Permit C ITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2008 - 00098
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 4/22/2008
PARCEL: 2S102BD - 00701
SITE ADDRESS: 12785 SW PACIFIC HWY ZONING: C -G
SUBDIVISION: NO. TIGARDVILLE ADDITION AMEND LOT: 008 JURISDICTION: TIG
PROJECT: WENDY'S
Project Description: Installing low voltage conduit underground.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: • HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER: : X
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
SPADA, FRED TRUSTEE OES LLC
WIENER, NORMAN J TRUSTEE 5285 NE ELAM YOUNG PKWY # A600
72907 BEL AIR RD HILLSBORO, OR 97124
PALM DESERT, CA 92260
Phone: Contact #: PRI 503- 693 -6000
FAX 503- 693 -8660
FEES Reg #: ELE 34 -572C
LIC 159395
Description Date Amount SUP 4122S
[ELPRMT] ELR Permit 4/22/2008 $75.00
[TAX] 12% State Surch 4/22/2008 $9.00 REQUIRED ITEMS AND REPORTS
Total $84.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By:�� % Permittee Signature:
GQ
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Application E GENEI FOR OIIl I(I; l S1 ONI.)
Received
q City of Tigard Dat e/B : %i Permit No : ' 1
13225 SW Hall Blvd., T OR 97223 Q 1 - v ---
1 DO Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 APR 2 A 20 Dateis �'x it:
Inspection Line: 503.639.4175 Date Read IB It eie
TEGA'R.n Ready /By: Q SeePage2for
Internet: www dgard o[ gov v c T IGARD Notified/Method Supplemental Information
k RI g ' � , , iz t sr 741:3'tzr, g YY r s ,�". 11I. 1. r q { , . r trr an am gr e r i .
310,221,1ULTT'
. Y A O t t psi$ ' 91t k• ,., . . 4 E4 u' , , E
❑ New construction n Addition/alte"ratl t n %'replacement Please check all that apply (submit 2 sets of plans w(items checked below):
❑ Service or feeder 400 amps or more Q Building over three stories.
❑ Demolition 0 Other: where the available fault current ❑ Marinas end boatyards.
�"� ) 8 �r `� ll � r ,H exceed 10,000 amps az 150 volts or ❑ Floating
cuttnra
t � l �� ar eal, If" e `_ t nifilluallthi f � less to und, or exceeds 14,00D ❑ Comme
❑ I - and 2 family dwelling IJ Commercial/industrial ❑ Accessory building �° agri
amps far all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑Fire pump. ❑ Installation of 75 KVA or
l i N i s '- ii a1 l ,iY .:1: . t -; t t l: ti 3 raR. . t t v p p rzw iu q. ! ail ipti I t ill l�l) E 1131 ❑ Emergency system. larger separately derived system.
t s
...oe a' .„ -..a ❑ Addition of new motor load of ❑ "A '8", "1-2 ", "1.3 ",
Job no.: Job sift 100HP or more. occupancy'.
�
/1 1! ❑Six or more residential units_ ❑ Recreational vehicle parks.
/ /
City / State/ZIP: 'Gi r _ �i � 7 � 572 ❑ Health -care facilities. 0 Supply voltage for more than
` ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: I Project name: 4,,r,, . `ie .w tart il ❑ Service or feeder 600 amps or mole
-!,■1} ICI,14 , `i'_ ° . 710EEDIOWINMEISM
Cross street/directions to job site: Ducr' tlon .
'r Qty. Fee, Total •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: I 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
T t (. d a t Oa L 1 ... _ 0 ' :0-VI t 4with abov q. $.) 75.00 2
!' L energy, multi - family
71, l rY)t,WP" 4 41, l t j ' L v residential (with above sq_ft.) 75.00 2
Services or feeders instal)ation, alteration, and/or relocation
200 amps or less 80.30 2
1 9 t , '; l,. P a t A T p cps
• 201 am Ps to 400 106.85 2
Name: 401 amps to 600 amps 160.60 2
601 snips to 1,000 amps 240.60 2
Address: Over 1.001) amps or volts 454.65 2
City/State /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps I33.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
A. Fee for branch circuits with
.atal it ' �di� i.s. 114iE t `5 ,_^ y t;fi t ' ix • o -� above service or feeder fee,
'' ,_ f each branch circuit 6.65 2
Business name: B. Fee for branch circuits
Contact name: withou service or feeder fee, 86.85 2
first branch circuit _
Address: Each add'l branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City /State/ZIP: Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone:
( ) I Fax: : ( ) Reconnect only 66,85 2
E-mail: Pump or irrigation circle 53.40 2
d3'' . • .ti, .3 a a`_ r i inn I ''' Sign or outline lighting 5340 I 2
Business name: tom' L.'.,� G 4 . Signal circuit {s) or limited -
energy panel, alteration, or
Address: j 4 ' fie w . o � / , 4 , 4 .... 6 .' 0 6 extension. Describe: Page 2 L.5".:00 2 •
City /State /ZIP: • /7,rivu o A 9,/ . 41 ,./ Each additional inspection over allowable in any of the above
Per inspection 62.50
/
Phone: (, ) t�7 000 Fax: (.$?3) I ,, ..� ii6
In vestigation per hour (1 hr min) 62 .50
CCB Lie.: „.„,--5, 3 7_< I Electrical Lic.: ,j V.5),2 (. Suprv, Lie,: fr ,',2, ,5 Industrial plant per hour 73.75
-' Mull, ar l tritaitarilut' tl
Subtotal: 9
Suprv. Electrician
• signature, required: :c s t * 00
Print name: g� O ,�c:; 5 Date: r r , i ' <`s Plan review (25% of permit fee):
'�' �� 7 `� State surcharge (12% of permit fee): al, (f0
Authorized signature: TOTAL PERMIT FEE: 6
Paint name; I This permit spa/karma expires if a permit is not obtained within 180
Date: days after it has been accepted as complete.
. Number of inspections allowed per permit.
I. UBuildiug \PermitskELGPerrnitApp.doc 05/23/06 440-4615T(I1 /05/COM/WEB
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CITY OF TIGARD
BUILDING DIVISION T PERMIT #: ELR2008 -00088
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: /22/2008
Phone: (503) 639-4171 / inN�m L.
Inspection Requests (24 Hrs.): (503) 639 -4175 ''f �..
INSPECTION WORKSHEET FOR DATE: 4/23/2008 TIME: 7:02AM PAGE: 27
SITE ADDRESS: 12785 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: NO. TIGARDVII ADDITION AMEND LOT #: 008 TYPE OF USE:
PROJECT NAME: WENDY'S
DESCRIPTION: Installing low voltage conduit underground.
OWNER: SPADA, FRED TRUSTEE, PHONE #:
CONTRACTOR: OES LLC • PHONE #: 503-683 -0000
Inspection Request Scheduled For: Date: 4/23/2008 Pour Time:
Code # Inspection Description Confirm Contact # Message
35 Low valta 06(4753-01 503 -69 8000 N
ctions /Commentsjlnstructio s:
0K). O1/4)I\ P466)_
0 FL5' 1mu 3
,.._...___....______
1
1.-=‘,. & 14;81-1 A
cli PASS N - • - ; _ 4 PPROVAL n CANCEL ❑ NO ACCESS.
❑ FAIL II CALL FOR INSPECTION _ ADDITIONAL FEES ASSESSED
Inspector: G (' L1W Date: 41 2 - 3 1 04 6 Phone #: (503) 718- �,K