Permit 44
A - d . �� CITY O TIGARD ELECTRICAL PERMIT _
RESTRICTED ENERGY
- 41ii DEVELOPMENT SERVICES PERMIT #: ELR2004 -00164
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/16/2004
SITE ADDRESS: 09800 SW WASHINGTON SQUARE RD SEARS PARCEL: 1S12600 -00300
SUBDIVISION: WASHINGTON SQUARE ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
Project Description: Data telecommunication cabling.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: X NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: : HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER: .
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
PPR WASHINGTON SQUARE LLC CACHE VALLEY ELECTRIC COMPANY
BY THE MACERICH COMPANY 919 NORTH 1000 WEST
9585 SW WASHINGTON SQ. RD. LOGAN, UT 84321
PORTLAND, OR 97223
Phone: Phone: 503- 431 -6600
Reg #: L933-624-11142122
ELB35- 75:6440SCLE
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 6/16/2004 $75.00 P I N AL,
[TAX] 8% State Surcharl 6/16/2004 $6.00
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 -00 -0100. You may obta +pies of these rules or direct questions • OUNC at (503) 24. •,s-:. /
� �1
i � / ,�j
I I / Perm ittee Signature �� ` j;�� �� /,
Issued by
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
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard DateB� / • , Permit No I • .
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review , � , • //
Phone: 503.639.4171 Fax: 503.598.1960 ` ,", ilii DateBy Other Permit.
Inspection Line: 503.639.4175 j 1 Date Ready/By: 1 RI See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: I6k Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction NLAddition/alteration/replacement Please check all that apply:
❑ Demolition ❑ Other: ❑Service over 225 amps, comm'l ❑Hazardous location
OService 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 E .Commercial /industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
['Building over three stories ['Feeders, 400 amps or more
❑ Multi- family 0 Master builder 0 Other:
['Occupant load over 99 persons ['Manufactured structures or
JOB SITE INFORMATION AND LOCATION ['Egress/lighting plan RV park
Job no.: yH ySG Job site address:q000 Sub A se R61, ❑Health - care facility ['Other Submit 2 sets of plans with any of the above.
City/State /ZIP: Por-t-I «nd / oR q i ag 2 The above are not applicable to temporary construction service.
pp FEE* SCHEDULE
Suite/bldg. /apt. no.: Project name: Sea te „mod , x
Description I Qty. I Fee. I Total
Cross street/directions to job site: At- 1 ,0 1 9, s 6 rj^ , � LiQv � New residential single- or multi - family dwelling unit.
� `yi Includes attached garage.
m QI I - SPae rs 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
dwelling, service and/or feeder 90.90 2
`,
\ CAD V O (Ittibl Services or feeders installation, alteration, and /or relocation
200 amps or less 80 30 2
❑ PROPERTY OWNER I Y4 TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Sott
Name: 601 amps to 1,000 amps 240.60 2
Address: Cigejc, SO l.(.l.,s11 U1 „• e - iqd , Over 1,000 amps or volts 454.65 2
`~J T Reconnect only 66.85 2
City/State /ZIP: and "1 as Temporary services or feeders installation, alteration, and /or
� t�� relocation
Phone: ( ) Fax: ( )
200 amps or less 66.85 I
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
XAPPLICANT 1 ❑ CONTACT PERSON A. Fee for branch circuits with
q service or feeder fee, each 6 65 2
Business name: 00 n Q l� {� 44: _ VT., branch circuit
Contact name: �a an � i Vanessa ' �
B. Fee for service circuits fd 46.85 2
f 1 without service or feeder fee,
Address: 9S1t A) m w ptyL each branch circuit
Each add'I branch circuit 6.65 2
City/State /ZIP: Qy q-� Miscellaneous (service or feeder not included)
'
Phone: ( " �31 ( I 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
,^ extension. Describe: I . Page 2 75 of 2
Business name: V l3.Qr O s ,
Address: q 61@ SLO (1 bus V`_' Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State /ZIP: t�" Dt 2 Investigation per hour (1 hr min) 62.50
'
Phone: ( y j J l 10(oQ L7 Fax: (c (DX if 1 Le-6 6 Industrial plant per hour 73.75
_ ELECTRICAL PERMIT FEES*
CCB Lic.: (ygaaa Electrical Lic.:ab' A 1 Suprv. Lic.:2a1(,L&13 Subtotal 75, 00
Suprv. Electrician signature, required: /a --oli Plan review (25 %ofpemiit fee)
I
State surcharge (8% of permit fee) ( . Oo
Print name:
."—R g i, i �'"i� , / 4 ' �D. �: ■ I O TOTAL PERMIT FEE $ O O
Authorized signature - � , � r �PM This permit application expires if a permit is not obtained within 180
`- 1° l'r /�'ta . days after it has been accepted as complete
Print name: � L +� , / `t,� p . 6 D • Fee .methodology set by Tri- County Building Industry Service Board
•• Number of inspections per permit allowed
1 \BudJmOl'emws \1 :1.C- I'ermitApp doe 12/03 440- 46151110102 /CO61/WEB
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business (503) 639 -4171 MST
BUP
Received Date Requested � f AM PM BUP
Location 7160 `� Q • Suite MEC
Contact Person Ph ( -5 / q PLM
Contractor CL/ /f7`" Z-T Ef-Ph ) — 01 2 'L SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Ftg Drain Access: ELR oq€ O y- 0
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam . MAE
Shear Anchors ���
• Ext Sheath/Shear • -..._. • -. - - .- : - • • .> • _ - • -
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall pA6sD Fire Sprinkler
Fire Alarm C � ,
Susp'd Ceiling
Roof
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
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
❑ Please call for reinspection RE: /// ❑ Unable to inspect — no access
Fire ADA Line v1 .. D / / 1644 �,� n
Approach/Sidewalk Date 1 (( Inspector 'a[J`
Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL