Permit CITY OF TIGARD ELECTRICAL PERMIT
Permit#: ELC2013-00686
COMMUNITY DEVELOPMENT Date Issued: 11/14/2013
.TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 2S112DD01300
Jurisdiction: Tigard
Site address: 15650 SW UPPER BOONES FERRY RD
Project: Burgerville Subdivision: 1994-006 PARTITION PLAT Lot: 2
Project Description: (1)branch circuit for new grease system
Contractor: OREGON ELECTRIC GROUP Owner: RYAN, JOANNE C&
1709 SE 3RD AVE CHARTER PROPERTIES III LLC
PORTLAND, OR 97124 BY BOB L SMITH
280 LIBERTY ST SE#300
SALEM, OR 97301
PHONE:
PHONE: 503-234-9900
FAX: 503-234-1001
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 11/14/2013 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 11/14/2013 $6.74
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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 952- 1-0090. You m y obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: • Permittee Signature: IAJ l9—",C./e.¢77Oh/
L•"
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.
Electrical Permit Application ...
-c-INVO . .._.... ... .. .
Etilt:141.-ITIC,li:,'111SE ON! •
■ . : - —' City of Tigard RecLived //47/11 ,VEM Permit Nom',
13125 SW Hall Blvd.,'Tigard,OR 9 - 3 IP)alaitein3Rev:iew
'''.'-1-- " •'-- Phone: 503.718.2439 Fax: 503.598.1960
III
Other Permit:
i 6,.A.aj,) Inspection Line: 503.639.4175 01 1 1 1-Ci\'1 Date ReadyiBy: funs. 0 See Page 2 for
Internet: wwwitgard-orgov 1,11 1) Notified/Method: it Supplemental Information
rif IXCI t%17t1A
......-:::::',..:-; -:-.:".---.'..-:::..-...:::.•=::•::::-..:1-. .:::::tyPEPF.j.!4,.cti:V.i:T.,--.., :-',.--.,1-15vr4 -----2.--..':---.... : -:-._'..- ::--.--.-,..:--: -.::-.2.::-..--,-:5-_-:-:04W'REVIEVV'.•.:.:-:-.-:.1:-:-'•• --;•- :-;•i•-1
ON
0 New construction Please check all that apply(submit 2 sets of plans whims checked below):
El Addition/alteratiotlitvOCAt
0 Demolition 0 Other: la 0 Service or feeder 400 amps or more 0 Building over three stories
V .
where the available fault current 0 Marinas and boatyards.
.--...'...,-1,:-., ..::: .i 'CATEGORli,"OF. CONSTRUCTION ;•"-....,..•... • -..,. •-..,. :.- ..;•:. :...;, exceeds 10,000 amps at 150 volts or CI Floating buildings.
......—........ less to groun d.or exceeds 14.000 0 Commemial-mse agricultural
0 1-and 2-family dwelling El Commercial/industrial 0 Accessory building amps for all other installations. buildings.
El Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 75 KVA or
. 0 Emergency system. larger separately derived system.
. ..; .. . ....: ' ., ; JOB SITE INFORMATION AND LOCATION .,. :,. ; .' ' . :, 0 Addition or new motor load of
Job no.:86107 Job site address: 15650 SW Upper Boones Ferry I 001-IP or more. occupancy.
0 Six or more residential units. 0 Recreational vehicle parks.
City/StateiZIP:Lake Oswego,OR 97035 0 I lualth-carc iheilitics 0 Supply voltage for more than
0 Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name: Burgerville 0 Service or feeder 600 amps or more.
FEE SCJfEDULE
Cross street/directions to job site: Deieripuan 1 Qw. 1 Fee. l Total [ t
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq.ft.or less _ . . .r168.54 4
Fa.add'l 500 sq.It.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
PROVIDE POWER FOR NEW GREASE SYSTEM. residential(with above sq.ft.)
Services or feeders installation,alteration,and/or relocation
200 amps or less 100.70 7
...:.:.:..0 PROPERTY 00/NER::.,... 0 TENANT::.- :, ;.. ,-•.-..: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name:BURGERVILLE,USA
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
Phone:( ) Fax:( ) 200 amps or less 59.36 _ I
201 amps to 400 amps 125.08 2
Owner installation:This installation is being made on property that I own which is not to 599 amps 168.54 -
2
intended for sale,lease,rent,or exchange,according to ORS 44'7.449.670.and 701. 401 amps
Branch circuits—new,alteration,or extension,per panel
Owner signature: Date: A.Fee for branch circuits with
• -, '.-- CI.APPLICANT- - -:..' :-.-;--riss,,s,.:..:JD,coNTAc,t.,4*.its-oN:-:,...:, above service or realer fee.. .r 7.42 2
each branch circuit
Business name: B.Fee for branch circuits without ,
service or harder lee.first 1 56.
56.1S 18 2
Contact name:RICH LADD branch circuit
Each add'I branch circuit. 1.47 -,
-
Address: Miscellaneous(service or feeder not included)
Each manufactured or modular
City/State/ZIP. dwelling,service and/or feeder 67.84
Phone:(503)535-2660 Fax: :( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E-mail: Sign or outline lighting 67.84 2
CONTRACTOR -. "-':•1-- -:- Signal eircuit(s)or limited-energy
•
panel,alteration,or extension. Page 2 i
-
Business name:OREGON ELECTRIC CONSTRUCTION,INC
Each additional inspection over allowable in any of the above
Address: 1709 SE 3"AVE . Additional inspection(1 br min) 66.25/hr .., —
Investigation(1 hr min) 66.25/hr
City/State/ZIP:PORTLAND,OR 97214
Industrial plant(1 hr min) 78.18/hr
Phone:(503)234-9900 Fax:(503)234-1001 inspections for which no tee is
90.00/hr
hr mm)
spixi
C li
I Electrical Lie.: 26-95C Suprv. Lic.: 481 8s , cally listed 'A
V CB Lie.: 203
''•-••. . :":-,-:--RLECTRICAL,PERMIT-FEES,,
Subtotal: 56.18
Suprv. Electrician signature,required:
. _
Plan review(25%of permit fee):
Print name: MARK WEINBENDER - Date: 11/11/13 State surcharge(12'70 of permit fee): 6.75
TOTAL PERMIT FEE: 62.93
Authorized signature: (7).? 1 0/•----.......—" This permit application expires Perthit is nh-dtlbtained within 180
(_. 0 ' days after it has been accepted as complete.
Print name:14444-K \,‘...)4 /1 o r_c.0.4 4 2 0, Date: 1 1 I l l 1 1---5 • Number of inspections allowed per permit.
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