Permit CITY OF TIGARD ELECTRICAL PERMIT
E .',, COMMUNITY DEVELOPMENT Permit#: ELC2017 00043
Date Issued: 01/19/2017
T[c;AR.D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 1 S 135BA00102
Jurisdiction: Tigard
Site address: 10124 SW WASHINGTON SQUARE RD
Project: Costa Vida Subdivision: OAKBURG Lot: 9
Project Description: (1)200 amp service and(25)branch circuits for TI
Contractor: SURGE ELECTRIC Owner: PPR SQUARE TOO LLC
13617 NE 61ST AVE PO BOX 847
VANCOUVER,WA 98686 CARLSBAD, CA 92018
PHONE: 360-772-1321 PHONE:
FAX: 866-929-4771
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 01/19/2017 $100.70
Specifics: amps or less
25 crt Branch Circuits w/Purchase 01/19/2017 $185.50
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 01/19/2017 $34.34
Electrical
Type of Const:
Occupancy Grp:
Total $320.54
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 0 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: / T_— 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:
/'1/ � CONTRACTOR INSTALLATION ONLY
,.r �'�rF 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 Applicatii'il1ECEJV D 10K 011•1(I. I sl:()NIA
City of Tigard Received }
Date/B : /// �7 • Permit#: !..e /.7 ®eh Y3'
13125 SW Hall Blvd.,Tigard,OR 97223,AN 1 9 2 0 1 7 Plan Review /�
II C Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Related Permit ljt/ j� � �
T 1 C A K U Inspection Line: 503.639.4175 CITY OF T"I G A RD Ready Date/By: Juris: ® See Page 2 for
BUILDING nivisION
Internet: www.tigard-or.gov l�rT°�! Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑New construction "Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition ❑Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑ 1-and 2-family dwelling ,Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder ❑Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: Job site address: ✓0/2 9 5441451-0N61 /s ak p 10011P or more. ❑"A","E","1-2","1-3",
`f a/�/� ❑Six or more residential units. occupancy.
City/State/ZIP:
l /!C D ❑Health-care facilities. 0 Recreational vehicle parks.
a
Suite ldg./apt.#:4..o 7 Project name: (Z6-7/5 4/A0A- ❑Hazardous locations. 0 Supply voltage for more than
c�
❑Service or feeder 600 amps or more. 600 volts nominal.
v,t
Cross street/directions to job site: > ,q 9,0,/..)70/..1 joon/ �/A(A- FEE SCHEDULE
" Description I Qty. I Each I Total I *
New residential single-or multi-family dwelling unit.
Subdivision: WALL_ 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
DESCRIPTION OF WORK Limited energy,residential
/� ' (with above sq.ft.) 75.00 2
/` if, 1 /-1�/2'/j/ �''� �t1 Oct "�„-- Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Renewable Energy 0 See Page 2
0 PROPERTY OWNER ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less / 100.70 joG>-7.,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:( ) 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
0 APPLICANT ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
above service or feeder fee, 2 '/
Business name: 7.42 leo,5 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:( ) Fax: :( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: Reconnect only 67.84 2
CONTRACTOR� Pump or irrigation circle 67.84 2
Business name: S,...42,e 6[ge%�1�- Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy Page j32&' /LAG: ii/41."," 59 5.6_,,,y--,c 7.—I y panel,alteration,or extension. 0 See Pa e 2 2
Each additional inspection over allowable in anyof the above
City/State/ZIP: v4Atot/✓,_ 6.in 926 6 p
Additional inspection(1 hr min) 66.25/hr
Phone:( 60 .7-72 ( 3 z( Fax:( ) Investigation(1 hr min) 90.00/hr
Email: s'L}2. � 16. G iv�jG ,-t--7 Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: /3p'. /o� Electrical Lic.:G !9 c 2 Suprv.Lic.:/ ,g y_5 specifically listed('/�hr min)
Suprv.Elec ciatdre required: J ELECTRICAL PERMIT FEES
p % �� Subtotal: Zg6,
Print name: 5 f S ‘4044,2„4#461 Date: �/y//7 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): j cz -3,,,,
Authorized signature:
TOTAL PERMIT FEE: ' r 7
This permit application expires if a permit is not obtaide within 180
Print name: Date: days after it has been accepted as complete. i/
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(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
*
Fee for all residential systems combined: $75.00 ne ReneRenewableQty' Each Total electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
❑ 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
n G• arage Door Opener* >100 kva(fee in accordance
with OAR 918-309-0040) 552.26 2
n Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System*
Each additional kva over 25 7.42 3
n V• acuum 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 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed('/z hr min)
COMMERCIAL WORK ONLY:
ELECTRICAL PERMIT TEES
Subtotal(Enter on Page 1):
Fee for each commercial system: $75.00 * Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
[1 Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
n M• edical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I:\Building\Permits\ELC_PermitAppELRERE.doc Rev 06/17/2015
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
10124 SW WASHINGTON SQUARE RD,
TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Electrical ELC2017-00043
Inspection Type: Inspector:
199 Electrical final Chip Barnett
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor