Permit CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
,rl DEVELOPMENT SERVICES PERMIT #: ELR2005 - 00416
44 - '�I II 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 11/17/2005
PARCEL: 1S12600-00300
SITE ADDRESS: 09585 SW WASHINGTON SQUARE RD Y04 ZONING: C -
SUBDIVISION: WASHINGTON SQUARE LOT: JURISDICTION: TIG
Project Description: Security System - Verizon Kiosk.
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: 1
Owner: Contractor:
WASHINGTON SQUARE LLC OREGON SECURITY & COMMUNICATIONS
BY THE MACERICH COMPANY PO BOX 83899
9585 SW WASHINGTON SQUARE RD PORTLAND, OR 97238 -0899
TIGARD, OR 97223
Phone: 503- 639 -8865 Phone: 503- 240 -1694 ex 201
Reg #: LIC 124421
ELE 5 -43CLE
FEES SUP 721 LEA
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 11/16/200: $75.00
[TAX] 8% State Surcha 11/16/200E. $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 - 001 -0100. You may obtain copies of these
rules or direct questions to OUNC at 503 - 246 -6699.
Issued By: '4 7� 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: % / —/7 -0 �,-
LICENSE NO: 72-1 LE-,4-
. 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.
• . E l e c t r i c a l Permit Ap r r `� • - . 6 Tor. O i n k E [ S E o\ 1_1
•
City of Tigard f� ' °jar + - ` ?oQg Plan Rev i��/ 7 I Permit No.vLilas al 5„, 13125 SW Hall Blvd., Tigard, OR 97223 �' " Review
Phone: 503.639.4171 Fax: 503.598.1960 • *s D�By: Other Permit: for
Inspection Line: 503.639.4175 CITY OF TIGARD = = � �l .� I - Date
: l tr Inrbrmauoo
Internet www.aa onus BUILDING DIVISION
TYPE OF WORK PLAN REVIEW
® New construction ❑ Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑Other ❑Service over 225 amps, comm'l ❑Hazardous location
❑ Service over 320 amps - rating ❑ Buildng over 10,000 sq. R,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
❑ I - and 2 family dwelling ® Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi - family El Master builder ❑ Other ❑Building over three stories ❑Feeders, 400 amps or more
❑Occupant load over 99 persons 0 Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park
Job no.: VW WSQ I Job site address: 9585 SW WASHINGTON SQ RI) ❑Health facility ❑ er:
Submit 2 sets of plans with any of the above.
City/State/ZIP: TIGARD OR 97223 The above are not applicable to temporary construction service.
Suite/bldg. /apt no.: Y-04 Project name: VERIZON WIRELESS KIOSK FEE* SCHEDULE
I tom. I t=ee. I Total I **
Cross street/directions to job site: WASHINGTON SQUARE NEW ADDITION New residential single or multi - family dwelling unit
Includes attached garage.
1,000 sq. R or less 145.15 4
Subdivision: I Lot no.: Ea add'l 500 sq. fl or portion 33.40 1
Tax map/parcel no.: Limited energy, residential 75.00 2
Limited energy, non-residential j 75.00 7.5 2
DESCRIPTION OF WORK Each manufactured or modular
INSTALL SECURITY SYSTEM 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 I to TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: VERIZON WIRELESS 601 amps to 1,000 amps 240.60 2
Address: 9585 SW WASHINGTON SQ RD Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/ State/ZIP: TIGARD OR 97223 Temporary services or feeders Installation, alteration, and/or
relocation
Phone: ( ) I 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 dry - 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,
each branch circuit 46.85 2
Address: Each add'l branch circuit 6.65 2
City/ State/ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) Fax:: ( ) Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
\ O extension. Describe: Page 2 2
Business name: DishNet Installation Service d.b.a. Oregon Security & Comm
1 Address: P.O. Box 83899 Each additional inspection over allowable in any of the above
Per inspection 62.50
City/ State/ZIP: Portland, OR 97283 hour 0899 Investigation per ho (t hr min) 62.50
A Phone: (503) 240 -1694 ext 201 I Fax (503) 286 - 2587 Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: 124421 I Electrical Lic.: 5 - 43CLE I Suprv. Lic.: 721LEA Subtotal
75 -
k9 Suprv. Electrician signature, requited: Plan review (25% of permit fee) —
Print name: I rz L I Date: 11/16/05 State surcharge (8% of permit fee) C - 0 0
k/ Q.-V t G ( /341 N1 4..P)
TOTAL PERMIT FEE S 1 , 00
Authorized signature: � Thh permit application expires If a permit is not obtained wlthln 180
days after It has been accepted as complete
Print name: Date: • Fee methodology set by Tri- County Building Industry Service Board
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2005 -00416
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED, 11/17/2005
Phone: (503) 639 -4171 1
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 11/23/2005 TIME: 7:00AM PAGE: 65
SITE ADDRESS: 095: • SW WASHINGTON SQUARE RD CLASS OF WORK:
SUBDIVISION: WASH GTON SQUARE LOT #: TYPE OF USE:
PROJECT NAME: WRIZO EL
DESCRIPTION: Security Sy m - Verizon Kiosk.
OWNER: WASHINGTON QUARE LLC, PHONE #: 503- 639 -8865
CONTRACTOR: OREGON SECU & COMMUNICATIONS PHONE #: 503- 240 -1694 ex 2(
•
Inspection Request Scheduled For: Date: 11/23/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
L . to : e 022298 -01 503-240-1697
Corrections /Comments/ • tructions:
•
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: c3 N LE Date: a 1 5l Phone #: (503) 718 - V(4