Permit CITY TI G A R D ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2007 -00405
r TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 11/1/2007
PARCEL: 1 S136CD -00102
SITE ADDRESS: 11685 SW PACIFIC HWY ZONING: C -G
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: BAJA FRESH MEXICAN GRILL
Project Description: Data /tele.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: X NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: : HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
WILLIAM & SALLY FLOWBERG MARK ADAMS ELECTRIC INC
834 SW ST CLAIR PO BOX 2748
PORTLAND, OR 97205 CLACKAMAS, OR 97015
Phone: 503- 225 -0700 Contact #: PRI 503 -557 -8543
• FAX 503 -557 -8508
FEES • Reg #: ELE C248
LIC 174094
Description Date Amount SUP 4810S
[ELPRMT] ELR Permit 11/1/2007 $75.00
[TAX] 8% State Surcha 11/1/2007 $6.00 REQUIRED ITEMS AND REPORTS
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or direct ques • ns to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By: 7it i 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'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.
Electrical Permit Application FOR OFFICE USE ONLY
Received • ' C ity of Ti ar(1 rmit No.
City g Date/By: < < 1 / 1 7 Be 8 1/ !_ v
13125 SW Hall Blvd., Tigard, OR 9 `1. 4' Ci VED Plan Review /
I I Phone: 503.639.4171 Fax: 503.59 3 '1t61 Date/By: Other Permit:
I" I C. n It D Inspection Line: 503.639.4175 Date Ready/By: Juris: El See Page 2 for
Internet: www.tigard - or.gov NOV — 1 l � / Notified/Method: Supplemental Information
TYPE OF W l $YOF rv/nnQh PLAN REVIEW
❑ New construction ddition/alt iii Please check all that apply (submit 2 sets of plans w /items checked below):
rON ❑ 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 ,®Kommercial /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 ❑ Emergency system. larger separately derived system.
A
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: 1 16g� 54.3 Il Six or or more. occupancy.
GU C N ❑ Six or more residential units. 0 Recreational vehicle parks.
City/State /ZIP: ( a ti t 9 - ? ❑Healthcare facilities. ❑ 600v no al. more than
/ ❑ Hazardous locations.
Suite/bldg. /apt. no.: Project name: IS r.9 A �t *OK{ 64(/ ❑Sevice or feeder 600 amps or more.
`' FEE SCHEDULE
Cross street /directions to job site: Description I qty. I Fee. 1 Total 1 •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
T s-L Limited energy, multi - family 75.00 2
t( cp / ,..6 , t ch 6d t ii residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
Et PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
Name: (� i (I t 4�. U ld 401 amps to 600 amps 160.60 2
q 1, 601 amps to 1,000 amps 240.60 2
Address: 3Y SC. � al , J Over 1,000 amps or volts 454.65 2
City/State /ZIP: AO r d-(�. 4 A 2 9 o Dom Temporary services or feeders installation, alteration, and/or
relocation
Phone: (Sp 3)Z Z o — y o o Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 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 •
❑ APPLICANT � B. A CONTACT PERSON above service or feeder fee, 6.65 2
ICo� � 1�.- each branch circuit
!�!7� Business name: 7r�r�� Fee for branch ch ca rcuits
� without service or feeder fee,
first branch circuit 46.85 2
Contact name: 7' JAn. e t
As? �`
Each
Address: Iz-2 c ot...) S(Liol(S r2w// branch circuit 6.
/ Miscellaneous (service e or feeder not included) ) 2
City/State /ZIP: I ty4 f 0 / 7, 3 Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: ( 5 ) s 9 0 . . , cosi Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: Signal circuit(s) or limited-
I'I r r7 � 5 _ i cy energy panel, alteration, or
Address: ' . Pa _ _ &DX Z7 VS . extension. Describe: Page 2 2
City/State /ZIP: CLA - CKII - mA S (5A . 970/57
Each additional inspection over allowable in any of the above
/ Per inspection 62.50
Phone: i 355 7 - 4_› Fax: , . Investigation per hour (I hr min) 62.50
CCB Lic.: / -'/O71/ j /04. L�: C ati p� Suprv. Lic.: Industrial plant per hour 73.75
,, : ELECTRICAL PERMIT FEES
Suprv. Electrician signature, qulred: Subtotal:
Print name: Date: Plan review (25% of permit fee):
_ State surcharge (8% of permit fee):
Authorized sig TOTAL PERMIT FEE: U' , 00
■
firs■- 20 0 This permit application expires if a permit is not obtained within 180
, Print name: , 1 Date: It — i — W In days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:\Building\Permits\ELC- PermitApp.doc 05/23/06 440- 4615T(II/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
E l 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- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
•
❑ Boiler Controls .
❑ Clock Systems
Data Telecommunication Installation
❑ Fire Alarm Installation
•
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
1
■ •
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I:\ Building \Permits\ELC- PermitApp.doc 03/23/06
CITY OF TIGARD
BUILDING DIVISION PERMIT #: El_R2007 00405
AM) 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/1/2007
Phone: (503) 639 -4171 t 11i 11(/‘ Inspection Requests (24 Hrs.): (503) 639 -4175 W _ ..
INSPECTION WORKSHEET FOR DATE: 12/4/2007 TIME: 7 :01AM PAGE: 45
SITE ADDRESS: 1 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: BAJA FRESH MEXICAN GRILL
DESCRIPTION: Data/teie.
OWNER: FLOWBERG, WILLIAM & SALLY PHONE #: 503-225 -0700
CONTRACTOR: MARK ADAMS ELECTRIC INC PHONE #: 503-557 -8543
Inspection Request Scheduled For: Date: 17J4/2007 Pour Time:
Code # Inspection Description n or)firm' Contact # Message
199 Electrical final 060700-01 97'1- 678.3094 N
Corrections /Comments /Instructions:
ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Z • N L4v, Date: 11-'4 1 39 Phone #: (503) 718- 1,4410 •
CITY OF TIGARD _
BUILDING DIVISION - PERMIT #: ELR2007 -00405
13125 SW Hall Blvd., Tigard, OR' 97223 DATE ISSUED: 1111/2007
Phone: (503) 639 -4171 14',A111
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 11/5/2007 TIME: 7:01AM PAGE: 32
SITE ADDRESS: 11685 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: BAJA FRESH MEXICAN GRILL
DESCRIPTION: Data/tele.
OWNER: FLOWBERG, WILLIAM & SALLY PHONE #: 503-225-0700
CONTRACTOR: MARK ADAMS ELECTRIC INC PHONE #: 503-557-8543
Inspection Request Scheduled For: Date: 11/5/2007 Pour Time:
Code # Inspection Description r m - # Contact # Message
135 Low voltage (pa
5B983 -01 ''. 971 -678 -3094 N
Corrections/Comments/Instructions:
SI,DASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED •
Inspector: ,•%11 L Date: I 1 • lS • 01 Phone #: (503) 718- M"L9