Permit ,
CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
4& DEVELOPMENT SERVICES PERMIT #: ELR2003 -00349
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/13/03
SITE ADDRESS: 10101 SW WASHINGTON SQUARE RD PARCEL: 1S135BA-00102
SUBDIVISION: OAKBURG ZONING: C -G
BLOCK: LOT: 001 JURISDICTION: TIG
Project Description: Data telecommunications system.
• A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATAITELE COMM: X NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: : HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
PPR SQUARE TOO LLC PROGRESSIVE TELEPHONE SYSTEMS
BY MACERICH COMPANY PO BOX 1950
ATTN: JANET FISHER, ASSET MGMT GRESHAM, OR 97030
SANTA MONICA, CA 90407
Phone: Phone: 503 665 - 4900
Reg #: ELE 26 -1 1 17CCLE
LIC 150175
SUP 3290LEA
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 11/13/03 $75.00 Elect'I Final
[TAX] 8% State Surchart 11/13/03 $6.00
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and
all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not
started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires
you to • ow rule - dopted by the • egon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 throuc
Iss -d by i 1*.A.J, I /id l Permittee Signature „IP - A
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N DATE:
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
1
4. `'`
Electrical Permit Applicat O l l i
Date received: NO Permit no.: f , ,i 3 -CO a *
,` r� 1 City of Tigard Project/appl. no.: date:
City of Tigard Ti Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: Receipt no.:
Phone: (503) 639 -4171 • - • p
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
IN Ph: 01: Pl.:RNM
0 1 & 2 family dwelling or accessory liikommercial/industrial 0 Multi- family 0 Tenant improvement
0 New construction 0 Addition/alteration /replacement CI Other: ❑ Partial
Job address: )p of 5 r a
tsh . .v. 2d Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: i Block: I Subdivisl n:
Project name: g 0 .g ,(1 I Description and location of work on premises: DATA Dezyx
Estimated date of completion/inspection: 2 w,<5
(1)NTR. %(' roil : ,I'1'I.I(A'IIO\ FF1: SCII1 :u1:1.F
Job no: Fee Max
Business name:
P$ C Description Qty. (ea) Total no.insp
New residential - single or multi-family per
Address: ) /c, .(/E c LEdE L ? QriJ§, dwellinmmit .Includesattachedgarage.
City:GQ p _ ) > / . • J , . r . ) I State: 0/L I ZIP: 9,c,; Servkeincluded:
Phone: ke,Sy9ob I Fax: ,ry /j01 E -mail: 1000 sq. ft. or less 4
Each additional 500 sq. ft. or portion thereof
CCB no.: /2j 1 7s IElec. bus. lic. no: z i / /7GLC Limited energy, residential 2
City /metro lic. no.: Limited energy, non - residential 2
+-ems - % /�/ Z / °3 Each manufactured home or modular dwelling
Signature of supervising electrician (required) Da Service and/or feeder 2
Sup. elect. name (print) E.4,) EA_ us License no:
Z cm_ „ .„4 Servicesorfeeders- installation,
alteration or relocation:
200 amps or less 2
Name (print): 201 amps to 400 amps 2
Mailing address:
401 1
amps to 600 amps 2
6
amps to 1000 amps 2
City: I State: I ZIP: Over 1000 amps or volts 2
Phone: I Fax: I E -mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services or feeders -
which is not intended for sale, lease, rent, or exchange according to installation, alteration,orrelocation:
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps to 400 amps 2
Owner's . signature: Date: 401 to 600 amps 2
E(; I :\ F F R Branch circuits - new, alteration,
or extension per panel:
Name: A Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: I State: I ZIP: B. Fee for branch circuits without purchase
Phone: Fax: E of service or feeder fee, first branch circuit: 2
Each additional branch circuit
P1. \ REVIEW (Please check all that apply') Misc. (Service or feeder not included):
Cl Service over 225 amps -commercial O Health -care facility Each pump or irrigation circle 2
O Service over 320 amps- rating of 18c2 0 Hazardous location Each sign or outline lighting 2
family dwellings 0 Building over 10,000 square feet four or Signal circutt(s) or a limited energy panel. 1 � j r>o 4 '
m �
O System over 600 volts nominal more residential units one structure alteration, or extension' S 2
O Building over three stones Cl Feeders. 400 amps or more •Description:
O Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
0 Egress/lighting plan 0 Other Per inspection I I
Submit _ sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Permit fee $ 75
Not all lunsdicttons accept credit cards. please call jurisdiction for more information. Notice: This permit application $
0 Visa O MasterCard expires if a permit is not obtained Plan review (at _ %)
Credit card number: / / within 180 days after it has been State surcharge (8 %) $ b `E e
Expires accepted as complete. TOTAL $ Sr / oar
Name of cardholder as shown on credit card
S
Cardholder signature Amount 4404615 (6100 /COM)