Permit CITY OF TIGARD ELECTRICAL PERMIT
''7 COMMUNITY DEVELOPMENT Permit#: ELC2015 00126
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/02/2015
Parcel: 1 S135BA00102
Jurisdiction: Tigard
Site address: 10218 SW WASHINGTON SQUARE RD
Project: Noodles&Co. Subdivision: OAKBURG Lot: 9
Project Description: TI for new tenant.
Contractor: RUDNICK ELECTRIC SIGNS LLC Owner: PPR SQUARE TOO LLC
1625 WASHINGTON ST PO BOX 847
OREGON CITY,OR 97045 CARLSBAD,CA 92018
PHONE: 503-655-2610 PHONE:
FAX: 503-980-7919
FEES
Quantity Description Date Amount
2 ea Sign or Outline Lighting 03/02/2015 $135.68
Specifics:
1 ea 12%State Surcharge- 03/02/2015 $16.28
Electrical
Type of Use: SF
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $151.96
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. Tho a rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You ma a cop t it @s or direct questions to OUNC by calling 503.232.19:7-or 1.800. 2.2344.
Issued By: Permitte ignature.01.1111PP.
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.
SG (� ,..aO 6 — Ooo33 4- 6003
Electrical Permit Application FOR OFFICE USE ONLI
Received
II al- City of Tigard c 1` 'c D Date/By: 7 Permit No.: _. o i' ,��(
13125 SW Hall Blvd.,Tigard,OR 9M G V G Plan Review
Phone: 503.639.4171 Fax: 503.59 �N.•JJ Date/8 : Other Permit: "cy I 4
TIGARD Inspection Line: 503.639.4175 ZO15 DateReadyBy: Juries-:--r- ® See Page 2 for
Internet: www.tigard-or.gov LIAR U1J Notified/Method: J Supplemental Information
TYPE OF WORky OF TIGARD PLAN REVIEW
at New construction ❑Addition/altera ip1VISIO N Please check all that apply(submit 2 sets of plans w/items checked below):
❑Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition ❑Other: B where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
less to ground,or exceeds 14,000 ❑Commercial-use agricultural
❑ 1-and 2-family dwelling ®Commercial/industrial ❑Accessory building amps for all other installations. buildings.
❑ Multi-family ❑ Master builder ❑Other: ❑Fire pump. ❑Installation of 75 KVA or
❑Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑Addition of new motor load of ❑"A","E","1-2","1-3",
���, � � Six or or o more residential R occupancy.Recreational Job no.: Job site address: Recreational vehicle parks.
i ❑Six or more residential units. ❑ P
City/State/ZIP: ❑Health-care facilities. ❑Supply voltage for more than
��C�� ❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name: t\. c.o Ie ❑Service or feeder 600 amps or more.
�' FEE SCHEDULE
Cross street/directions to job site: Description 1 Qty. I Fee. I Total I *
New residential single-or multi-family dwelling unit.
X11 CaAs cc V-A_ Includes attached garage.
Subdivision: Lot no.: 1,000 sq.ft.or less 168.54 4
Ea.add'I 500 sq.ft.or portion 33.92 1
Tax map/parcel no.: Limited energy,residential
75.00 2
DESCRIPTION OF WORK (with above sq.ft.)
(� Limited energy,multi-family 75.00 2
I „� _S` (4> LE v �s,�Y ci ciN residential(with above sq.ft.)
(q, � t �CGGG'���' Services or feeders installation,alteration,and/or relocation
li0� 1 M e %,vC∎ 200 amps or less 100.70 2
❑ PROPERTY OWNER 1 'TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: O V...ecs 1 ill 601 amps to 1,000 amps 301.04 2
Address: k a`e, S nntecrx■ rut3C-.- Over 1,000 amps or volts 552.26 2
,� Temporary services or feeders installation,alteration,and/or
City/State/ZIP: c, relocation
Phone:( ) I Fax:( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701.
Branch circuits—new,alteration,or extension,per panel
Owner signature: Date: A.Fee for branch circuits with
Sr APPLICANT I awe CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: t Q� %\ U.--e— B.Fee for branch circuits without
C Q Y�j service or feeder fee,first 56.18 2
Contact name: C ■ O branch circuit
Each add'I branch circuit 7.42 2
Address: '`ko W �13 +eS,/k Miscellaneous(service or feeder not included)
y �� �\ q C Each manufactured eicand/or or r modular 67.84 2
City/State/ZIP: ` l
dwelling,service and/or feeder
Phone:( j) ,j �( Fax: :(60'� ) q8 -- `q Reconnect only 67.84 2
//�� ` p� Pump or irrigation circle 67.84 2
E-mail: tet.,e .i C",R�C e�1,-4,1■CS i' r- 9 C S N Sign or outline lighting 67.84 /357 5. 6 7 2
CONTRACTOR Signal circuit(s)or limited-energy
Business name: d \\ panel,alteration,or extension. Page 2 2
4Av ;�JG�JC 1/49, \��� Each additional inspection over allowable in any of the above
Address: kW 7s--- , , _ �_.t. Additional inspection(1 hr min) 66.25/hr
City/State/ZIP: �}. /9 6‘'4C46-- Investigation(1 hr min) 66.25/hr
ie c l "� [� Industrial plant(1 hr min) 78.18/hr
Phone:(SZ ) cc� r 0 Fax:(�3 ) A�,-40 1 Inspections for which no fee is 90.00/hr
specifically listed(14 hr min)
CCB Lic.: ` e., I Electrical Lie.: e_1..., 01- I Suprv.Lic.: -4y2SLC2 ELECTRICAL PERMIT FEES
Subtotal: 457&0
Suprv.Electrician signature,required Plan review(25%of permit fee):
Print name: �,.tcei Y k v Date: 2l l (VS- State surcharge(12%of permit fee): 16.44 do,\\\\���� ( TOTAL PERMIT FEE: 751, `fl'
Authorized signature:c This permit application expires if a permit is not obtained within 180
?\,, days after it has been accepted as complete.
Print name: %.1stt,.)e& \ ek Date: 7 i Y n r * Number of inspections allowed per permit.
I:\Building\Permits\ELC-PermitApp.doe 07/01/10 440-4615T(11/05/COM/WEB
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
199 Electrical final
PASS - No C of O
ELC2015-00126
Jeff Grove
Violation Summary:
Inspector Contractor