Permit CITY OF TIGARD ELECTRICAL PERMIT
Per
COMMUNITY DEVELOPMENT
Permit #: ELC2012 -00479
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08114!2012
T [ G: \RO 9 Parcel: 1 S134BC00101
Jurisdiction: Tigard
Site address: 12144 SW SCHOLLS FERRY RD
Project: Carl's Jr Subdivision: WINDSOR PLACE Lot: 32
Project Description: (10) branch circuits for repositioning electrical for new restaurant equipment
Contractor: IDEAL SERVICES INC Owner: GREENWAY CENTER LLC
5113 PACIFIC HIGHWAY EAST #13 ANA KALAKAUA CENTER
FIFE, WA 98424 2155 KALAKAUA AVE #602
HONOLULU, HI 96815
PHONE: 253 -475 -8884 PHONE:
FAX: 253 -475 -8886
FEES
Quantity Description Date Amount
10 crt Branch Circuits wo /Purchase 08/14/2012 $122.96
Specifics: Service or Feeder
1 ea 12% State Surcharge - 08/14/2012 $14.76
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $137.72
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 • er applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days 'issuan• , or if work is s •ended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility N tification C ' er. Those rule - s -
952- 001 -0010 through OA 2 -001- 90. You ma obtain a copy of the rules or direct questions to OUNC by callin 03.232.19• .800.332. >
Issued By: 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:
— C!R? T..tTT • N 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 site at the time of each Inspection.
Electrical Permit Application RECEIVE FOR OFFICE USE ONLY
) L Perm No.:
City of Tigard Received AUG Date/By: g !2 °y( LGL��la— pDcF7f
i ll 13125 SW Hall Blvd., Tigard, OR 97223 1 4 Z0� Plan Review
C : Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Other Permit:
T 1 G A R D Inspection Line: 503.639.4175 CPf YOFTIG ' ' 1 Date Ready /By: 1u " s i / HI See Page 2 for
Internet: www.tigard - or.gov RUINGDIVIS
IIAI:,,, ified/Method: 1 tSP Supplemental Information
TYPE OF WORK 11 1IYY,�LiV J 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 ❑ 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 ❑ Emergency system. larger separately derived system.
A
❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "1 -3 ",
Job no.: 12 - 1844 Job site address:pril0 SW Scholis Ferry Road 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: Tigard, OR 97223 12404 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: Carts Jr ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: 121 and Scholis Ferry Road 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.)
Limited energy, multi - family 75.00 2
Repositioning electrical for new restaurant equiptment residential (with above sq. ft.) _ -
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER ® TENANT 201 amps to 400 amps 133.56 2
Name: Carts Jr 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: 12140 SW Scholis Ferry Road Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City/State/ZIP: Tigard, OR 97223 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
® APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: Ideal Services Inc B. Fee for branch circuits without
service or feeder fee, first 1 56.18 56.18 2
Contact name: Tom Duncan branch circuit
Each add'I branch circuit 9 7.42 66.78 2
Address: 5113 Pacific Hwy E #13 Miscellaneous (service or feeder not included) _
City/State /ZIP: Fife, WA 98424 Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: (253) 475 - 8884 Fax: : (253) 475 -8886 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail: permits @idealservicesinc.com Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited - energy
Business name: Ideal Services Inc panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 5113 Pacific Hwy E #13 Additional inspection (I hr min) 66.25/ hr
City/State /ZIP: Fife, WA 98424 Investigation (I hr min) 66.25/ hr
Industrial plant (I hr min) 78.18/ hr
Phone: (253) 475 - 8884 Fax: (253) 475 - 8886 Inspections for which no fee is 90.00/ hr
specifically listed (%2 hr min)
CCB Lic.: 154353 Electrical Lic.: 37 -988c Suprv. Lic.: 51295 ELECTRICAL PERMIT FEES
Subtotal: 122.96
Suprv. Electrician signature, required: Plan review (25 % of permit fee): . ‘i f
Print name: Ray Salzer Date: 8/10/12 State surcharge (12% of permit fee): 14.75
TOTAL PERMIT FEE: 137.71
Authorized signature: t This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: James Duncan Date: 8/10/12
• N umber o inspections allowed per permit.
J - !a 7.`72
I:\ Building \Permits\ELC - PermitApp.doc 07/01/10 4404615T(II/05 /COM/WEB