Permit r>w CITY OF TIGARD ELECTRICAL PERMIT
' ; COMMUNITY DEVELOPMENT Permit #: ELC2011 -00293
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/02/2011
Parcel: 1 S 136AD06502
Jurisdiction: Tigard
Site address: 10935 SW 68TH PKWY
Project: Blitz Sports Pub Subdivision: WAY LEE Lot: 1
Project Description: (4) branch circuits for walk -in cooler and arcade games.
Contractor: ALL CITY ELECTRIC LLC Owner: WAY W LEE
PO BOX 21672 5210 SE 26TH AVE
KAISER, OR 97307 PORTLAND, OR 97202
PHONE: 503 - 839 -7224 PHONE:
FAX:
FEES
Quantity Description Date Amount
4 crt Branch Circuits wo /Purchase 06/02/2011 $78.44
Specifics:, Service or Feeder
1 ea 12% State Surcharge - 06/02/2011 $9.41
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $87.85
Required Items and Reports (Conditions)
This permit is issued subL 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 ac ance with"appro • •lans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTE ION: Oregon la requ es ou to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 -0 0 thr•ugh OAR 952-' -009. may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issue By: f U
L % Permittee Signature: �CH =, /�"" /—.7
OWNER INSTALLATION ONLY V
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
i
SIGNATURE OF SUPR. ELEC' 401111 r /- �� i 4i Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
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.
May 31 11 05 :10p Rich Grimes 503 - 552 -9817 p.1
F -1
Ma 27 11 08:57a Jim a Lori � lJ 503- 723 -0801
� ned .. _.__.._. _ __ .
t ; 9
Electrical Permit Applicatio` :,— v L. Folz t a psi.: 0.1.1 .
City of Tigard I 1 2011 i Rec ee / // k i Perrrit Nc.: AO/ 1- a0 �93
Ilit 13125 SW Ha1LB1vd, Tigard, OR 972 P1onRepiew
11 Phone: 503.718.2439 Fast: 503.598.1 G D : Other Permit: , S /-o-eo '
1 w,�ttn Inspection Line: 503 639.4175 CITY OF 1 '" IGARD Dote Ready/By: kris. el See Paget for
Itrternct: www.t.igarrl-oz.gov RI III_ DING DIVISION I Nn in'xi1Mahod: Supplemental Information
TYPE OF WORK I PLAN REVIEW 1
Q New construction Addition/alteration/replacement r Please check an that apply (submit a sus of plans writcros checked bolow):
0 Service of feeder 40D amps or most ❑ Building over throe stories.
❑ Demolition Other. I J whore tho available fault current 0 Marinas and boatyards.
C E ORY OF CONSTRUCTION exceeds 10,100 amps of 150'otty Of C1 Floating buildings.
less to ground, or rxceeds 14,000 0 Commercial - use agricultural
❑ 1 - and 2- family dwelling Commercial/industrial Q Accessory building nips for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Ocher: 0'w- ❑ lnstallaiion of 75 KVA cr
JOB SITE INFORMATION AND LOCATION 0 Emergency system. largo separately derived system.
0 lvlditiva of a cw motor load of ❑'A ^, "E ". "1 -2 ", "t -3 ".
/ p�`�' 100HP or more. occupancy.
Job no.: Job site address: l0 , 5 CAO ` lei y _ 0 Sire or more residential units. 0 Recreational vehicle parks.
� ' : 0 Hoaltheare (acuities. D Supply voltage for mote than
Cit}15tatc/ZIP: I 0 i 1.7 1_ t....- l i [] Haarudow lorafions. 600 voles nominal
Suitc/bldg.lapt. no.. Project Dame: 1 � � }' .I -ti/ 0 Service or :ceder 600 amps or more,
_ I ` FEE SCHEDULE
1 CroSS street/directions to job site: �S t l. C7 p.rertptbn Q'.. I Fee. t Tsai I •
L. New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: ' Lot no.. r 1 1„OM Sq' n ' or less i 168.54 4
Ea. arld'i sort sq. it or portion 33.92 1
j
Tax mapipareel no.: 1 Limited clergy, resideatial
DESCRIPTION OF WORK I (with above sq. ft.)
75.D0 2
} ( ( r Limited energy, multi - family l
1.-To • iA . p I,� Gi ` k 1 `. r dc y - Y residential (with above sq. ft.) I I 5 l 2
C yy r - Services or fecdent and/or relocation
R e( zDt 2_ C , -c --vt 4 O J(' c a G�v�ti4< I 200ampsorless r eration, ; installation, 100 -70 t ' 2
❑ PROPERTY OWNER 0 TENANT 1 201 amps to 400 amps 133.56 2
/ - ! 401 amps to 600 amps I 200.34 2
aa]t: I 601 amps to 1,000 amps 301.04 2
Addf�• ` / ' � wet 1,000 snips or volts _ 1 552 j 2
� Temporary services or feeders Installation, altcrratioa, and /or
Ci • `ctrl i relocation •
'/��DW ��� 2" arnpa or le 59.36 1
ss
jr�'��/ 4 tot amps to400 amps 12s.(ff3 Ti 2
II ,' I. r - taljat • • : This ins' ation ' being • • - • •eon • • openy l�!T own w • tclt i • •
got amps to 599 stags 166.57 2
. d or use, rent, o e ange, acco ding • ORS 447, 449, 670, : d t I.
Branch circuits - new, alteration, or extension. per panel
• • net si: store: r Date: j A. Fee for branch circuits with
❑ APPLacorF J MCONTACI PERSON 7.42 2
each branch circuit _
Business name: A 1 C I k--'y �- above s or feeler fee,
1 eG.�r t C... service or feeder fee, fist , 56. I8 9 1 1_.., L , e I B. Fee for branch circuits without
JJ f 1 b
Contact name: branch circuit } JJJ 2
} n pin \,.....X.,„.„, C' ¢ '� r ----I Each add't braash circuit .3 7.42 '� 1 ' �_U 2
Address ?O 24 ♦7� I ( I Miscellaneous (service or feeder not included)
City/State/ZIP: ` � 4 �' P 0 11 9• +,, / e1 � �® l I Each 67.84 2
d welling, service na dlor fe ede
- Reconnect l 67.84 2
Phone: � 3 } v 7 77- 32_,-7 � Fax:: ( ) • • Recoect only
r Pump or Lrrigatton circle 67.84 2
E -mail; �� � �/�"�(c ) r Cr1
Sign or outline Lighting 67.84 2
CONTRACTOR Sipnsl circuits) or (united -cnergy
panel, alteration, or extension, , Page 2 . 2
Business name:A`L- V- - t a l • L� Q -4 Each additional [rupee lion over allowable in any of the above
Address, rC) . • licit w! ? i 1 ( 7 1 1 Additional ias () hr min) 66.25/ hr
,� /�'"'` ^' a In ostiout (1 hr rain) _ 66.25/1r
City/State/ZIP: _ y � S <D . 9
.dustrialplant(1 78.18/ht
Phone: ( rs Inspections fox which no fee is 90.00/ ht
speciGwtly tinted (15 hrmin)
CCB Lie.: NEM Electrical Lie.:[ , I3 ,, Sup . Lic.:2'_'7rj- Subtotal: i w ELECTRICAL PERMIT FEES
`• r / r r /O , . wring. Sups. Elcaric s ' y -ix , eq . l- I u � Pinn review (25% of permit fee):
a r y/
P tent name: i - • D $. ' � State surcharge (12% of perms: fe s
.. r .;. 11 .� r .
TU "f AL HERMIT FEE: y _. . ;�
Anlharizedsignattue: � � � !• ��, ID. — ... l Thisperonkopplleadoneapires IFa yenoitisnoto. .. within 180
days after ti has been accepted as compkle. ? '
?rent name: NT%:q I L am - Date: a 20 ' Number of inspections allowod per permis.
hairigeoniinntmermaru t.nrc 57rpl•t0 4a• tFTILU051COSYt1'LB
„ CITY OF TIGARD ELECTRICAL PERMIT
ih,
: , = COMMUNITY DEVELOPMENT Permit*: ELC2011 00293
T1GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/02/2011
Parcel: 1S136AD06502
Jurisdiction: Tigard
Site address: 10935 SW 68TH PKWY
Project: Blitz Sports Pub Subdivision: WAY LEE Lot: 1
Project Description: (4) branch circuits for walk -in cooler and arcade games. 6/9/11: Add (1) branch circuit for exhaust hood (reprint
permit when paid). DLH
Contractor: ALL CITY ELECTRIC LLC Owner: WAY W LEE
PO BOX 21672 5210 SE 26TH AVE
KAISER, OR 97307 PORTLAND, OR 97202
PHONE: 503 - 839 -7224 PHONE:
FAX:
FEES
Quantity Description Date Amount
4 crt Branch Circuits wo /Purchase 06/02/2011 $78.44
Specifics: Service or Feeder
1 ea 12% State Surcharge - 06/02/2011 $9.41
Type of Use: COM Electrical
Class of Work: ALT 1 crt Branch Circuits w /Purchase 07/15/2011 $7.42
Service or Feeder
Type of Const: 0 ea 12% State Surcharge - 07/15/2011 $0.89
Occupancy Grp: Electrical
Total $96.16
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 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: .e f7 /
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 the next available inspection date.
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.