Permit a CITY OF TIGARD ELECTRICAL PERMIT
.111 COMMUNITY DEVELOPMENT Permit #: ELC2010 -00450
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/26/2010
Parcel: 1S133AD16200
Jurisdiction: Tigard
Site address: 12700 SW NORTH DAKOTA ST 100
Subdivision: Lot: 0
Project: Pasta Pronto
Project Description: (7) branch circuits for kitchen equipment.
Owner: FEES
PACIFIC CREST PARTNERS SCHOLLS L Quantity Description Date Amount
1430 EASTSIDE RD
HOOD RIVER, OR 97031 7 crt Branch Circuits 08/26/2010 $100.70
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 08/26/2010 $12.08
Electrical
Contractor:
AMERICAN ELECTRICAL SERVICE
PO BOX 1057
SHERWOOD, OR 97140
PHONE: 503 - 537 -2121
FAX: 503 - 554 -8506
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $112.78
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 r - • - • = copy of r direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
4OP /
Issued By:V .. .�'�� _ 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' 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.
Aug 26 10 10:19a David Haupt 503- 554 -8506 p.1
Electrical Permit Applicatio c ` �l'' :, : r IQI2 OrrlcE 1'SE ON
S,
Ciw of Ti and Received 1 2i' O L '
ty g Date, : q
.� s 13125 SW Hall Blvd., Tigard, OR 97223A U G 2 6 2 01 Plan Review
Phone: 503.639.4171 Fax: 503398.1960 DateBv: Other Permit'
Inspection Line: 503.639.4175 r a;' " � _ �tfi l' Date Read t an T la See Pass 2 for
T I G :� D P ` t I Notified/Method: Supplemental Information
Internet www.tigard-or.gov p; tit P_11l!!(_-` D:1 /iSlfll•' I
TYPE OF WO RK PLAN REVIEW
❑ New construction Rf Addition/alterationtreplacement Please check all that apply lsubmit sets of plans waiters checked below):
fl Service or feeder 400 amps or more ❑ Buldiag over three stories.
❑ Demolition ❑ Other where the available fault current ❑ Marinas and boatyards
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating boildmgs.
less to ground, or exceeds 14,000 ❑ Commercial-use agricultural
❑ 1- and 2- family dwelling E{ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder 0 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 ❑'W, "E", "I -2 "1-3
,,-) /y / ] / ( �i t Addition
Percy
Job no.: I Job site address: t 2_4470 j�W l k vt �j �' ❑ Six t00H or more: more residential units. ❑ Recreational vehicle parks.
City /State/Z[P: y El Health -care facilities. ❑ Supply voltage for more than
`T L ❑Hazardous locations. 600 volts nominal.
Suite/bldgJapt. no.: l 00 Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Desrriaio. 1 Qt.. 1 Fee. 1 Total 1
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. R or less 168.54 ' 4
Ea. add'I 500 sq. R or portion 3392 1 ,
Tax map /parcel no.: Limited energy, residential
75.00 2
DESCRIPTION OF WORK • (with above sq. ft)
1 r Limited energy, multi - family above sq. 75.00 2
C b 2 )� [ f� 1�Ci r1 v7'et 1l. Gl�9r i .�' 11V residential (with R)
J� YL CJ Services or feeders installation, alteration, and/or relocation
200 amps or Tess 100.70 2
❑ PROPERTY OWNER l ig TENANT 201 amps to 400 amps 133.56 2
�� 401 amps to 600 amps 200.34 2
Name: 3, 4 �. fy ph 601 amps to 1,000 amps 301.04 2
Address: `2 ( (9 P St1) p j_ tk Q � • i 1 i t • +J Over 1,000 tangs or volts 552.26 2
l (v!7?^ � *hl Temporary services or feeders installation, alteration, and /or
CitylState/Z1P: ! ei .Le be. relocation _
Phone: (7b3) '� � ., 11 ( 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 j 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
❑ APPLItCANT 1 42f CONTACT PERSON . above service or feeder fee, 7.42 2
each branch circuit
Business name: Y 9 v r p „ j B. Fee for branch circuits without J 1s�
ex b G� , service or feeder fee, first ' 56.18 51 ' a 2
Contact name: ✓� /111 GD h t; branch circuit
Each add'I branch circuit _ G 7.42 c/9, 5 2
Address: I '2.• • 6. 0 5 /✓ k DA, �.-1/ -el, Miscellaneous (service or feeder nor included)
!' Each manufactured or modular
City /State/Z1P: Ti it.. :- C2 Y dwelling, service and/or feeder 67.84 2
Phone: (5,7) 4177 44 I Fax:: ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E-mail: '
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
Business name: 4 en ` Y1 C• Z+ ' t panel, alteration, or extetuion Pane 2 2
.r plc, r1/d t.[ Each additional Inspection over allows ble in any of the above
Address: r-I> at 1 1 Additional inspection (l hr min) 66.25/ hr
$ A z�sN -0-0 �Zr /Tq / y p Investigation (t hr trust) Industrial 66.25/ hr
City/StatelZIP: .� ' C Industrial plant (I hr min 78.18/ hr
Phone: ( 5. ' ofi / / Fax: (5i 3 gy - Apr Inspections for which no fee is 90.00/ hr
7 specifically listed (Y- hr mm)
CCB Lic.: i0/5 Electrical Lic.:3i — 54c I Suprv. Lic.: 'fol. j ELECTRICAL PERMIT FEES .
Subtotal: Ao. ZV
Suprv. Electrician signature, required: a d Plan review (25% of permit fee):
Print name: D aV Lc°,1 _, , f Da : �GL — % D State surcharge (12%ofpermit fee): Z, '
^ ""7 TOTAL PERMIT FEE: i i T_ 7r
Authorized signature: Ilia permit application expires if a permit is not obtained within 180
j1/4S"1 days after it has been accepted as complete.
Print name: I Date: • Number of inspections allowed per permit
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