Permit s 'J
ilki .; v CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2009 -00661
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 12/15/2009
T f GARD, Parcel: 2S102BD01701
Jurisdiction: Tigard
Site address: 12830 SW PACIFIC HWY
Subdivision: Lot: 0
Project: Davidson's Casual Dining
Project Description: Add /alter (2) branch circuits for reconnect roof top gaspack.
Owner: FEES
DAVIDSON, WILLIAM G & DIXIE L Quantity Description Date Amount
8915 SW COMMERCIAL ST
TIGARD, OR 97223 2 crt Branch Circuits 12/15/2009 $63.60
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 12/15/2009 $7.63
Electrical
Contractor:
PRO CIRCUIT ELECTRIC LLC
PO BOX 3948
WILSONVILLE, OR 97070
PHONE: 971 - 563 -8211
FAX: 503 - 266 -1349
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $71.23
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 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
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Issued By: ,. \�
` '1 f I. 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' QK `J F Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
, d� t e,o � � Gb L
Electrical Yerrnit Appiicatio ` ', ,. - F r
DECEIVED u O „414 , r'r II.C,US'CQV LN t t a • Ilk _
', - ' C of Tigard Received ijJ) Et (12C09 (o(Q1
b Dat e/B Permit No.:
'� 13125 Su Han Blvd. Tigard OR 97223 y '
r g 0 C 15 2 009 Pla Review
- s t 1 Phone: 503.6394171 Fax: 503.598.1 Elate/By: Giber Permit:
j Inspection Line: 503.634.4175 Dote Readylny: /mit' Id See Pogo? for
.0 a w,
Internet: wwtigard or.gov CITY OFTIGARD Notified/Method: C Supplemental Information
TYPE o �ING DIVISION PLAN REVIEW
0 New construction Addition/alteration/replacement Please chxk all that apply (submit 2 sets of plans w/items checked below):
['Service or feeder 400 amps or more 0 Building over three stories.
❑ Demolition El Other: • 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: ❑ Film pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system.
1 ❑ Addition of new motor toad of ❑ "A ", "l ',"1 - "! - ",
Job no.: Job site address: 1 Z $ SW ��� �` 1��' or more. occupancy.
0 Six or more residential units. ❑ Recreational vehicle parks. •
City /State /ZIP: L LAID ❑ Healthcare facilities. ❑ Supply voltage for more than
/ p,L)�j ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: 1 Project name'T 7 - ^ 1 tr `rV �>. ❑ Service or feeder amps or more.
1 OOOCCC.../// FEE SCHEDULE
Cross street/directions to job site: Description ! Qty. 1 Fce. I Tout
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
' - Ea. add'( 500 sq. ft. or porlicn 33.92 1
7 ax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. R.) 67.84 2
2 e`ON _ J& GAS ?4C It- Limisid residential energy, (with above sq. 67.84 2
� 1 Ivti-- O/�I T1✓�r residential withabovc s 1t
Services or feeders installation, alterat and/or relocation
200 amps or less 100.70 2
a PROPERTY OWNER J ❑ TENANT 201 amps to 400 amps 133.56 2
Name: I J I `-D 90 / t _ 5 ` / =, I 401 amps to 600 amps 200.34 2
[l 601 amps to 1,000 amps 301.04 2
Address: 1 Over 1,000 amps or volts 552.26 2
City/State/ZIP: ' Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59.36 I
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Owner signature: Dale: • Branch circuits— new, alteration, or extension, per panel 1
A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or fccdcr fee, 1
'2.42 7r'/ Z 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name' wirhoui service or fccdcr fee, I 56.18 Jc 2
first branch circuit
Address: Each add'I branch circuit 7.42 2
t Miscellaneous (service or feeder_ not included)
City /Stale /ZIP: Each manufactured or modular
dwelling, scrvicc and/or fccdcr
Phone: ( ) Fax: : ( ) 67.84 2
Reconnect only 67.84 ` 2
E -mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name: 1O C V� L.&_7(1-11.1._ Signal circuit(s) or limited -
energy panel, alteration, or
Address: T. D 39 .-{Q extension_ Describe: Page 2 2
City/State /ZIP: 1 ),1'30 t.a tt n � o k o7 O Each additional inspection over allowable in any of the above
s,--z_ Per inspection 66.25
Phone: (911 ) .5 ,3 L ( Fax: ( 51 7...-CD(o f / 4
� � Investigation per hour (1 lu min) 66.25
CCl3 Lic.: t? Electrical Lic.: —��t ` Suprv. Lic.: 6 5 . Industrial plant per hour 78.18
1 ELECTRICAL PERMIT FEES
it Suprv. Electrician signature, required: t Subtotal: ( ,k
Print nam e_ Al I:\ (c t Dale: t O ... 0 Plan review (25 %ofpermit fcc): I State surcharge (12% ofpermit fcc): 7, (
Authorized signature: TOTAL PERMIT FEE: _2l ZT,
Print name: Date: This permit application expires it a permit is not obtained within Itin
days after it has been accepted as complete.
• Number of inspections allowed per permit.
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