Permit C ITY OF T I GA R D ELECTRICAL PERMIT -
RESTRICTED ENERGY
Y
, akfiiik i
- 13125 DEVELOPMENT T r S O RV SERVICES (503) 639 -4171 DATE ISSUED: E 0321 O/
SITE ADDRESS: 09585 SW WASHINGTON SQUARE RD MGMT PARCEL: 1S12600 -00300
SUBDIVISION: EIENGTON SQUARE ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
Project Description: Addition to existing CCTV system.
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: CCTV X
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
WASHINGTON SQUARE LLC HUSER INTEGRATED TECHNOLOGIES
BY THE MACERICH COMPANY 1313 NW 17TH AVE
9585 SW WASHINGTON SQUARE RD PORTLAND, OR 97209
TIGARD, OR 97223
Phone: Phone: 503 227 - 5941
Reg #: L503- 227€,6
ELE 26- 562CLE
SUP 3609LEA
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 10/18/2004 $75.00 Elect'I Final
[TAX] 8% State Surchart 10/18/2004 $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
yo ollow rufes.a by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010
t ough OAR 952 -00 011! You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699.
I sued by / /« .I .. Permittee Signature C/
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 pp ' al Permit Application FOR OFFICE USE ONLY
�- Received Q� � A
City of 7Cigard
� Date/By / I4' o N Permit No.: ea 9�v -� 3,/
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
i�
Phone 503 639.4171 Fax: 503 598 1960 � Date/By Other Permit.
Inspection Line: 503.639.4175 Date Ready /By tun 0 See Page 2 for
Internet: www.cl.tigard or.us Nonfied/Method. Supplemental Information
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 DBuildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling R 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 DEgress/lighting plan RV park
❑Health -care facility ['Other Job no.: Job site address: q S yc-- c/j (e+,•n Jit tad Submit 2 sets of plans with any of the above.
City/State /ZIP: V` Ut 2 9 . 7 22 3 The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: FEE* SCHEDULE
Description I Qty. I Fee. I Total I **
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'I 500 sq. ft. or portion 33.40 1
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
LL I V S ./ `3. e el u CA v( u Ti i- Services or feeders installation, alteration, and /or relocation
200 amps or less 80 30 2
❑ PROPERTY OWNER I ❑ 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 ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: gut s,a L „re, iu i_rA o,) T L i i,,,51,9 branch circuit
V B. Fee for branch circuits
Contact name: l v, A di 8 v-1) without service or feeder fee, 46.85 2
Address: each branch circuit
3 3 iii t, �� a,, j _ Each add'l branch circuit 6.65 2
City/State /ZIP: /� c9 � �
) c (� 9 ZD Miscellaneous (service or feeder not included)
I` I GI✓� f `1
Pump or irrigation circle 53 40 2
Phone: ( Z 7_ ( cc ‘ Fax:: (S`�3) 2 7 _ 7c1 Y / Sign or outline lighting 53.40 2
..(
E -mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
extension. Describe: !! Page 2 2
Business name: 1' 7s�
Address: Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State /ZIP: Investigation per hour (I hr mm) 62.50
Phone: ( ) Fax: Industrial plant per hour 73.75
�/ $ ( ) ELECTRICAL PERMIT FEES*
CCB Lic.: ( c, Electrical Lic.: ) 1 , c is - Suprv. Lic.: 3 (y 0 Cj LEi4 Subtotal
Suprv. Electrician signature, required: --a_ i't%J 7/'4' 10 tif‘ Plan review (25% of permit fee) 75 0
Print name: 19 �✓hu� Date. p , 1 �_� State surcharge (8% of permit fee) 6, 00
TOTAL PERMIT FEE 81 , 00
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: • Fee methodology set by Tn -County Building Industry Service Board
•• Number of inspections per permit allowed.
t \Buildtng\Permtts\ELC- PermttApp doe 12/03 440- 4615T(10 /02 /COM/WEB
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 system $75.00
(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*
❑ Protective Signaling
a Other I V
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
0Butlding\Permas'ELC- PenmtApp doc 04/03
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2004- 00321
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10118/2004
Phone: (503) 639 -4171 Q
Inspection Requests (24 Hrs.): (503) 639 -4175 s- °'I �..-
INSPECTION WORKSHEET FOR DATE: 11/8/2005 TIME: 7 :00AM PAGE: 87
SITE ADDRESS: 09585 SW WASHINGTON SQUARE RD MGMT CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE:
PROJECT NAME: WASHINGTON SQUARE MALL
DESCRIPTION: Addition to existing CCTV system.
OWNER: WASHINGTON SQUARE LLC, PHONE #:
CONTRACTOR: HUSER INTEGRATED TECHNOLOGIES PHONE #: 503- 227 -6688
Inspection Request Scheduled For: Date: 11/8/2005 Pour Time:
Code # nspection Descn • • • n Confirm # Contact # Message
199 Iectrical fit 020585-01 603- 227 -6688 Y
•
Corrections /Comments /Instructions:
•
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: MY; Date: 1 1 ' to` IAD Phone #: (503) 718-V VO