Permit q CITY OF TIGARD ELECTRICAL PERMIT
s COMMUNITY DEVELOPMENT Permit#: ELC2015-00143
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/11/2015
Parcel: 151260000300
Jurisdiction: Tigard
Site address: 9585 SW WASHINGTON SQUARE RD
Project: Koi Fusion Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: S
Project Description: (5)branch circuits for temporary kiosk in food court.
Contractor: ON ELECTRIC LLC Owner: PPR WASHINGTON SQUARE LLC
15555 SW BANGY RD PO BOX 847
LAKE OSWEGO, OR 97035 CARLSBAD, CA 92018
PHONE: 503-313-6016 PHONE:
FAX:
FEES
Quantity Description Date Amount
5 crt Branch Circuits wo/Purchase 03/11/2015 $85.86
Specifics: Service or Feeder
1 ea 12%State Surcharge- 03/11/2015 $10.30
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $96.16
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. 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 the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. ee—tale re set forth in AR
952-001-0010 through OAR 952-001-0090. You m=_ obtain- •• o ules or direct questions to OUNC by calling 503.232.198
Issued By: 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' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
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.
x% WVA\T
Electrical Permit Applicatio _ jet FOR OFFICE USE()NI.\
lig 5-City of Ti and Received
Dte/By: // /'�( (j Permit#: ■1e/
eiC// 3
• 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
0 Phone: 503.718.2439 Fax: 503.598.19MAR 1 1 2015 Date/By: Related Permit#:
T I c A R D Inspection Line: 503.639.4175 Ready Date/By: �� knia ®See Page 2 for
Internet: lnvw.ligard-or.gov V r,,I, Notified/Melltod: � � Supplemental Information ►
i l� P►� . '! `} O PLAN REVIEW -
TyiFE OF a ,..„ILL f`4 f V
RI New construction ❑Addition/ad .• 1! , &W el "' " Lt • Please check all that apply(submit a sets of plans w/items checked):
❑Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition ❑Other: where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑ I-and 2-family dwelling 0 Comercial/industrial 1.]Accessory building less to ground,or exceeds 14,000 0 agricultural
m
amps for all other installations. buildings.
El Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or r
'JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
Job#: Job site address:�f L` 1,A5415311-y (� ❑Addition of new motor load of system.
•Q 3 S g S t"�} sk H/ tOO11P or more. ❑"A„..E....t_2","t_3,.
❑Six or more residential units. occupancy.
City/State/ZIP:
ertafeD C)R ❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name: ❑Hazardous locations. ❑Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site:
FEE SCHEDULE -
Oescriollon I Qty. I Each I Total I •
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage,
I
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'I 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
p� �r �I �/ �^ (with above sq.ft.) 75.00 2
T e M iU' -C.- + - 1W 5'(, t Nt 5.6 CO uQ { V 1 * S Limited energy,muki-family 75.00 2
residential(with above sq.ft.) '
pit Renewable Energy ❑ See Page 2 t•PROPERTY.OWNER I 0 TENANT Services or feeders installation,alteration,and/or relocation ?
Name: Q. • C C 200 amps or less 100.70 2
Address: 201 amps to 400 amps 133.56 2
Po S� 401 amps to 600 amps 200.34 2
City/State/ZIP: ctA2LS4 ftD 1 r a t:fiA tic 601 amps to 1,000 amps 301.04 2
Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or 1
Email: relocation t
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 I
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 _ 2
Owner signature: Date: 401 amps to 599 amps 168.54 _ 2
.APPLICANT CONTACT PERSON Branch circuits-new,alteration,or extension, i er panel I
A.Fee for branch circuits with
Business name: above service or feeder fee,
7.42 2
each branch circuit
Contact name: B.Fee for branch circuits withatd
Address: service or feeder fee,first I 56,18 c •A 2
branch circuit
City/State/ZIP: Each add'l branch circuit Lk 7.42 2-�l.t. 2
Miscellaneous(service or feeder not included)
Phone:( ) l Fax::( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email:
Reconnect only 67.84 2 j
, 'CONTRACTOR Pump or irrigation circle 67.84 2
Business name: 0 n AA c.c- 1 C-.. LLC Signor outline lighting 67.84 2
Address: C{ �, Signal circuit(s)or limited-energy ❑ Sec Page 2 2 i
\\Q+MeC-�\Q \,S C. 5{-�, z,.�',0 panel,alteration,or extension.
City/State/ZIP: i \ L ror, C 8-106 C� Each additional inspection over allowable in any of the above
/ I Additional inspection(I hr min) 66.25/hr
Phone:(5o 7 ) S i 3 ice'k Lo Fax:(5-b3) (s S''( — 2-e■ Investigation(I hr min) 66.25/hr
Email: 1.--e,u, dvCr't-Z\Ei ,(. -(c't ■ Industrial plant(lhrmin) 78.18/hr
Inspections for which no fee is
CCB Lie.: .0 fj t,o 0 Electrical Lie.:C\O`1 6 Suprv.Lie.: 3 tr q s'5 specifically listed(Y hr min) 90.00/hr
'Z
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required. , c am- Subtotal: 85, 'see
Print name: mac L
,,, (' ,i pc Date: 3)q I/S ❑Plan Review Required(25%of permit fee): --•--
State surcharge(12%of permit fee): Jo.'10
Authorized signature: TOTAL PERMIT FEE: C`i 42,/(p
�� ,[� � � This permit application expires if a permit is not obtained within 180
Print name: �tiI t 1�"w>✓,,,. Date:3/q As— I days after it has been accepted as complete.
( • Number of inspections allowed per permit.
I:lauitding\PermitslELC_ParmitApp EUt_ERE.doc Rev 04/21/2014 440.4615T(t t/0S/COM/WEtl
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
9585 SW WASHINGTON SQUARE RD, TIGARD,
OR, 97223
Commercial - Electrical
199 Electrical final
PASS - No C of O
ELC2015-00143
Chip Barnett
Violation Summary:
Inspector Contractor