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Permit CITY OF TIGARD ELECTRICAL PERMIT • • - COMMUNITY DEVELOPMENT Permit #: ELC2011 -00708 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/20/2011 Parcel: 15136C000100 Jurisdiction: Tigard Site address: 11705 SW PACIFIC HWY M Project: Sushi Hanna Subdivision: 2006 -016 PARTITION PLAT Lot: 3 Project Description: (1) service, (22) branch circuits and (1) low voltage for data. Contractor: HUNGNAM OH ELECTRIC Owner: PACIFIC CROSSROADS PROPERTIES IN 10580 SW 82ND AVE BY WYSE INVESTMENT SERVICES CO TIGARD, OR 97223 1501 SW TAYLOR ST STE 100 PORTLAND, OR 97205 PHONE: 503 - 381 -4910 PHONE: FAX: FEES Quantity Description Date Amount 1 ea Services or Feeders - 200 12/20/2011 $100.70 Specifics: amps or less 22 crt Branch Circuits w /Purchase 12/20/2011 $163.24 Type of Use: COM Service or Feeder Class of Work: ALT 1 ea Signal circuit or Limited 12/20/2011 $75.00 Energy Panel Type of Const: 1 ea 12% State Surcharge - 12/20/2011 $40.67 Occupancy Grp: Electrical Total $379.61 Required Items and Reports (Conditions) This permit is is •. 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 - cordance with a• : oved 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 law a. ' as yo t. follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0110 throw h OAR 952-001-0190. Y, ay o.tain a copy of the rul or direct questions to OUNC by calling 503.232.1987 or 1. .332. 44. I Issued = 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 INSTALI,,ATION ONLY SIGNATURE OF SUPR. ELEC' �.. 1 1 Date: p/ 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 Applicatio FOR OFFICE USE ONLY �g Received A City of Tigard �" DateBy: l/ 1 /� ,/, Permit No.: �L � �� S q 13125 SW Hall Blvd., Tigard, OR 97 2 Plan Review A. Z : DEC Phone: 503.718.2439 Fax: 503.598.196 Date/By: Other Permit: TIGARD Inspection Line: 503.639.4175 2 0 2011 Date Ready/By: Juris: ® See Page 2 for Internet: www.tigard- or.gov CITY OF 7 IGARD Notified/Method: Supplemental Information I _ / TYPE' OF `DING DIVISION PLAN REVIEW Please check all that apply (submit 2 sets of plans w /items checked below): ❑ New construction IJ Addition/alteration/replacement ❑ Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards CATE VRY OF CONSTRUCTION exceeds 10,000 amps at ISO volts or ❑ Floating buildings. , less to ground, or exceeds 14,000 ❑ Commercial - use agricultural El 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 JOB SITE INFORMATION AND LOCATION LJ(,(� t ❑ Emergency system. larger separately derived system. Pi ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ", Job no.: Job site address: 1 < r] D ✓ & I^f pQC.I f : C 4W y 100HP or more. occupancy. Q ❑ Six or more residential units. ❑ Recreational vehicle parks. City/State/ZIP: T' y / D ❑ Health -care facilities. ❑ Supply voltage for more than `(+! H 1 n ❑Hazardous locations. 600 volts nominal. Suite /bldg. /apt. no.: Project name: 41,1 y 1 H ; a Q. ❑ Service or feeder 600 amps or more. 1L1��1 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'I 500 sq. ft. or portion 33.92 1 Tax map /parcel no.: Limited energy, residential 75.00 2 DESCRIPTION OF WORK (with above sq. ft.) Y Limited energy, multi- family 75.00 2 -r - J- W D KV , residential (with above sq ft ) Services or feeders installation, alteration, and /or relocation �/ 200 amps or less ! 100.70 (01). to 2 ❑ PROPERTY OWNER c TENANT 201 amps to 400 amps 133.56 2 Name: G C� h - -H o h a 401 amps to 600 amps 200.34 2 601 amps to 1,000 amps 301.04 2 Address: 1 111 0 S S. i W , I C.. i f . rr 14- yJ T Over 1,000 amps or volts 552.26 2 City /State /ZIP: + Temporary services or feeders installation, alteration, and /or t relocation Phone: ( ) 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 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 PPLICANT ❑ CONTACT PERSON above service or feeder fee, 21. 7.42 // 7. '� 2 Ly' A each branch circuit (/ P Business name: .14 u h h Q.v 0 I E .Q—(4'(r'e C. B. Fee for branch circuits without service or feeder fee, first Contact name: u K in et- C)11 branch circuit 56.18 2 Each add'I branch circuit 7.42 2 Address: I 0 9 — o g . . $-� " A--0,4- Miscellaneous (service or feeder not included) City /State /ZIP: pay.- Each manufactured or modular 4_ © 9 0 L L 3 dwelling, service and/or feeder 67.84 2 Phone: (, 5-03 ( Q� I — f( T ( ( ) Reconnect only 67.84 2 r7 p l / Fax: '" fl Pump or irrigation circle 67.84 2 E -mail: Dt et p- t -� G @ LI A.v1 0 • c4 P11 Sign or outline lighting 67.84 2 CONTRACTOR Signal circuit(s) or limited - energy - '6 Business name: {� (,� Q l 4- ' panel, alteration, or extension. I Page 2 75 2 ` ' LV1�I a Q '! �' ` �' r• L Each additional inspection over allowable in any of the above Address: l o 8 $,W . e�-wel i.t/„Q, Additional inspection (1 hr min) 66.25/ hr City /State /ZIP: !� 0-4,--g- � q /� Investigation (1 hr min) 66.25/ hr : / 0 K 1 ' f 2 3 Industrial plant (1 hr min) 78.18/ hr Phone: ( TO - t �� Fax: ( ) Inspections for which no fee is ` —T l 7 1 � � I 4 �� /z 3 specifically listed (% hr min) 90 00/ hr CCB Lic.: t Z b Z t) T Electrical Lic.: 3 4 —441c__, Suprv. Lie.: ,4.3 7 S'S ELECTRICAL PERMIT FEES LL Q �� /� Subtotal: 3 p• l q Suprv. Electri st ure, required: Plan review (25% of permit fee): Print name: t l . h„ 0 ii Z Date: , / I q/ I I State surcharge (12% of permit fee): IQ .427 11 r TOTAL PERMIT FEE: 3 7 q • COI 1 ( Authorized signature: �f6d Ie I 2 / I T his permit application expires if a permit is not obtained within 180 Print name: V{ Date: *.. / G) /' * days after it has been accepted as complete. r1 Q YY� ® [/ I 1( Number of inspections allowed per permit. I'\Building\Permits\ELC- PermitApp doc 07/01/10 440- 4615T(1 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: n Audio and Stereo Systems* ❑ Burglar Alarm • ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* n 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 11 7. IData Telecommunication Installation n Fire Alarm Installation ❑ HVAC ❑ Instrumentation n Intercom and Paging Systems • n Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls • ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other Total number of commercial systems: _ . *No licenses are required. Licenses are required for all other installations P\ Building 'Permits\ELC- PermitApp.doc 07/01/10