Permit (69) 1114 CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2016-00333
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/25/2016
T I c;A I.Dg Parcel: 1 S 135BA00102
Jurisdiction: Tigard
Site address: 10140 SW WASHINGTON SQUARE RD
Project: Zoup! Subdivision: OAKBURG Lot: 9
Project Description: Electrical for TI:(41)branch circuits.
Contractor: MARK ADAMS ELECTRIC INC Owner: PPR SQUARE TOO LLC
PO BOX 2748 PO BOX 847
CLACKAMAS, OR 97015 CARLSBAD, CA 92018
PHONE: 503-557-8543 PHONE:
FAX: 503-557-8508
FEES
Quantity Description Date Amount
41 crt Branch Circuits wo/Purchase 04/25/2016 $352.98
Specifics: Service or Feeder
1 ea 12%State Surcharge- 04/25/2016 $42.36
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $395.34
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 ma obtain afppye€b8,,rules or direct questions to OUNC by calling 503.232 X87 or 1.800. 32.2344.
Issued By: 4 ...c.,.. _ �,3 Permittee Signature: Jp
�' / A
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 ,� k vS1 FOR 01.-FR t: 1 Sl: ON 1.1
City of TigardVA-)
Received ` ' 4,� I I
111
Date/13
13125 SW Hall Blvd.,Tigard,OR 972 Ptan Review j
_ Phone: 503.718.2439 Fax: 503.598.1960 q 5 1p1) Date/B ��(l: Related Permit#: t . i
Inspection Line: 503.639.4175 nPR (� Ready Date/By: ® See Page 2 for
l I C::1
' RD Internet: www.tigard-or.gov � �) Notified/Method: Supplemental Information
..
®New construction 0 Addition/alteratio1 Please check all that apply(submit 2 sets of plans w/items checked):
❑Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition 0 Other: where the available fault current
['Marinas and boatyards.
..'..,#,,,2,...70.7771771, ',..1tt1'" b t e ' t exceeds 10,000 amps at 150 volts or ❑Floating buildings.
ID1-and 2-family dwelling ®Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
sg & 1 t ` t
El Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: Job site address: 10140 SW Washington Square Roa 10oHP or more. ❑"A","E","1-2'°,"1-3'°,
City/State/ZIP:Tigard,OR 97223 ❑Six or more residential units. occupancy.
0 Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.4:213 Project name:Zoup TI ❑Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: 3 `"` x i;1,
Description I Qty. I Each I Total9 I •
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
Tax map/parcel 4: 1,000 sq.ft.or less 168.54 4
Ea.add'I 500 sq.ft.or portion 33.92 1
I ,, K _ S.. €' ii:.,:;-? Limited energy,residential 75.00 2
(with above sq.ft.)
Electrical circuits for Tenant Improvment Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
.. Renewable Energy ❑ See Page 2
4ve: ,< . .Cl ,€),:'1'•, '„',:;;°;',4'.,',.. :.J., g.f.., ,,A,,,, ,CO 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 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 si a ature: Date: 401 amps to 599 amps 168.54 2
w• Branch circuits—new,alteration,or extension,per panel
2.:.:0,4„...,„,
r��� ice , �a�aA��.a �.� ; �.. �� tD .. �, . °.R� a L
��a•�•• �_�•-• «• � 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
service or feeder fee,first 1 56.18 56.18 2
Address: branch circuit
City/State/ZIP: Each add'I branch circuit 40 7.42 296.80 2
-- Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email Reconnect only 67.84 2
° ' . O1NIN1 '.'1,111,:', -
4>„1s: ,,:: Pump or irrigation circle 67.84 2
Business name:Mark Adams Electric,Inc Sign or outline lighting 67.84 2
Address:P.O.Box 2748 Signal circuits)or limited-energy 0 See Page 2 2
panel,alteration,or extension.
Each additional inspection over allowable in any of the above
City/State/ZIP:Clackamas,OR 97015 Additional inspection(1 hr min) 66.25/hr
Phone:(503)557-8543 Fax:(503)8508 Investigation(1 hr min) 90.00/hr
Industrial plant(1 hr min) 78.18/hr
Email: mark@markadamselectric.com
Inspections for which no fee is
CCB Lic.: 174094 Electrical Lic.: C248 Suprv.Li • 4810S specifically listed Y.hr,mi90.00/hr
,o)
Suprv. Electrician signature,required: Subtotal: 352.98
Print name: Mark Adams I Date: 4/22/16 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): 42.36
TOTAL PERMIT FEE: 395.34
Authorized signature: _ This permit application expires if a
permit is not obtained within 180
Print name: Mark Adams Date: 4/22/16 days after it has been accepted as complete.
Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB