Permit CITY OF T IGARD/ ELECTRICAL PERMIT
° PERMIT #: ELC2008 -00597
1 ` COMMUNITY DEVELOPMENT r
DATE ISSUED: 10/22/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503:639.4171
/ PARCEL: 1S136DB -02600
SITE ADDRESS: 11201 SW 72ND AVE / ` / ZONING: C -
SUBDIVISION: 1 i
LOT : JURISDICTION: TIG
PROJECT: MCDONALDS v /
Project Description: (1) se and (12) branch circuits for new beverage center.
/•
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: 1 W /SERVICE OR FEEDER: 12 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 0 PER HOUR:
401 - 600 amp:, EA ADD'L BRNCH CIRC: 0 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:
MIKE KENNEDY ADVANCED ELECTRIC INC
8255 SW HUNZIKER ST 203 21811 NE 58TH ST
TIGARD, OR 97223 VANCOUVER, WA 98682
Phone: 503 - 519 -9524 Contact #: FAX 360 - 254 -2854
PRI 360 - 254 -6864
/
FEES
Description Date Amount Reg #: ELE 37 -873C
[ELPRMT] ELC Permit 10/22/2001 $160.10 LIC 117052
[TAX] 12 % State 10/22/2001 $19.21 SUP 37345
Total $179.31 REQUIRED ITEMS AND REPORTS
This Permit is subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws.
All work will be do a 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 86 -days. ATTENTION: Oregon law requires you to follow rules adopte the Oregon Utility Notification Center.
Thos rules are set fo�th AR 001 -0010 through OAR 952 -001 -0100. You may obtain co "es of these rules or direct questions to OUNC at
503.246.6699 tar 1.800.332. 3a / q. _ .
Issued By: ( 1 _,(,,, � �. I ) 014/1/00.4 . _ Permittee Sign re: -e /4 )
- - - --
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 IN TALLATION 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.
0 22 2008(IWED) 06: Advanced Electric (FRX)360 2542854 P.001/001
e- .
Electrical Permit Application Fc)It Oh'riCE USIC ()Nix
City of Tigard
ii Received / ✓
UPI � Datcm . /O � �� Permit No.. Eke „� - pQ6
13125 SW Hall Blvd , Ti_.. : ;`S S . 97 t•' c �Z Plan Review i / �_ G/
Pl use: 503.639.4171 . K ':'. 9(.0 S) iQJ Dale/n . •
Other Permit: f ri
-f 1 c; A u I7 Inspection Line: 503.63') 't Date Ready /By: i "/ (i 121 Sec Pam for
Internet: www,tigard- or.gov O§, Ikci0 ♦`" oN Notified/Method: Supplcmentil tnr�mnation
gyp g� p,�
!! !IIIIII MfMIIMI l' ' I l ixh4ti ��gg��pp k ' l''. l'1r, ` ' '4'' ':
t '' iii tN I''' Pi r' -ill i' ;1 " (. I ,11
❑ New construction I Addition/ : t� - ' 1, • emcnt Please check all that apply (submit /seta ot' pbue< w /Item.4 checked below):
t�I 0 Service or feeder 400 amps or more ❑ Building overtime storms
❑ Demolition ❑Other: where the available fault current 0 Marinas and boatyards.
I'mj?n;1,7 :' 1 0: : u' ''.,;h+, . '11�1, :''' 1 11i��1; �I ' 141 exceeds 10,000 amps at 150 volts or 0 Floating buildings.
" 1. less to und. or exceeds 14000
gm , ❑ Cum narcinl -use agricultural
❑ 1 - and 2- family dwelling El Commercial /industrial ❑ Accessory building an for all mbar imaallutions. buildings.
yIMINI Multi- family
p�py�p��� El Master builder y1 �y�, ❑ Other. ❑ rite mum 0 Installation of75 KVA or
ld Nt I' 1(PN(U(tt!! `±'fiatOMi P gr 14
-s 4:01 ,,, ill i ii ! t�' i ,, ,,' 1:^ ' Q Emergency o system -A-, ^ rha i-r, dered system
• ' Addition of new motor load of Q "A ", "C", "I •T ", - 1-3 - ,
Job no.: I Job site address: 11201 SW 72 nd Ave - 16(IHr or more. uccuptntcy.
❑ Six or more residential units. ❑ Recreational vehicle porky.
City/State/ZIP: Tigard, Or. 97223 ❑ Health-eatc facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nundttal.
Suite/bldg. /apt no.: Project name: Add coffee bar ❑ Service or [elder 600 amps or more.
l'q PiF1:1; i', lilluml ivatas mogivq., !I S :17;1, gimu f(f �l
Cross street/directions to job site: SW Pacific Hwy and 72 Ave Description 1 Vic 1 P... I TMar 1
New residential single or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. rt. or less 145.15 4
Tax map /parcel no- Ea. add'[ 500 sq. a. or portion 33.40 1
Limited residential
ciailit .
�MI�{�RI1.t -.• „ i id 8�.:........��.��(kSG� , 1 i;:b� fwith abovc sq. tt ) t 75.00 2
Limited energy, multi - Gamily 75.00 2
Add 1 sub pal and 12 ckts residential (with above sq. ft.)
Services or feeders inatailation i nn, and/or relocatio
g�p��� 200 amps or less 1 80.30 xn.30 2
y' I °i �h�� r'i ' I' /, _ a , ° ` r11 ° .i l ;ri;" y 1 il ;: SEW r2110 l n' ` • I' -MI 2(11 amps to 400 sales 106.85 2
Name: McDonald's Restaurant CBB # 111011 401 amps to 600 amps 160.60 2
601 amps to 1,000 amp 240.60 2
Address: 11201 SW 72" Ave Over 1,000 amps or volts 454.65 _ 2
City/State/ZIP: Tigard, Or. 97223 Temporary services or feeders insr IJatlon, alteration, and/o
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.115 1
Owner installation: This installation ir. being made on property that I own which is not 201 amps to 400 amps 10030 2
intended for sale, lease. rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133,75 2
Branch circuits new, alteration, or extension, per panel
Owner signature: _ Date: _ A. Fee for branch circuits with
,I ;Vt t S Pi � . °, • 1 1!,,,1, .,,I , .i.; '11.1'1` OBEN .. [m ; jl, f igt +age 01, Mil above service or feeder fee,
each branch circuit 6.65 2
Business name: 13. Fee for hranch circuits
Conulct Warne: without service ur feeder fee, 46.85 2
first branch circuit
Address: Each ndd'1 branch circuit 12 6.65 79 - 80 - 2
Miscellaneous (service or feeder not Included)
City/ State /ZIP: Each manufactured or modular
90.90 2
dwelling, service and /or feeder
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E - mail: Pump or irrigation circle 53.40 .. 2
i i < : ''li' #i : l !TIP' , i', I,'' i'Ia t o ' 1 Ni 1 H c c . ' .,! ,, .1 iMIIIIIl INN , ,i:' , Anal! : ,,, u'' 1 P Sign or outline lighting 53.40 2
Signal circuit(s) or limited -
Business name: Advanced Electric Inc. energy panel, alteration, or
Address: 21811 NE 58 St. extension. Describe: Page 2 2
City/State/ZiP: Vancouver, Wa. 98682 Each additional inspection over allo In any of the above
Phone: (360) 254 - 6864 I Fax: (360) 254 - 2854 Per inspection 62.50
Investigation per hour (1 hr min) 62.50
CCB Lie.: 117052 Electrical Lic.: 7 -873C w Suprv. 3734S Industrial plant per hour 73.75
Suety. Electrician signature, required `
`d%/ [! ' : itime;ll {il(�i • • . rr u y, •.0 4 n,; it :v .3.� � j�r,I,tr,' . d'ig69kT�li'811N°
4 Subtotal: 160.10
Plun review (25% of permit fee):
Print name: Kenneth 14. Mtmgcr Date: 10/21/0: State surcharge (12 % ofperrttit fee): 19,21
Authorized signature: TOTAL PERMrr FEB: 17931
Thts permit appbcutinn expires If a permit is not obtained wlthIn 180
Print name: same Date: days after it Ira■ been accepted as complete.
Number of inspections allowed lur permit,
1:1kuIiJl \PcmtlIe,kl.C.PermltApp.dnc (15!73!06 410- 1615Tf1110S /COM/WEB
1 e ° Community Development
Request for Permit Action
TIGARD
TO: CITY OF TIGARD
Building Division Services Coordinator
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov
FROM: ❑ Owner ❑ Applicant ❑ Contractor City Staff
(check one)
REFUND OR Name:
INVOICE TO: (Business or Individual)
fi„vdrAi7
v 0 1 ® Mailing Address:
/4/ (/o _, City/State /Zip:
Phone No.:
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (I):
CANCEL PERMIT APPLICATION.
❑ REFUND PERMIT FEES (attach receipt, if available).
❑ INVOICE FOR FEES DUE (attach case fee schedule and explain below).
❑ REMOVE CONTRACTOR FROM PERMIT not cancel permit).
Permit #: ` LCOQC J " <) ¶79 (C -0o s9 )
Site Address or Parcel #: I — 0 ��2d � � / X(l 7o.?
/7 vim•
Project Name: rqe fir/ LC� S
•
Subdivision Name: ILot #:
•
EXPLANATION: ro r. TA A ofrjer4-cA.Y-l( CJ ,.?
/ vin 1'7' ( cs r r rrA/d e . //d - 4e.1 ea /4,2 / /rG -t
Signature: I3 te: /0 p 1 v 1
Print Name: /M EC, l i1. i I ':- r
•
Refund Policy
1. The Director or Building Official may authorize the refund of:
a) any fee which was erroneously paid or collected.
b) not more than 80% of the land use application fee when an application,is withdrawn or canceled before any review effort has been expended.
c) not more than 80% of the land use application fee for issued permits.
d) not more than 80% of the building plan review fee when an application is canceled before any plan review effort has been expended.
e) not more than 80% of the building permit fee for issued permits prior to any inspection requests.
2. Refunds will be returned to the original Payer in the same method in which payment was received. Please allow 1 -2 weeks for processing refunds.
FOR OFFICE USE ONLY
\ Rte to S s Admin: Date i sma B 1%' Rte to Bld: Admin: Date /dMr`M B
Refund Processed: Date /V1/9-- By Invoice Processed: Date ' By
Permit Canceled: Date /Q /,2yp� Byit- Parcel Tag Added: Date By
Receipt # Date / Method Amount $
l:\ Building \Forms \RegPermitAction.doe Rev 07 /26/07
r
CITY OF TIGARD ,
BUILDING DIVISION 5 PERMIT #: ELC2008 00697
13125 SW Hall Blvd., Tigard, OR 97223 _ D ATE ISSUED: 10/22/2008
Phone: (503) 639 -4171 ; Az� I I
Inspection Requests (24 Hrs.): (503) 639 -4175 M `'.
INSPECTION WORKSHEET FOR DATE: 11/14/2008 TIME: 7:OOAM PAGE: 25
SITE ADDRESS: 11201 SW 72ND AVE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: MCDONALDS
DESCRIPTION: (1) service and (12) branch circuits for new beverage center.
OWNER: KENNEDY, MIKE PHONE #: 503 -519 -9524
CONTRACTOR: ADVANCED ELECTRIC INC PHONE #: 360.254 -6864
Inspection Request Scheduled For: Date: 11114/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
1
199 Flectiical final 078061 -01 360- 2E46864 Y
Corrections/Comments/Instructions:
R•4(stvkiv 1-eggz. 44.10 wAtip fRtsit\ EtiT
'\\
C lk, i\A I
Ig ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
i
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 3. N(% LE Date: 4 1 Phone #: (503) 718- t414)_
•
CITY OF TIGARD
BUILDING DIVISION w PERMIT #: t LC2008 00597
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/22/2008
Phone: (503) 639 -4171 "1141111`
Inspection Requests (24 Hrs.): (503) 639 -4175 • I..
INSPECTION WORKSHEET FOR DATE: 11/1012008 TIME: 7:02AM PAGE: 28
SITE ADDRESS: 11201 SW 72ND AVE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: MCDONALDS
DESCRIPTION: (1) service and (12) branch circuits for new beverage center.
OWNER: KENNEDY, MIKE PHONE #: b03- 619.9524
CONTRACTOR: ADVANCED ELECTRIC INC PHONE #: 360 -254 -6884
Inspection Request Scheduled For: Date: 11110/2008 Pour Time:
Code # Inspection Description Confirm # • . - , Message
199 Electrical final 077846.01 360.254 -6864 N
Corrections /Comments /Instructions: '
�1
c..QlA... D t w I 1 t , S A da
A vja06 NY\
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL CA CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ' ��� Date: i 1 0 Phone #: (503) 718- 1,1W1
CITY OF TIGARD
BUILDING DIVISION ^ PERMIT #: ELC2008 -00697
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/22/:1008
Phone: (503) 639 -4171 //cu ■l�l °I
Inspection Requests (24 Hrs.): (503) 639 -4175 s R _..
INSPECTION WORKSHEET FOR DATE: 11/6/2008 TIME: 7:0OAM PAGE: 8
SITE ADDRESS: 11201 SW 72ND AVE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: MCDONALDS
DESCRIPTION: (1) service and (12) branch circuits for new beverage center.
OWNER: KENNEDY. MIKE PHONE #: 803..513 -9574
CONTRACTOR: ADVANCED ELECTRIC INC PHONE #: 360 -254 -6864
Inspection Request Scheduled For: Date: 11/6/1008 Pour Time:
Code # Inspection Description Confir • Cont. • # Message
125 Wall cover i 077760-01 360- 772 -3576 Y
Corrections /Comments/ Instructions:
..
LOVE (Z - s N\mR v4 PL-L- ' c
•
tlk 1 11 0 1 .A. r ~ A 4..1■
1C ix t.16Aa C. ' ` Pt> Ul e,
-PASS I= PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
w.
IL •-'4 LL FOR INSPECTION ill ADDITIONAL FEES ASSESSED
Inspector: 5r N6Q LG Date: I► I) fcs% Phone #: (503) 718- Igliz_____
CITY OF TIGARD _ _
BUILDING DIVISION - L* I PERMIT #: El_C100800 97
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/22/2008
Phone: (503) 639 -4171 � ^d' b' �
Inspection Requests (24 Hrs.): (503) 639 -4175 � ,L- ' I
INSPECTION WORKSHEET FOR DATE: 11/5/2008 ' TIME: 7:01AM PAGE: 2
SITE ADDRESS: 11201 SW 72ND AVE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:.
PROJECT NAME: MCDONALDS
DESCRIPTION: (1) service and (12) branch circuits for new beverage center.
OWNER: KENNEDY, MIKE PHONE #: 603-619-9624
CONTRACTOR: ADVANCED ELECTRIC INC PHONE #: 360-254-6864
Inspection Request Scheduled For: Date: 11/6/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
125 Wall cover 077695-01 360-772-3676 N. Y
Corrections /Comments/ Instructions:
eA -k- s E(Z ∎ c cov6 - 6L
LI )grOs -
cD INC. 1 .4$. 2 t - r1) °10 - tiri-t4 Ds r fN) EZ..)/0 6F
-
f C. 7 5 N 4Q AL.Lsay.14 4.
MA &t • N (1 M ta. i' 4 + 3 60 14 AL)
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
VA FAIL )4 CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: • N (% L( Date: UI ICA Phone #: (503) 718- /-1,4b