Permit 4 CITY OF TIGARD
RESTRICTED ENERGY PERMIT
r ,.n
° ,. II COMMUNITY DEVELOPMENT Permit #: ELR2010 -00105
7 rld' ARE) 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 06/08/2010
Parcel: 2S110DB00500
Jurisdiction: Tigard
Site address: 15336 SW PACIFIC HWY
Subdivision: Lot: 0
Project: Sonic Drive -In Restaurant
Project Description: Alarm system
Owner: FEES
MWF TIGARD LLC Description Date Amount
2123 NW ALOCLEK DR #1203 Restricted Energy Permit 06/08/2010 $67.84
HILLSBORO, OR 97124 12% State Surcharge - Electrical 06/08/2010 $8.14
PHONE: 503 - 617 -0175
Contractor:
ALLIED FIRE & SECURITY
530 NE COUCH ST
PORTLAND, OR 97232
PHONE: 503 - 231 -9550
FAX: 503 - 231 -9551
Type of Use: COM
Class of Work: NEW
Total Number of Systems: 1
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: N Fire Alarm: N
HVAC: N Instrumentation: N Total $75.98
Intercom /Paging: N Landscape /Irrigation: N Required Items and Reports (Conditions)
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: y
Other Desc:
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. /
Issued By: � ' 7‘
Permittee Signature: l//✓ ��j L!C -%779' .
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 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.
06- 08 -'10 08:04 FROM- T -880 P0001/0003 F -582
Electrical Permit Application V-4 ,�.^, j am° FOR OFFICE USE ONLY
City of Tigard 1 � Date/13 : Other Permit t�(,[� — DatelBy. Permit No.: 20 / 0 V✓
" 13125 SW Hall Blvd., Tigard. OR 97223 ?Ili* 1' plan Review
' • ' • Phone: 503.639.4171 Fax: 503.598.1960 A, /�
inspection Line: 503.639.4175 ,U \V 1-%* � /�� /t J ��
T1C ARI] p fl r /By: RI See Paget for
Internet: www.tigard•or.gov +r t ifedlMethotl: , Supplemental InPor
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❑ A r a/ Wig ` please check all that apply (submit 2 sets of plans w /items checked below):
g New construction Addition/alteratiordre
❑ Demolition ❑Other: El Service or feeder 400 amps or more 0 Building over (luxe stories.
�� where the available fault current ❑ Marinas and boatyards.
p ;l : �: v ,� ,, : i Il (� 1p+`• ' t, NP,:. r��c.. '�t ! 6 v�[" r'ti ��
. Z4Xvfo *. <K.,�✓:4,. >.',V, i. i �• :C�,...„ £ ! � } � 1:..',', a.::a±K....f,i - - r , ... , r' 3t �F,t,i%.. exceeds 10,000 amps at 150 volts or [] Flossing buildings.
°YI*r� less to ound or exceeds 14,000
gr . ❑ Commercial-use xgricutrwai
❑ 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
,w y� n -,( f� ❑ Erttergcncy system, larger separately derived system.
ti v� � J�x,. �,. - .,f3",.. _ ❑ Addition of new motor load of ❑ •'A" "B" "1 2" "1
tot�cb1• rQ 100 Or or more. occupancy.
U lob no.: eta Job site address: 1633(.4 00,4 q4
❑ Six or more residential units.
0 Recreational vehicle parks.
City /State/ZIP: ,.r S op ❑ Health -care facilities. ❑ Supply voltage for more than
0 Hazardous locations 600 volts nominal.
Suite/bldg. /apt. no.: Project name: 5066. -- Drtu•t. t•A AkelfM S • ['Service or feeder 600 amps or more.
� �,r �,, r >.( }. S " ) of , ' '� � G
Cross street/directions to job site: /► }: i :. •' . F> ,Wi `� :? :,L
• -- C N / neseripoon Qt ee � Total r :
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 ft. or less 168.54 4
Tax map/parcel no_: Ea. add'I 500 sq. ft. or portion 33.92 I
;r ��•yyyy���, M Limited energy, residential
67,84
'',,,lr R'1ed 5 v l.' ( �° t" \ , -: � iti � ,Xt >3;°' a ,S:z <I 'f �.� (with above sq. R.)
7. 4 2
<... '
xk >W,n- *i... ,, .'k , ,.. ,�.. vI'�:, n:a ,a, Limited energy. Multi- family
nl!� /(�1 67.84 2
Pro
'd701•e Ana( toll \ At.kra vsNI A-A- residential (with above sq, ft,)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
t' <4'+' tr7 ✓ k''0 0# # R '. • it M " "z "7./7. ,.t. AkT ° -.h },. ` 201 amps to 400 amps 133.56
��"'� An
Name: "ILA (�1aSc 1 401 amps to 600 amps 200.34 2
y 601 amps to 1.000 amps 301.04 2
Address: 7.t13 eta A(J) c( -b(2,, 4 i TO7 _ Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City /State/ZIP: \ \5\„,,,,, og ei'1(2'( relocation
Phone: (j ) ( /1- 0/75' l Fax: ( ) 200 amps or less 59.36 1
201 amps [0 400 amps _ 1 25.08 2
w`
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, er panel
Owner signature: Date: • A. Fee for branch circuits with
'.fi{ hi is ji Y ,¢jgts , H . ' � . Jti { , :i r , ',v _ g � t ; y above service or feeder fee, 7.42 2
bcZF = each branch circuit
Business nam Cczk�/ B. Fee for branch circuits
service or feeder fee. first 56.18 2
Contact name: L-A) gerk branch circuit
-w - - — Each add'l branch circuit 7.42 2
Address: X x s E 0 t k.\ si' , Miscellaneous (service or feeder not included)
City /State/ZIP:(.j .� gy �y Each manufactured or modular
r O '7 7 Z 2 dwelling, service and/or feeder 67.84 2
Phone: ( ) Z ?l, 47 SS,D Fax: • (53 ) .- 2 , g 1 _ 75 Reconnect only 67.84 2
E-mail �j�i(rt) .4G k e o it t,4b Seet,,i rt -e tam Si or irrigation t in g e 67.84 2
,t,. �� � � � T Sign or outline lighting 67.84 2
`•. i -&, d�.Aa''_ .S' „ct_ilt, =A' v.. i jt F �. tfgtCO. T:''.;' :l:P t ar l?,'':'i r � ' K 's ' 'F-
'¢r - .�<.,y r .$`:r tt ; . ;; Signal circuit(s) or limited energy I � ` 7'5y
Business name: AL( (E �=igr . f 5p 11 `f panel, alteration, or extension, Page 2 t1 2
!Fa Each additional inspection over allowable in any of the above
Address: ev %,.\ s —r. Additional inspection (1 hr min) 66.25/ hr
City /State /ZIP: •' . k Q Gi 'Z7 Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (5Q3 ) Z31_, p ,5p I Fax: ( n ( - q$ Inspections for which no fee is
L
specifically listed (rh hr min) 90.00/ hr
CCB Lic.: G /9(,E Electrical Lic.: ZL -Da Cte Sup rv, Lie.: a rrif, !Gl ; h :: ? ''tj�� f
�y Subtotal: (/ $ '
Suprv. Electrician signature, required; /� ;�' - Plan review (25% of pertnit fcc):
-
Print name: AA/2 C p- Date: 06, /f)8vp State surcharge (12% of permit fee): $ , 1 C.(
TOTAL PERMIT PEE: - -ra 9g
Authorized signature: /�,� T his p ermit a ppl i cat i on exp i f a permit is not obtained within 180
R � / \ v ` days after It has been accepted as complete.
Print name: /40 /Zv /t AA . "g x Date: C1 /6137 /0 + Number of inspections allowed per permit.
lA building 1Permits\ELC- PennitApp.doc 10/01/09 440 4615T(11/05 /Co4vwEB
06- 08 -'10 08:04 FROM- T -880 P0002/0003 F -582
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITER] ENERGY PERMIT FEES:
Fee for all residential systems combined ... $67.84
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
r � /h ° V 1 [ � ; �mk - 1 r:r,,,k �'Jiw e .F9t fi �� � . "i 4a4r aa'
G' � .w ^. dil' ad',"Mw,). ��"M�"W�y +� � ° ��s,M;��t�'"�� �F..�!wm,� �%���`�"w'`.�.VE v y'79�.�. �,.�
Pee for each commercial $67.84
system
(SPE OAR 918 -309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
IS Other , Acs Sys
Total number of commercial systems: t
"No licenses are required. Licenses are required
for all other installations
1:16uitdingW nits\EF.0 -P ThiIApp.dx 10)01/09