Permit �'l, � CITY O F TIGARD ELECTRICAL PERMIT
r ° „ COMMUNITY DEVELOPMENT PERMIT #: ELC2007 -00737
-,1{,14,_,,,,„. uha DATE ISSUED: 11/1/2007
'�TIAR 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
t'`' ° ° ' : ' ' : PARCEL: 1 S 134AA -01900
SITE ADDRESS: 10105 SW NIMBUS AVE ZONING: MUE-2
SUBDIVISION: IKOLL BUSINESS CENTER TIGARD LOT : 001 JURISDICTION: TIG
PROJECT: BURGER KING
Project Description: (6) circuits.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HM/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 5 IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
ROBINSON, WILLIAM R /CONSTANCE A FIVE STAR ELECTRIC, INC.
ROBINSON, LYNN + BELL, KAY ET PO BOX 555
BY ELLIOTT ASSOC BANKS, OR 97106
PORTLAND, OR 97204
Phone: Contact #: PRI 503 - 324 -0948
FAX 503 - 324 -0973
FEES
Description Date Amount Reg #: ELE 34 -665C
IELPRMTI ELC Permit 10/31/200' $80.10 LIC 158231
[TAX] 8% State Surcharge 10/31/200' $6.41 SUP 4622S
Reversal - IELPRMT] ELC 10/31/200' - $80.10
(additional fees not listed here) REQUIRED ITEMS AND REPORTS
Total $86.51
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in
OAR 952 - 001 -0010 t rough OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344. •
Issued By: /_!— 1 Permittee Signature: eh d
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'N: 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.
IlL OCT -30 -2007 15 :14 FIVE STAR ELECTRIC P.01
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Received C�
, City of Tigard Date B,: D p Permit N7_ 0.1
13125 SW Hall Blvd.. Tigard, OR 97223 0 C T 3 0 2007 Plan Review /
Phone: 503.639.4171 Fax: 503.598.196 : I Date-'13v: Other Perna,: Ins
Inspection Line: 503.639.4175 U ITYOF it A.!14.;r j� ' ti 1, Date Ready By: ‘wis 63 See Page: for
P g BUu 8e®INGDIWI x ION . R, Notified' Method: Supplemental Information
Internet: www.ei.ti ard.o 8e tYV� l7t tyf�Y Y� t l
TYPE OF WORK PLAN REVIEW
•
❑ New construction Addition /alteration /replacement Please check all that apply:
❑Service ox er 225 amps. comm ❑hazardous location
❑ Demolition ❑ Other:
['Service over 320 amps • - rat +ng ❑Bulldog over 10.000 sq. ft..
CATEGORY OF CONSTRUCTION of 1- and 2-family dwelling, 4 or more new residential
❑ I- and 2 - family dwelling [Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
['Building over three stories ❑Fcedcrs_ 400 amps or more
❑ Multi family - 0 Master builder ❑ Other:
Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress!lighiing plan RV park
(((' ❑Health -care facility ❑Other .__ _ _ __ Job Job no.: F EA Job site address: O 1 N
� W k YYI h�S - Submit 2 sets of plans with any of the above
City/State /Z1P: — vv- A0 , ( 6 f A2 on 2n • Ihe above are not applicable to temporary construction service.
i
L 1 V i i t FEE'' SCHEDULE
Suite /bldg. /apt. no.: Project name: \ V1 r(� �u„ Description 1 Otv. 1 Fee. 1 Total 1 '"
`'( New' residential single- or multi -family duelling Cross street/directions to job site: 3 u �.G�Gl2 �, l � - ^ '� t; g unit,
- Includes attached garage.
1.000 sq. ft. or less 145.15 4
Subdivision: I.ut no.: Ea. adds 500 sq. ft. or portion 33.40 , 1 ,
Limited energy, residential 75.00 2
Tax map /parcel no.: Limited energy. non- residential 75.00 2
DESCRIPTION OF WORK Each tnanutactured or modular
• dwelling. service and,or feeder , 90.90 1 , 2
0 CAVCV 1,.kS Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
12 PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
. 401 amps to 600 amps 160.60 2
Name: 601 amps to 1.000 amps 240.60 2
Address Over 1.000 amps or volts 451,65 2
— - Reconnect only 66.85 2
City /State/ZIP: Temporary services or feeders installation. alteration. and /or
relocation
Phone: ( ) Fax: ( )
200 amps or less 66.85 1
Owner installation: This installation is bring made on property that 1 own which is not 201 amps to 400 amps 100.30 2
intended for sale. lease. rent, or exchange, according to ORS 447, 449. 670. and 701. 401 amps to 600 amps 133.75 1 2
Owner signature: . _, Date - Branch circuits - new, alteration. or extension. per panel
❑ APPLICANT ❑ CONTACT PERSON A. Fee for branch circuits rrirh
service or feeder Ice, each
Business name: branch circuit 6.65 2
' 13. Fee for branch Circuits
Contact name: s /h',' scry iec or reedcr ice. 1 �
each branch circuit
46.8: '1
Address: .
Fach add] branch circuit 6.65 33, if. 2
City /State /7.1 P: 'Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 1 2
Phone: ( ) Fax: : ( )
Sign or outline lighiine 53.40 2
E -mail: Signal circuitts) or limited -
CONTRACTOR energy panel, alteration. or
' extension Describe: Page 2
Business name: Five Star Electric, Inc. +
Each additional inspection over allowable in any of the above
Address: PO Box 555 t
Per inspection ' 62.50
City /State /ZIP: Banks, OR 97106 investigation per hour i_; hr mini 62 50
Phone: (503) 324 -0948 Fax: (503) 4 -0973 4 1 i o f 4 I 1 Industrial plant per hour 73 75
` ELECTRICAL PERMIT FEES*
CCB i_ic.: 158231 1 Electrical Lie.: 34-665C .Suprv. Lie.: 622 Subtotal t' iC� —
Suprv. Electrician signature. required: ,'Ian review (25 of permit feel
1 E. am^
State surcharge (8°.`o of permit tee) (t),4 }
Print name:
A �i. s� Date: 101 ll �/ 16-7 - TOTAL PERMIT FEE $to
Authorized signature: This permit application expires if a permit is not obtained within 180
day after it bas been accepted as complete
Print name: Date: s,.li .•d•,,iogp set 1, Fri -Cowin Buildir ; ;deslry Service board
. N'mnker:. :hnns p i permit nliessed.
i' 9uil ding>Pennits'•EL,C- PermitApp.doc 12103 440- 46151(10112:('OWWL..Et