Permit ELECTRICAL PERMIT
CITY T I G A R D PERMIT #: ELC2000 -00648
y1 DEVELOPMENT SERVICES DATE ISSUED: 11/28/00
+L r- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S126C0-01107
SITE ADDRESS: 09585 SW WASHINGTON SQUARE RD
SUBDIVISION: WI15"!ff)RE ZONING: C -G
BLOCK: LOT : JURISDICTION: TIG
Project Description: Installation of (1) one 200 amp or less service and (4) four branch circuits to a newly installed cell
monopole. Monopole is located behind Target/Good Guys.
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: 1 W /SERVICE OR FEEDER: 4 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 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:
PPR WASHINGTON SQUARE LLC MONTI ELECTRIC INC
BY THE MACERICH COMPANY PO BOX 30478
ATTN: JANET FISHER, ASSET MGNT PORTLAND, OR 97294
SANTA MONICA, CA 90407
Phone: Phone: 503 - 860 -2682
Reg #: ELE 26- -1018C
LIC 135326
SUP 4591S
FEES Required Inspections
Type By Date Amount Receipt Wall Cover
PRMT CTR 11/28/00 $106.90 2720000000( Elect'l Service
5PCT CTR 11/28/00 $8.55 2720000000( Elect'l Final
Total $115.45
This Permit is issued subject to the regulations co ntained in the Tigard Munidpal Code, State of OR. Spedalty 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 ted by the Oregon Utility Notification Center. Those
rules are set forth in OAR 952 - 001 - 0010 through OAR 952 - 001 -0080. You may obtain pies of th- : rules or direct questions to OUNC at (503)
246 -1987. /
PERMITTEE'S SIGNATURE • ISS ED BY: / ��
VINO'
Mt) WNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: - DATE: I) 17$1
ONTRACTOR INSTALLATION ONLY •
SIGNATURE OF SUPR. ELEC'N: disk _ = DATE: 11 It1
LICENSE NO:
� ssi s -
Call 639 -4175 by 7:00pm for an inspection the next business day
2Lc20zrO- (pN
Electrical Permit Application
Date received: / /,,,n - 00 Permit no.: & C9ove, -ai
: a.r:
- 1! City of Tigard Project/appl.no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 9722 Date issued: By: I Receiptno.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 • Case file no.: Payment type:
Land use approval: 6u/1 0 -063 7
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ommercial/industrial ❑ Multi- family O Tenant improvement .
❑ New construction 0 Addition/alteration /replacement 0 Other: ❑ Partial
JOB SITE INFORMATION
Job address: ()cgs 5 , W,,,v,,,,y , 1 Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: 1 Block: I Subdivision'
Project name: Sp R. 1 a I Description and location of work on premises: Q `,, �t,)v:^ SC -- 0
Estimated date of completion/inspection: I a ! is o ` J
Job no: Fee Max
Business name: V1 El % c -k�i� -=r„ Description Qty. (ea) Total no. insp
Address:.—P.0 ) New residential - tingle or multi-family per
l �t\ R04-) � dwelling milt. includes attached garage.
City: Pcoz tbthd 1 State:D I ZIP: C I"�Z. C � `'1 Serviceiachtded:
Phone(Sar,) prep —z,szi Fax: 2S 3r S ll E -mail: 1000 sq. ft. or less 4
CCB no.: 1 35-3u I Elec. bus. lic. no: 21.„- 10151,c_
Each additional 500 sq. ft. or portion thereof
b Limited energy, residential 2
City /metro lic. no.:
1 Limited energy, non - residential 2
CO Each manufactured home or modular dwelling
Signs re of •'"l . ing electrician required) Date Service and/or feeder 2
Su elect. name (print): � i � Services or feeders — installation,
p• c 3�h o License no: y. . S
PROPERTY OWNER 200 ampsorlessocaHoo: OA.6 2
Name (print): 201 amps to 400 amps 0 � - 2
401 amps to 600 amps 2
Mailing address: 601 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 am .s 2
ENGINEER Branch circuits - new, alteration,
Name: or extension per p anel:
A. Fee for branch circuits with purchase of /r r, Or� 'r
n'
Address: service or feeder fee, each branch circuit w �' 2
City: I State: I ZIP: B. Fee for branch circuits without purchase
Phone Fax E -mail of service or feeder fee, first branch circuit: 2
Each additional branch circuit:
PLAN REVIEW (Please check all that apply) , Misc. (Service or feeder not Included):
❑ Service over 225 amps - commercial ❑ Health -care facility Each pump or irrigation circle 2
❑ Service over 320 amps -rating of l &2 ❑ Hazardous location Each sign or outline lighting 2
family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
❑ System over600 volts nominal more residential units in one structure alteration, or extension* 2
O Building over three stories ❑ Feeders, 400 amps or more *Description:
O Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
O Egress/lightingplan ❑ Other. Per inspection I
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Permit fee $ rot, 96
permit Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This peit application
O 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 %) $
Expires accepted as complete. TOTAL $ //c. Ii
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440 -4615 (6R00/COM)
Electrical Permit Fees: Limited Energy Fees: -
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
P Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total Check Type of Work Involved:
Residential - per unit
1000 sq. ft. or less $145.15 4 ❑ Audio and Stereo Systems
Each additional 500 sq. ft. or
portion thereof $33.40 1 ❑ Burglar Alarm
Limited Energy $75.00
Each Manufd Home or Modular
Dwelling Service or Feeder $90.90 2 ❑ Garage Door Opener
Services or Feeders ❑ Heating, Ventilation and Air Conditioning System'
Installation, alteration, or relocation
200 amps or less $80.30 2
201 amps to 400 amps $106.85 2 ❑ Vacuum Systems`
401 amps to 600 amps $160.60 2
601 amps to 1000 amps $240.60 2 ❑ Other
Over 1000 amps or volts $454.65 2
Reconnect only $66.85 2
Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY
Installation, alteration, or relocation Fee for each system $75.00
200 amps or less $66.85 2 (SEE OAR 918-260 -260)
201 amps to 400 amps $100.30 2
401 amps to 600 amps $133.75 2 Check Type of Work Involved:
Over 600 amps to 1000 volts,
see "b" above. ❑ Audio and Stereo Systems
Branch Circuits
New, alteration or extension per panel ❑ Boiler Controls .
a) The fee for branch circuits
with purchase of service or ❑ Clock Systems
feeder fee.
Each branch circuit $6.65 2 ❑ Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service ❑
or feeder fee. Fire Alarm Installation
First branch circuit $46.85
Each additional branch circuit $6.65 ❑ HVAC
Miscellaneous ❑ Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40
Each sign or outline lighting $53.40. ❑ Intercom and Paging Systems
Signal circuit(s) or a limited energy
panel, alteration or extension $75.00 ❑ Landscape Irrigation Control`
Minor Labels (10) $125.00
Each additional inspection over ❑ Medical
the allowable In any of the above
Per inspection $62.50 ❑ Nurse Calls
Per hour $62.50
In Plant $73.75 ❑ Outdoor Landscape Lighting'
Fees: ❑ Protective Signaling
Enter total of above fees $ I I Other
8% State Surcharge $
Number of Systems
25% Plan Review Fee
See "Plan Review" section on $ * No licenses are required. Licenses are required for all other installations
front of application.
Fees:
• Total Balance Due $
Enter total of above fees $
❑ Trust Account # 8% State Surcharge $
Total Balance Due $
i:\dsts\fonns\elc- fees.doc 10/09/00
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
p BUP
Date Requested / Z / 0 AM PM BLD
Location a fsis .5 14,1 5 /d Suite .NEC
Contact Person Cd Pherq sty, • // Ph 040 G Z PLM
Contractor M0 ok('- k Se /e— Ph SWR �d
BUILDING Tenant/Owner ELC govt - 641 ict
Retaining Wall ELR
Footing Access:
Foundation q / FPS
Ftg Drain a p CCvi • 74- L -7 SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
R Ceiling
Roof
Misc:
•
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
kELECIR AL
Service
Rough In
UG /Slab
Low Voltage •
F' - Alarm
ice,:•
PART FAIL
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd •
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: / //' nable to inspect - no access
ADA
Approach/Sidewalk
Other Date L , J Inspector // . �L Ext -
Final
PASS PART FAIL D • NOT REMOVE this inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspection Line: 639 -4175 Business Line: 639 -4171 MST
BUP
' $dSre Requested / Z — 3 AM PM BLD
Location r3 G(�G S .S Suite MEC
Contact Person! h 14 AA e 0 7 ') J C- 9v^, Ph 37) fGG 261 2 — PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC 70)(//) -60 4v'
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall .
Fire Sprinkler -
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final .
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab .
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
I FCTRICAL
lear
- ough In
UG /Slab
Low Voltage
Fire Alarm
Fin
S� PART FAIL
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: ] Unable to inspect - no access
ADA
Approach /Sidewalk Date /2 c C/ C/ Inspector Ext
Other
Final
PASS PART FAIL DO NO REMOVE this inspection record from the job site.