Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Permit
p CITY OF TIGARD ELECTRICAL PERMIT a COMMUNITY DEVELOPMENT Permit #: ELC2012 -00574 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/02/2012 Parcel: 1 S 136DB00600 Jurisdiction: Tigard Site address: 11635 SW PACIFIC HWY Project: Taco Bell Subdivision: AZOIC TERRACE Lot: 1 Project Description: (8) branch circuits for TI Contractor: SQUARE 1 ELECTRIC INC Owner: ZAPP FAMILY REVOCABLE LIVING TRU 10117 SE SUNNYSIDE RD., STE. F -216 TYSON FAMILY TRUST CLACKAMAS, OR 97015 BY TBC #016600 PO BOX 35370 LOUISVILLE, KY 40232 PHONE: 503 - 867 -2423 PHONE: FAX: 503 - 914 -0432 FEES Quantity Description Date Amount 8 crt Branch Circuits wo /Purchase 10/02/2012 $108.12 Specifics: Service or Feeder • 1 ea 12% State Surcharge - 10/02/2012 $12.97 Type of Use: COM Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $121.09 Required Items and Reports (Conditions) This permit i. ' -d subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be don- n accordance ' 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 , . equires you to follow the rules adopted by the Oregon Ut�ilj •n Center. Those rules are set forth in OAR 952-'01-0010 th •ugh OAR • : r r r 1 . You may obtain a copy of the rules or direct questions to OUNC by • • • . ' .1987 or 1.800.332.2344. • Is ed By: I Permittee Signature: ` w Al I 1 ZfL/tIkAkk-t 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' - M I aii... i., • Date: p A. z LICENSE NO. 5 377 S 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. Oct 02 12 01:46p Square 1 ELec 5038553516 p.2 Electrical Permit Applicati k g ; ;t 4 . r Re FOR OFFICE ( ONLY City of Tigard nr Date/B . / ©�� p ermit - -No.: �LCo?O %Z -00 , C 13125 SW Hall Blvd., Tigard, OR 9 3 T 0 2 2012 Plan Review Other Permit: ,bet Pittr /A. " 0 Phone: 503.718.2439 Fax: 503.598.1960 Date/15 : Inspection Line: 503.639.4175 C,w Dare Ready/By: 1 Auer El See Paget for TIG.4RU l i r t .l) " ° r y (= r P vi '_ Notified/Method Supplemental laformation Internet: www.tigard -or.gov n 1 i ,�_ !� ' J _ TYPE OF WORK n • f � e i PLAN REVIEW . Please check all that apply (submit 2 sets of plans whims checked below): ID New construction Addition/alterationlreplacemc ❑ Service or feeder 40D amps or more ❑ Building over three stories. ❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards. CATEGORY OF CONSTRUCTION I 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 II Commercial /industrial El Accessory building amps for all other installations. buildings. ❑ Multi- family ❑ Master builder ❑ Other. ❑ Fire pump. ❑ Installation of 75 KVA or ❑ Emergency system. larger separately derived system. JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E", "1 -2 ", "1-3". r � I OOHP or more. occupancy. Job no.: 1 Job site address: 1 ( � S sW r(x G I- l.1 Q Six or more residential units ❑ Reecaliooa! vehicle parks. � i (7-1 �� ❑ Health -care facilities. ❑ Supply voltage for more than City / State/ZIP: I /� ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt no.: Project name: ' CL) -j ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: " Description I Ore_ 1 Wee 1 Taal 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'l 500 sq. ft. or portion 33.92 1 Tax map /parcel no.: Limited enera, residential 75.00 2 DESC'RIPT'ION OF WORK (with above sq. IL) Limited energy, multi- family 75.00 2 i (� residential (with above sq. ft.) 7hr p.� Services or feeders installation, alteration, and/or relocation 200 amps or less 100.70 2 ❑ PROPERTY OWNER 1 ❑ TENANT 201 ampsto 1 33.56 2 401 amps to 600 amps 20034 2 Name: 601 amps to 1,000 amps 301.04 2 Address: ; 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 m 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 Q CONTACT PERSON above service or feeder fee, 7.42 2 each branch circuit B. Fee for branch circuits without Business name: service or feeder fee, first � �{ blanch circuit 56.18 ij V 2 br Contact name: Each add'I branch circuit 1 7.42 1 51 .19 2 Address: Miscellaneous (service or feeder not included) Each manufactured or modular 67.84 2 Ciryl$tateJZIP: dwelling service and/or feeder Reconnect only 67.84 2 Phone: ( ) Fax: : ( ) Pump or irrigation circle 67 84 I 2 E -mail: Sign or outline lighting 67.84 2 CONTRACTOR - Signal circuit(s) or limited- energy panel, alteration, or extension. Page 2 2 Business name: S E. , .5.. e Le L x , Each additional inspection over allowable in any of the above 1 Address: j O I r &Ln n S iGl2 Q� • S 1 r Additional inspection (1 hr min) 1 6625/ hr J � � j Investigation ([ hr min) 662 hr n City /State /ZIP: l i Q c)< o_.mas r OR 4 Industrial plant (I hr rein) 78.18/ hr Fax (jp ) q j 4 - O' 32 Inspections far which no fees 90.00/ hr Phone: (503) 13401 2-� r Z 3 specifically listed (:4 In min) CCB Lic.:1 Oi 5 ( qo 1 Electrical Lic.: C.I 2 ( Suprv. Lie.: 53,1 S ELECTRICAL PERMIT FEES Subtotal: /0 /u, Suprv. Electrician signature, required: r /��%— Plan review (25% of permit fee): — Print name: sKI A.R k ?R(?&, j 34- Date: 10 J f/ a �- _ State surcharge 02% of permit fee): /a1. 97 J TOTAL PERMIT FEE: AP,/ ,/ . O p Authorized signature: X�y�� This permit application expires if a permit is not obtained within 180 �J x days after it has been accepted as complete. Print name: Date: • Number of inspections allowed per permit. t:ttuitding \PermiiL CC- PaestApp.doe 07.'01/10 440.4615T(11i05/COx.IWEa