Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit#: ELR2015-00148
T IGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/03/2015
Parcel: 1 S135BA00102
Jurisdiction: TIGARD
Site address: 10218 SW WASHINGTON SQUARE RD
Project: Noodles&Co. Subdivision: OAKBURG Lot: 9
Project Description: Data telecommunications system.
Contractor: ASHLAN COMMUNICATIONS INC. Owner: PPR SQUARE TOO LLC
7534 N ELMORE AVE PO BOX 847
PORTLAND, OR 97217 CARLSBAD, CA 92018
PHONE: 503-849-9523 PHONE:
FAX: 503-286-2158
FEES
Description Date Amount
Specifics: Restricted Energy Permit 06/03/2015 $75.00
12%State Surcharge-Electrical 06/03/2015 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio&Stereo: 0 Boiler Controls: 0
CCTV: 0 Clock Systems: 0
Data&Telecommunications: 1 Fire Alarm: 0
HVAC: 0 Instrumentation: 0
Intercom/Paging: 0 Landscape/Irrigation: 0
Landscape Lighting: 0 Medical: 0
Nurse Calls: 0 Protective Signal: 0
Security Alarm: 0 Other: 0 Total $84.00
Other Desc: 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. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a f the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: vPermittee 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.
Electrical Permit Application FOR OFFICE l'SE ONLY
• :4 Received
City of Tigard i DateB : - Permit#: - ,.1>'— •t '
11111 - • 13125 SW Hall Blvd.,Tigard,OR S);j7 3� Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Related Permit#:
Inspection Line: 503.639.4175 ? Ready Date/By: ® See Page 2 for
1 1( 1't) Internet: www.tigard-or.gov Notified/Method: � Supplemental Information
ew construction ❑Addition/alterati6i/repIiccnietit. Please check all that apply(submit 2 sets of plans w/items checked):
t, ❑Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition ❑Other: ,, ., - where the available fault current ❑Marinas and boatyards.
" exceeds 10,000 amps at 150 volts or ❑Floating buildings.
❑ 1-and 2-family dwelling tc ommercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
❑Emergency system. larger separately derived
Job 4: Job site address: p ❑Addition of new motor load of system.
�02/�/ .‘,.�4)4j6„ ,sy 4 / IOOHPormore. ❑ A„ E„ 1_2„ l-3>
City/State/ZIP: ,/ ❑Six or more residential units. occupancy.
ty /�Gfx- d/ ❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.4: �J Project name: ❑Hazardous locations. ❑Supply voltage for more than
4/0470/%9 ❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site:
Description Qty. Each Total •
New residential single-or multi-family dwelling unit.
Subdivision: I Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'l 500 sq.ft.or portion 33.92 1
Limited energy,residential 75.00 2
�/f.I 141�44� al Vo'`v9 _/ A
(with ne gy, lti •
T GrA Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 100.70 2
Address: 201 amps to 400 amps 133.56 2
-
401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( ) I Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
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
Branch circuits-new,alteration,or extension, er panel
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 without
Address: service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP: Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( .) I Fax: :( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
Business name: /if I/44 rovo,p,lJq/1.146,4 TAI Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy ❑ See Pae 2 2
2--y ri V ,t-, /.,,cyP g
e panel,alteration,or extension. 7 f co
City/State/ZIP: /�/� Q1€ 97ii7 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( e) )8yq 9y j Fax:( ) Investigation(1 hr min) 66.25/hr
r Industrial plant(1 hr min) 78.18/hr
Email:
t J A�a.*(OMM F / 9 40. ro401 Inspections for which no fee is
CCB Lic.: /6 y 2 3 Electrical Lic.: ei,7 Suprv.Lic.:/,(17- J3 s. cificall listed %:hr min `��/hr
Suprv.Electrician ,required: "7„.. ..._ 1 '� 0/t/ ' 7 Subtotal:
/ , 7r.
Print name: �•rj�i s/41e- r Date: / S ❑Plan Review Required(25%of permit fee):
•
State surcharge(12%of permit fee): GJ.cr-/-
Authorized signature:
TOTAL PERMIT FEE: P 61(.,
This permit application expires if a permit is not obtained within 180
Print name: �f0,- �t�j Date: ,(j,/j days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:\Building\Permits\ELC_PeimitApp_ELR_ERE.doc Rev 04/21/2014 440-46i5T(11/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
systems combined: $75.00 Renewable tiara I Qty. I Each I Total I
Fee for all residential s
y Rene electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
El Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
❑ Garage Door Opener* >100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
❑ Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over25 7.42 3
❑ Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ Other: Each additional inspection is 66.25/hr
charged at an hourly(I hr min)
Inspections for which no fee is 90.00/hr
s ificall listed Y2 hr min
COMMEitaAL WORK ONLY: . J , ! ,
Subtotal(Enter on Page 1):
Fee for each commercial system: $75.00 Number of ins
(SEE OAR 918-309-0000) pections allowed per permit.
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
AData Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
El Medical
El Nurse Calls
❑ Outdoor Landscape Lighting*
El Protective Signaling
El Other:
Total number of commercial systems: /
*No licenses are required. Licenses are required for all
other installations
I:\Building\Pamits\ELC_PermitApp_ELR_ERE.doc Rev 04/21/2014
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
10218 SW WASHINGTON SQUARE RD,
TIGARD, OR, 97223
Commercial - Electrical Limited Energy
198 Low voltage final
PASS - No C of O
ELR2015-00148
Chip Barnett
Violation Summary:
Inspector Contractor