Permit i
CITY OF TIGARD /p <Peal ELECTRICAL PERMIT
• m- COMMUNITY DEVELOPMENT Permit # ELC2D11 -00572
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Date Issued 10/20/2011
Parcel 1 S136AD06000
Jurisdiction TIGARD
Site address 11437 SW PACIFIC HWY
Project Carl's Jr Restaurant Subdivision VILLA RIDGE Lot 2
Project Description Electrical work for new drive -in restaurant 10/26/11, reprinted to add temporary service
Contractor DOUBLE E ELECTRIC INC Owner EJM PROPERTIES INC &
2626 SE SPRUCE ST MAVERICK DECATUR GEORGIA LLC
HILLSBORO, OR 97123 BY MAVERICK INVESTMENTS
3633 E BROADWAY
LONG BEACH, CA 90803
PHONE 503- 807 -5156 PHONE
FAX 503 - 430 -5966
FEES
Quantity Description Date Amount
2 ea Services or Feeders - 200 10/20/2011 $201 40
Specifics: amps or less
3 ea Services or Feeders - 201 to 10/20/2011 $400 68
Type of Use COM 400 amps
Class of Work NEW 170 el Branch Circuits w /Purchase 10/20/2011 $1,261 40
Service or Feeder
Type of Const 1 ea Plan Review Eleclncial 10/20/2011 $465 87
Occupancy Grp 1 ea 12% State Surcharge - 10/20/2011 $223 62
Electrical
1 ea Temp Services or Feeders - 10/26/2011 $59 36
200 amps or less
7 12% State Surcharge - 10/26/2011 $7 12
Electrical (manual)
Total $2,61945
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 rdance 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 ATT NTION Oregon w re you to follow the rules adopted by the Oregon utility �. - • enter Those rules are set forth in OAR
952 -001 -0 10 through OAR 952 -001- 90 may obtain a copy of ff the rules or direct questions to OU 987 or 1 800 333 x ' 44
Issued I'N- �'te�' /r'-s �'t -- Perm ittee Sig �' �� %L� %.:
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 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
r •� CITY OF TIGARD ELECTRICAL PERMIT
1111 t r . COMMUNITY DEVELOPMEN Permit #: ELC2011 00572
Date Issued: 10/20/2011
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.7182439 Parcel: 1S136AD06000
Jurisdiction: TIGARD
Site address: 11437 SW PACIFIC HWY
Project: Carl's Jr Restaurant Subdivision: VILLA RIDGE Lot: 2
Project Description: Electrical work for new drive -in restaurant.
Contractor: DOUBLE E ELECTRIC INC Owner: EJM PROPERTIES INC &
2626 SE SPRUCE ST MAVERICK DECATUR GEORGIA LLC
HILLSBORO, OR 97123 BY MAVERICK INVESTMENTS
3633 E BROADWAY
LONG BEACH, CA 90803
PHONE: 503 - 807 -5156 PHONE:
FAX: 503 - 430 -5966
FEES
Quantity Description Date Amount
2 ea Services or Feeders - 200 10/20/2011 $201 40
Specifics: amps or less
3 ea Services or Feeders - 201 to 10/20/2011 $400 68
Type of Use: COM 400 amps
Class of Work: NEW 170 crt Branch Circuits w /Purchase 10/20/2011 $1,261 40
Service or Feeder
Type of Const: 1 ea Plan Review Electricial 10/20/2011 $465.87
Occupancy Grp: 1 ea 12% State Surcharge - 10/20/2011 $223.62
Electrical
Total $2,552 97
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 accordanc- . ith 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. • TTENTION Orego la quires you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR
952 -'i01 -0010 through OAR 95 S01 -00• • You may obtain - copy of the rules or direct questions to OUNC by calling 503 232 1987 or 1 800 332 2344
Is ed By: Permittee Signature: Vh
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' -_ O � , 1 _ �� 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.
Electrical Permit Application
EC 8VED FOR .OFFICE,I'S E. ON I.
City of Tigard OCT 2 4 2011 Received o ax, ry • Permtl E�e.�e✓i �s17,2
DaterBy Reams
13123 SW Hail Blvd, Tigard, OR 97223 Plan Renew Other Permit.
CITY OF TIGARD arsR) ,nit I ® See Pape 2 for
Phone 503 71 S 2439 Fax 503 598 t D D pate Ready/By
TIGARD Inspection Line 503 639 4175 4 Nm e R eadle thud Supplemental Information Internet www tigard-or goo BUILDING • DIVISIOF'
PLAN REVIEW
` TYPE OF WORK Please check all that apply (submit 2 sets of plans wildcats checked below)
1,21 New construction ❑Addition/alteration /replacement Q Service or fader 400 amps or mote ❑ Pudding over three stones
wherethe available fault canent ❑ Mammas sad boatyards
❑ Demolition CI Other: - exceeds 10,000 arms at t50 voles or ❑ H bui
CATEGORY OF CONSTRUCTION Junto ground, or exceeds 14,000 0 Commercial-Lae agricultural
❑t - and 2 - family dwelling is) Commerclalimdustnal ❑ Accessory building amps for ail ether ancmhmwns �bodmagtonof75KV4or
❑ fire pump
❑MUIn- family 0 Master builder ❑ Othf:f. O Emergency system larger separately derived system
JOB SITE INFORMATION AND LOCATION O Addition Gina meter load of occupancy l2 "13
100HP or mom
Six or mare residential MIS 4 Rrcreattonal vehicle parks
Job no I Job site address. 11433 SW Pacific Hwy p supply voltage for more than
❑ Health -tire facilities S00vollssgm� not
City/State/ZIP Tigard, OR 97224 O Hazardous locations
pS or feeder 600 amps or more
Sutte!bldg.(apL no. , Protect name Carts JR FEE SCHEDULE
osewtien I QN I Fe. I 'rout I '
Cross slreeUduections to job 5rte: New residential single- or multi - family dwelling unit.
Includes attached garage. 4
1 ,000 se ft or less 16854
Subdivision Lot no. Ea add'l 500 so- ft or portion 33 92 I
Tax map /parcel no ' Limned energy, residential 75 00 2
(with above sµ. ft )
DESCRIPTION OF WORK Landed energy, multi-family 75 00 I 2
residential (with above sq ft )
- Services or feeders installation, alteration, and/or relocation
200 amps or less l y 10070
2
Temp Service
TENANT 201 amps to 400 amps 13356 2
❑ PROPERTY OWNER 401 amps to 600 amps 207 34 2
Name 601 amps to 1,000 amps 30104 2
Over 1,000 amps or volts
55226 2
Address Temporary services or feeders installation, alteration, and /or
CityiState/ZIP relocation
200 amps or less 1 59 36 59 36 1
Phone: ( ) Fax ( ) 201 amps to 400 amps 125 08 2
property 401 amps m 5 amps 168.54 i 2
Owner installation; This installation exchange, is bet cg according to ORS that 670, and 701 not
intended for save, lease. rent, or exchange, g Branch circuits— new, alteration, or extension, per panel
Dale- A Fee for branch circuits with
Owner signature: each branch ch circuit feeder fee, 7 42 abase
❑ APPLICANT ❑ CONTACT PERSON each branch circuit
B Fee for branch cucut5 wallow
Business name. _ service or feeder fee, first 5618 2
branch circuit 2
Contact name Each add' I branch ctrcutt 742 _
— Address- Miscellaneous (eerviee or feeder not included) 2
Each manufactured or modular 67 84
City /StatdlW: dwelling, service andor feeder
R Pump Reconnect econn'cl only or circle 67 84
Phone: ( ) Fax ( ) ne 67 34 2
Sign or outline lighting 67.84 2
E
CONTRACTOR Signal circutt(s) or limned -eOer Page 2 2
panel, alteration, or extension
Business name: Double E Electric Inc -- Each additional ins Mien over allowable in a ny of the above
Additional mspectum (1 hr min) 6625/ hr
Address: 2626 SE Spruce St _ Investigation (I hr mm) 6625/ hr
Industrial plant (1 hr mm) 78 I8/ hr
City(StateIZiP. Hillsboro , OR 97123
/ Inspectors Inspecus tot wh•ch no fee is 9000 /hr
Phone (503) 807 -5156 u�� — I Fax specifically listed ('h hr mm)
ELECTRICAL PERMIT FEES
CCB Lic 152985 Electrical Lie. 4-6270 Supn Lin 4620S — Subtotal 59 36
Suprv. Electrician signature, required:
CI Plan review (25% of permit fee)
Date: 10/24/2011 State surcharge (12% of paid fee): 7 12
Print name: Fredric Ekstrom TOTAL PERMIT FEE 66 48
' Thim permit spoliator expires as permit is not obtained withm la
Authorized signature: days after it has been accepted as compicrr. ��✓
Date • Number ofinspealaa allowed per permit
Print name.
a4346151M I 105rCOMuvvem
I w&.ildngwPmn,nwEl.e- PermnApp doe atNV10 ,
I. d 99690E4E0S ou)oe13 3 alp nog d40 Z l l l 43100
Electrical Permit Application FOR OFFICE USE , ,.
RECEDED � - ONLY
City Received Q � D / /„ Cs 57
.2
Ilh i ty of Tigard Date /By � �,/ Permit No O"�L ! ..
1 3125 SW Hall Blvd , Tigard, OR 97223 O C 3 Z 11 Plan Date /B Review I /��// /,//� J�
Phone. 503.718 2439 Fax. 50 3 .598 1960 I o R J G•0•1 Other Permit 410Oi(/! [ i xG C/C/
y 1
Inspection Line. 503 639.4175 D ate Ready/By Jens See Page 2 for
Internet' www ttgard- or.gov Notified/Method l A k o CITY OF TIGARI) q )
fied/Method 1l' f 9 /f vvvv 7 / j Supplemental information
TYPE OF WORK 1• ` ,V (11 fr D 1 PLAN REVIEW
lk New construction ❑ Addition /alteration /replacement Ple check all that apply (submit 2 sets of plans w /items checked below)
Service or feeder 400 amps or more ❑ Building 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 buildings
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling Commercial /industrial ❑ Accessory building amps for all other installations buildings
i • u ti -fame ❑ Master builder ❑ Other: ❑ Fire pump ❑ installation of 75 KVA or
/ J 7 JOB SITE INFORMATION AND LOCATION ❑ Emergency system larger separately derived system
❑ Addition of new motor load of ❑ "A ", "E ", "1 - ", "1 - ",
Jo . ... Jo r 5i3 t Cl ("CC to tN'-e. iOOHP or more occupancy
❑ Six or more residential units ❑ Recreational vehicle parks
City /State /ZIP: il(.i ARC) , og 41'7 ❑ Health -care facilities ❑ Supply voltage for more than
❑ Hazardous locations 600 volts nominal.
Suite /bldg. /apt. no.: Project name: C, A .(.S .x 2 . ❑ Service or feeder 600 amps or more
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total I *
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq ft. or less 168 54 4
Ea add'l 500 sq ft or portion 33 92 1
Tax map /parcel no.. Limited energy, residential
DESCRIPTION OF WORK (with above sq ft) 75 00 2
Limited energy, multi - family 75 00 2
( €AA) (L e S T A(,AS t---cr residential (with above sq ft )
Services or feeders installation, alteration, and /or relocation
200 amps or less 1 1 100 70 al, 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 311 133 56 WO 2
401 amps to 600 amps 200 34 2
Name:
601 amps to 1,000 amps 301 04 2
Address: Over 1,000 amps or volts 552 26 2
Temporary services or feeders installation, alteration, and /or
City /State /ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or less 59 36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125 08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168 54 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A Fee for branch circuits with r 1
0 APPLICANT 0 CONTACT PERSON above service or feeder fee,
176 7 42 0 bye ®2
each branch circuit
Business name: B Fee for branch circuits without
service or feeder fee, first 56 18 2
Contact name branch circuit
Each add'I branch circuit 7 42 2
Address: Miscellaneous (service or feeder not included)
Each City /State /ZIP: dwelling, service manufactured
nd/or feeder 67 84 2
Phone: ( ) 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: t3�,C, e Ettc rtztc- , 1..-.v---C.... panel, alteration, or extension Page 2 2
Each additional inspection over allowable in any of the above
Address: 'Z(e7.(o SL-. 5 h(zuce. S l . Additional inspection (1 hr mm) 66 25/ hr
City /State /ZIP: (4 ILLS 13Cgut e q-7 I Z3 Investigation (1 hr mm) 66 25/ hr
Industrial plant (1 hr min) 78 18/ hr
Phone: (St)3) 646- cShc ax: (5133) 430 - S9 6(..t, Inspections for which no fee is 90 00/ hr
T lti specifically listed (/ hr mm)
CCB Lic.: 1 c2.diS ' Electrical Lic.: g4—(42.1 C. Suprv. Lic.• 4LeaCaS ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required. Subtotal Ele3 4 6 r -f88
Plan review (25% of permit fee)'��z�
Print name: f z - IZI ( E v SZ(2.p(Yt Date: (Al (,3 z t i. \ State surcharge (12% of permit fee) 22.r 472
TOTAL PERMIT FEE. -552 C7
Authorized signature
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
Number of inspections allowed per permit
I \Buddmg\Permits\ELC- PermitApp doe 07/01/10 440- 4615T(I I /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - `Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined . $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
n Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918 309 - 0000)
Check Type of Work Involved:
n Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
n HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
n Outdoor Landscape Lighting*
❑ Protective Signaling
n Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I \Budding\Permns\ELC- PermotApp doe 07/01/10