Fee methodology set by Tn- County Building Industry Service Board
•• Number of inspections per permit allowed.
I:\ Building\Perrnits\ELC- PermitApp doe 03/23/06 440.46I5T(I I /05 /COM/WEB
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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.
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(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* n
1I�►' rotective Signaling /
❑ Other
Total number of commercial systems:
•
*No licenses are required. Licenses are required
for all other installations
I \Building\Permm\ELC- PermitApp doc 03/23/06
CffY OF TIGARD
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BUILDING DIVISION PERMIT #: EL12.3(.'06.03083
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/17/20(1;
Phone: (503) 639 -4171 j�
Inspection Requests (24 Hrs.): (503) 639 -4175 "_
INSPECTION WORKSHEET FOR DATE: 6120/2006 TIME: 7:01AM PAGE:
ADDRESS: 09777 SW WASHING—ION SQUARE RD D9,10 CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE:
PROJECT NAME: HOLLISTER CO.
DESCRIPTION: Low voltagc/burglar abrm.
OWNER: WASHINGTON SQUARE L.LC, PHONE #:
CONTRACTOR: AMERICAN VETERANS PHONE #: 50;3 3'19 - 11Vt
Inspection Request Scheduled For: Date: 6120/20135 Pour Time:
- # Inspection Description Confirm # Contact # Message
199 Electrical final 031965 -01 972 -749 -6895 N
Corrections /Comments /Instructions:
ZPASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Oe i Date: 2.0iUt, Phone #: (503) 718 - '1-1'146.