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Permit u CITY OF TIGARD 8 I 101- ELECTRICAL PERMIT 0 • COMMUNITY DEVELOPMENT Permit #: ELC2012 00244 T t G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/26/2012 Parcel: 1 S134BC00200 Jurisdiction: Tigard Site address: 12160 SW SCHOLLS FERRY RD 100 Project: Berry Farm Yogurt Subdivision: W NDSOR PLACE Lot: 32 Project Description: (1) 100 amp service and (12) branch circuits. "REPRINT 8/14/12 to correct address and project name" Contractor: TOTAL ENERGY SOLUTIONS Owner: GREENWAY CENTER LLC PMB 453 12042 SE SUNNYSIDE RD ANA KALAKAUA CENTER CLACKAMAS, OR 97015 2155 KALAKAUA AVE #602 HONOLULU, HI 96815 PHONE: 503 - 775 -0880 PHONE: FAX: 503 - 775 -6006 FEES Quantity Description Date Amount 1 ea Services or Feeders - 200 04/26/2012 $100.70 Specifics: amps or less 12 crt Branch Circuits w /Purchase 04/26/2012 $89.04 Type of Use: COM Service or Feeder Class of Work: ALT 1 ea 12% State Surcharge - 04/26/2012 $22.77 Electrical Type of Const: Occupancy Grp: • Total $212.51 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 5 - 001 -00 . You m A1 - 114 - ayobttain a copy of the rules or direct questions to OUNC by calling 503.232. or 1.800.332.2344. ' ) Issued By: Permittee Signature: Oki 4 PA ci of + 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 she at the time of each Inspection. V CITY OF TIGARD ELECTRICAL PERMIT , 3 COMMUNITY DEVELOPMENT Permit #: ELC2012 -00244 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/26/2012 Parcel: 1 S134BC00200 Jurisdiction: Tigard Site address: 12160 SW SCHOLLS FERRY RD 200 Project: Subway Subdivision: WINDSOR PLACE Lot: 32 Project Description: (1) 100 amp service and (12) branch circuits. Contractor: TOTAL ENERGY SOLUTIONS Owner: GREENWAY CENTER LLC PMB 453 12042 SE SUNNYSIDE RD ANA KALAKAUA CENTER CLACKAMAS, OR 97015 2155 KALAKAUA AVE #602 HONOLULU, HI 96815 PHONE: 503 - 775 -0880 PHONE: FAX: 503 - 775 -6006 FEES Quantity Description Date Amount 1 ea Services or Feeders - 200 04/26/2012 $100.70 Specifics: amps or less 12 crt Branch Circuits w /Purchase 04 /26/2012 $89.04 Type of Use: COM Service or Feeder Class of Work: DEM 1 ea 12% State Surcharge - 04/26/2012 $22.77 Electrical Type of Const: Occupancy Grp: Total $212.51 Required Items and Reports (Conditions) This permi '- ' • -.'ect to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be d• - : in accordance with = • •roved •lans. This permit will expire if work is not started within 180 days of issuance, or if work is suspe ded for or = the 180 d- . ATTENTION: Oregon law -quire• ou to follow the rules adopted by the Oregon Utility Notification Ce ter. Those rules e set • in OAR • 2- 001 -0010 thrpuugh OAR 952-0e 0 0090 Y• / a n y obtain a ccopyy of the rules or direct questions to OUNC by calling 503.232. '8 • 1.800 32.2344. Issued By: , \ / 1� ,f2( A4 , Permittee Signature: 14 ' "_J OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale, lease or rent. OWNERS SIGNATURE Date: —, CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC' i ir. . _, i ., / .; B..,,....._ Date: �„.14,41....... / 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 FoR OFFICE USE ONLY City of Tigard Date/B : , , Permit No. :6,/,A/a _ ,,,,,„,. II n 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review 11 Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Other Permit: r I G n tt D Inspection Line: 503.639.4175 Date Ready/By: kris: 0 See Page 2 for Internet: www.tigard- or.gov Notified/Method: Supplemental Information TYPE OF WORK PLAN REVIEW ❑ New construction Addition/alteration/replacement Please 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 0 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. ❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or JOB SITE INFORMATION AND LOCATION El Emergency system. larger separately derived system. ❑ Addition of new motor load of ❑ °A ", "E ", "I -2 ", "1 -3 ", Job no.: Job site address: 1 2 1 60 510/ Ste, 1Is rtnr 100HP or more. occupancy. 1 d !! ❑ Six or more residential units. ❑ Recreational vehicle parks. City/State/ZIP: T 4r4 0 'n ~f �. 3 2o ❑ Health facilities. ❑ Supply voltage for more than s� ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: S 1 bwa Y /s - kQx ❑ service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: Description I Q. I Fee. I Total I Sw Sc.• its harr Rd / SU/ 1 2 1 s — A VG New residential single- g or multi- family dwelling unit. Includes attached garage. Subdivision: G•r'een w4 V Gcn 'k 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.: 15 13 _1 f�. B Goo OO ZOO Limited energy, residential 75.00 2 DESCRIPTION OF WORK (with above sq. ft.) Limited energy, multi - family 75.00 2 2 v 3 Ik 1 O ( � C n 4111r ; n p /t��M1 residential with above sq. ft.) �� / l J Services or feeders installation, alteration, and/or relocation 200 amps or less 7 100.70 11)6,70 2 ❑ PROPERTY OWNER I I TENANT 201 amps to 400 amps 133.56 2 Yo 401 amps to 600 amps 200.34 2 Name: err v rar1'h 1 4f r 601 amps to 1,000 amps 301.04 2 Address: i 2 16 0 5IA/ S e_ I ` O I O / IS Fern R d - 200 Over 1,000 amps or volts 552.26 2 T Ord , 0 R q 7 223 Y relocation or feeders installation, alteration, and/or City/State/ZIP: n J l Q Phone: (S03) 547. 51 q ( 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 401 amps to 599 amps 168.54 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits - new, alteration, or extension, per panel Owner signature: Date: A. Fee for branch circuits with APPLICANT I ❑ CONTACT P ERSON above service or feeder fee, 42. 7 42 0 �� i f 2 ��±± each branch circuit Business name: ecr, F4t'pN YO Q kr t. B. Fee for branch circuits without V service or feeder fee, first Contact name: branch circuit 56.18 2 ('�'!'�G Sc a n n �I I Each add'I branch circuit 7.42 2 Address: 16o 60 W C.0+6: trd / o n C Miscellaneous (service or feeder not included) City/Statc/ZIP: � � Each manufactured or modular &a �r , � - 0 q 1} s►' 00 / y dwelling, service and/or feeder 67.84 2 Phone: (5 17 , S lc? q Fax: : ( ) Reconnect only 67.84 Pump or irrigation circle 67.84 2 E -mail: 5C4 AA e.I I it' e. ont: er. ct Sign or outline lighting 67.84 2 CONTRACTOR Signal circuit(s) or limited -energy Business name: .173t-r-Q I G r r S I - f - panel, alteration, or extension. Page 2 2 o U I o n S .LA Each additional inspection over allowable in any of the above ■ Address: Additional inspection (1 hr min) 66.25/ hr Pm g 1.4, S3 I 20 5E Si Rci / Q Investigation (1 hr min) 66.25/ hr City /State /ZIP: l� I a G K n t o a f o R 57 Industrial plant (t hr min) 78.18/ hr Phone: ( 5 77 5 - O g 8 Fax: (5 77 e - -- 6006 Inspections for which no fee is specifically listed (%: min 90.00 / hr Lic.: i 9 3 6 o 3 Elec trical Lic.: e7 y g I Suprv. Lic. q qs ELECTRI PERMIT FEES u . I✓lect signature, required: 7�► �ryQ r Subtotal: e�. n .P _ P lan re v hr iew (25% of permit fee): -T— Print name: n u ,. _� n / : �r G t� C Date: 5 / State surcharge (12% of permit fee): a.2 • 7 7 _ - r �Tr / TOTAL PERMIT FEE: 9,9, • 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:\ Building \Permits\ELC- Perm /W itApp.doe 07/01 /10 440- 4615T(l1 /05 /COMEB '