Permit CITY OF TIGARD ELECTRICAL PERMIT
3 • COMMUNITY DEVELOPMENT Permit# ELC2012 00538
Date Issued 09/18/2012
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Parcel 1S136DB02600
Jurisdiction Tigard
Site address 11201 SW 72ND AVE
Project McDonalds Subdivision AZOIC TERRACE Lot 1
Project Description (7) branch circuits for remodel of existing restaurant
Contractor DOUBLE E ELECTRIC INC Owner STEWART /BARI PROPERTIES LLC
2626 SE SPRUCE ST STEWART TRUST
HILLSBORO, OR 97123 BY US BANK
BOX 64142
ST PAUL, MN 55164
PHONE 503 - 807 -5156 PHONE
FAX 503 - 430 -5966
FEES
Quantity Description Date Amount
7 crt Branch Circuits wo /Purchase 09/18/2012 $100 70
Specifics Service or Feeder
1 ea 12% State Surcharge - 09/18/2012 $12 08
Type of Use COM Electrical
Class of Work ALT
Type of Const
Occupancy Grp
Total $112 78
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 OA 95 -001-0090 You
'
may obtain a copy of the rules or direct questions to OUNC by calling 503 232 1987 or 1 800332 23
Issued By bit t1/1-1-4-1
1l Permittee Signature Did AWL 6477
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 site at the time of each inspection
,
1
Electrical Permit Applica s 1 r.FivED FOR oFhlcl: (:sr. (11.1
City of Tigard 17 2 2
Received 1 /gr I� Si Permit No EL� -38
lig 13125 SW Hall Blvd., Tigard, OR 97 Plan Review Oilier Permit SW aQ /� - QQ( 37
Phone 503.7182439 Fax 503 60 Dtitel6
Inspection line 503 639 4175 urn( OF TIGARD Date Ready /By ® See Page 2 for
T I G:1 f U Notifred/Method Supplemental Information
Internet w►vtvn rd -orgov suit r ytn° � p9
TYPE OF WORK ' 3 " I � . ' ! F P LAN REVIEW
Please check all that apply (submit b sets of plans w /items checked below)'
❑ New construction Additiortialteration /replacement 0 Service or feeder 400 mnps or mere ❑ Snddmg over three stones
❑ Demolition ❑ Other: whom tho available fault current ❑ Mammas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 salts or ❑ Floating buildings.
tem io ground, or exceeds 14,000 ❑ Commercial -use agncultural
❑ I- and 2- family dwelling X Commercial/industrial ❑ Accessory building amps for an other installations buildings 1
❑ Multi-family ❑ Master builder ['Other ❑ Fire pomp ❑ Installation oft 5 KVA or
❑ Emergency system larger separately darned system
JOB SITE INFORMATION AND LOCATION ❑ Addition of aew motor load of ❑ "A'', E", - 1 -2 ", "1 -3 ",
�qr0 1 OOH? or more. occupancy no.: Job site address 11 2(31 (9 $ W / 4 AV E ❑ Six or more rcvdcotial units ❑ Recreational vehicle parts
_ l (, r 7 �� ❑ Healthcare facilities. ❑ Supply voltage for more than
City City/State/ZIP: l ❑ Homrdous locations 600 volts nominal
Suite/bldgJapL no.: Project name. /l(1 ON ettLCS . ❑ Service or feeder 600 amps or more
FEE SCHEDULE
Cross str+eet'directtons to job site: newnono• Lo' I re e. 1 'rant 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'1 500 sq ft or portion 33 92 1
Tax map /parcel no.: Lunaed e nergy, residential 75 00 2
DESCRIPTION OF WORK (with above sq R)
Limited energy, multi - family 75 00 2
ReMCi:),tt. (g eau crr4 f7r-r •P* residential (with above sq ft.)
��+� Services or feeders installation, alteration, and/or relocation
200 amps or less 1 100 70 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps t 33 56 2
401 amps to 600 amps 200 34 2
Name' 601 amps to 1,000 amps 301 04 2
Addres.S Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and /or
City /State/ZIP: relocation
200 amps or less 59 36 1
Phone ( ) Fax ( ) 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 — ttew, alteration, or extension, p r panel
Owner signature: " Date: A Fee for branch circuits with
CONTACT PERSON above service or feeder fee 7 42 2
❑ APPLICANT 1 ❑ each branch circuit
B Fee for branch circuits wallow
Business name: service or feeder fee, first p 5618 5(9.18 2
branch circuit A
Contact name Each add'! branch circuit , 6, 7 42 44.gZ 2
Address. Miscellaneous (service or feeder not included)
Each manufactured or modular 67 84 2
City /State /ZIP dwelling service and/or feeder
Reconnect only 67 84 2
' Phone { ) Fax: ( Pump or imgation circle 6 84 2
E-mail: Sign or outline lighting 67 84 2
CONTRACTOR Signal eircuit(s) or limited -energy
� �� f panel, alteration, or extension. 1 Page 2 2
.'�'_
Jt e
1 Business name: , Ezr--l� Each additional inspection over allowable in any of the above
Address 2424 5E, se sr. . Additional inspection (1 hr min) 66 25/ hr
f �,,p� Investigation (1 hr mm) 66 25/ hr
Clty/State/ZIP:4,1.(t,wB�Qr c:R cniz3 lndustnal plant (1 hr min) 7818 /hr
Phone: 603) an- S I Sb [Fax: 513) 4.31,-.396L Inspections for which no fee is 90 00/ lir
specifically listed (A hr mm)
CCB Lrc.:•tS 1 Electrical Lic .; • _ Cr Supry Lic : 5 ELECTRICAL PERMIT FEES
t Subtotal. 1 10b.13
Suprv. Electrician signature, required: I1(e� Plan review (25 % ofpermit lee)
p yl/� 1 Date State surcharge (12% of permit feel 0 Z. O
Print name: 1140(C, TOTAL PFI2MIT FEE t { Z l .
•
Authorized signature: i
-
This permit application expires it a permit is not obtained wind. IN
days after it has been accepted as complete.
Print name: I Date: • Number of inspections allowed per permit
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