Permit C ITY OF TIGARD ELECTRICAL PERMIT
- PERMIT #: ELC2004 -00748
DEVELOPMENT SERVICES DATE ISSUED: 11/23/2004
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S135BA-00102
SITE ADDRESS: 10230 SW WASHINGTON SQUARE RD
SUBDIVISION: GIRBURG ZONING: C -G
BLOCK: LOT : 001 JURISDICTION: TIG
Project Description: (4) branch circuits.
Job # 3435.
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: 3 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 HILLSBORO ELECTRIC
BY THE MACERICH COMPANY 21185 NW EVERGREEN PARKWAY
9585 SW WASHINGTON SQUARE RD HILLSBORO, OR 97124
TIGARD, OR 97223
Phone: Phone: 503 - 439 -9666
Reg #: ELE 34 -4399C
LIC 134481
FEES SUP 4941S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 1 1/23/200' $66.80
[TAX] 8% State Surcharge 11/23/200' $5.34 Rough -
Elect'I Final
Total $72.14
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Speaalty 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 obtain copies of these rules or direct questions to OUNC at (503)
246 -6699 or 1 -800- 332 -2344. �y
Issued By: /r4Z.CZ(1 Permit Signature: r u Z. (
V e
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 7:00pm for an inspection the next business day
F r om : H I LLSBORO ELECTRIC LLC. 5036013680 11/22/2004 11:53 #344 P.001
Electrical Permit ApplEIEC
FIVE . , FOR 01'' ICE IJSE ONLY
City of Tigard NOV 2 2 104 re // ' va _/ ��
13125 SW Hall Blvd, Tigard, OR 97223 • Plan Review '
Phone: 503.639.4171 Fax 503.598.1960 '� -'=v ��jl +' Datc/B Other Permit.
Inspection Line: 503.639.4175 CITY OF TI ' !� •`-r ' pair Road ray' ®see Page z for
Internet: www.ci.tigard.or.us G • Notified/Method. SupplementalIaforntadoe
BUILDING 171vcIGN
E OF WORK , •::. -•• , .. ' •' •' • PLAN REVIEW , • ' `
Ilea'►`- construction A dditi0n /aIter81I0n/replacement Please check all that apply:
molition ❑Outer ❑Service over 225 amps, comm'I ❑Hazardous location
- ['Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
' . . • CATEC9RY •OF CONSTRUCTION -. .• • = • - . of 1- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling Commercial/industrial ❑ Accessory building System over 600 volts nominal units in one structure
❑ Multi - family ❑ Master builder 0 Other. ['Building over three stories ❑Feeders, 400 amps or more
Occupant load over 99 persons ❑Manufactured structures or
, ' JOB SITE INFORMATION AND LOCATION':•,' 1 , ❑Egress/lighting RV park
JOb no. :.3l- ( 3 Job site address: (0 s " 00 61,11n, ❑Health -care facility ❑Other
Submit a sets of plans with any of the shove.
City/ State/Z1P: T . l _ The above are not applicable to temporary construction service.
Suite/bidg /apt no.: 1 Project name: i�l�- ,4 , •
D > FEE* SCHEDULE '�
mcriptium . ....... I Qty Fee. I Tout
Cross street/directions to job site: (•, ., / 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 500 sq. ft or portion 33 40 1
Tax map /parcel no.: •
Limited energy. residential 75.00 . 2
75 00
' '- :: :1;° ^• DESCRIPTION OF WORfC :a ,;:;�•.,,::.' .
l,tmr energy, non -rani enna 2
•
. , . _ .. ....i . . , . • _ ,. r _ Each menufbt:tured or modular
- dwelling. service and/or feeder ' 90.90 2
- Services or feeders Installation. alteration, and /or relocation
200 amps or lean 80.30 '2 • PROPERTY OWNER • ,' " ❑' TENANT ..g., 201 amps to 400 amps 106.85 2
"` 401 amps to 600 amps 160.60 2
Name: l_ A ., _ C. 6 601 amps to 1,000 amps 240.60 2
Address: j c.,..4.2.'25-
, •4.2.' . 1-1- \ 3� J Over 1.000 amps or volts 454.65 2
Reconnect only 2
City/ State/ZIP: •,....., C... k � 01 r _ • • Temporary services or feeders installation. . alteration, and/or
relocation
Pa x:
Phone: ( ) ( ) 200 amps or less 66.85 1 . 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
13 ';APPLICANT ' • • ''t.; i'!' " °:: ❑ •COPITACT PERSON• ;'. "• A. Fee for branch circuits with
t - • service or feeder fee, each
6.65 2
Business name: branch circuit _
B.
Contact name: without for
ur service or feeder fee,
each branch circuit 1 46.85 Lk" . 2
Address:
Each adds branch circuit 3 6.65 19 ft t 2
City /State/ZIP: Miscellaneous (service or feeder not Included)
•
Phone: ( ) I Fax:: ( ) Pump or irrigation circle 53.40 2
L Sign or outline lighting 53,40 2
E -mail: • Signal circuit(s) or limited-
•
. .. _ .;�: .::: ...: .......'• '', ""' CONTRACTOR:.:.. • - r • : ••;•) '• :'- . •. "•` . -.. . energy panel, tJtemtiort, r o
extension. Dagcribc. Page 2 3
Business name: Hillsboro Electric L.
Address: Each additional inspection over allowable In any of the above
21 185 NW Evergreen PKWY Ste �] 1 0 Per inspection 62.50
City/State/ZIP: Hillsboro, OR. 97124 Investilation per hour ti hr ram) 62.50
(5 0 3 ) 6 01 - 3 6 8 0 Industrial plant per hour 73.75
Phone :(503> 439 -9666 Fax:
• ELECTRICAL; "PERMIT FEES" •
CCB Lic.:1 3 4 4 81 Electrical Lic.:3 4- 4 9 9 C f Suprv. Lic.: 4941 S ,•;•
' Subtotal
Suprv. Electrician signature, required ' V _. Plan review (25% of permit fee) ��
%� Date: State surcharge (8% of permit fee) . 0
Print name: . .
Joey Vi tacco 11laa ioLl
TOTAL PERMIT WEE 7 „2 ,,
Authorized signature: This permit application expires if u permit is oat obtained within I
days ater it has been accepted as complete
Print name: Date: • Fee methodology set by Tri- County Building Industry Service Board
"Number of Inspections per permit allowed
i; 1Buildma \PmnutslELC- PenunApp.doc I1I(B 44I.4615T(IovvcoM/WEB
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 1 J a te) A' -. SO- Suite MEC
Contact Person Hac-r Ph ( ) 3 C l - 9466 PLM
Contractor Ph ( ) SWR 5 •G
BUILDING Tenant/Owner ELC ° ( f —
Footing
Footing ELC `a.d 0 ) O'7 $ ' I
Foundation Access: S
Ftg
}
Cr awl l Drain ��/ L � -- ff ELR
Crawl
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam /
Under Slab l
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL //�� *1 [� r /,'
Post Rough-In 6N �,,\ \V N� ��n �D' l`��L �11 G'" 1 -47 C,cvc-ia
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL ( Ij - h(
Service
Rough -In �%C.VX,�D ' !N c1 4\/-1/‘ P P11
UG/Slab
Low Voltage
Fire Alarm
/� Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line Ext / Inspector /
ADA / `� Ins -n G�
Approach/Sidewalk Date �/ p
Other:
Final DO NOT REMOVE this Inspection record from the site.
PASS PART FAIL