Permit CITY OF TIGARD ELECTRICAL PERMIT
• ° s. PERMIT #: ELC2008 - 00595
COMMUNITY DEVELOPMENT DATE ISSUED: 10/21/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 115 BA -00100
SITE ADDRESS: 16200 SW PACIFIC HWY P - - ZONING: C -G
SUBDIVISION: TIGARD TOWNE SQUARE LOT : JURISDICTION: TIG
PROJECT: MC DONALDS
Project Description: (12) branch circuits for new beverage center.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMPIIRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HM/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10):
SERVICE/FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 11 IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
IBJ SCHRODER BANK & TRUST CO ADVANCED ELECTRIC INC
BY ALBERTSONS INC #565 21811 NE 58TH ST
ATTN: CORPORATE ACCTG DEPT VANCOUVER, WA 98682
BOISE, ID 83726
Phone: Contact #: FAX 360 - 254 - 2854
PRI 360 - 254 -6864
FEES
Description Date Amount Reg #: ELE 37 -873C
[ELPRMT] ELC Permit 10/21/2001 $120.00 LIC 117052
[TAX] 12% State Surchar 10/21/2001 $14.40 SUP 3734S
Total $134.40 REQUIRED ITEMS AND REPORTS
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All
work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for
more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in
OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
•
Issued By . Permittee Signature: 5 cam /� C GyfZ
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
, ^ET 21 - 2008(TUE) 08: 50 Advanced Electric (FAX)360 2542854 P. 001 /004
Electrical Permit Application ( �� F U1 2 o f F'ICE USE L}
ON
City of Tigard v ' 1 0 ATd
13125 SW Hall Rivd•, Tigard, OR 9722 '1 eo a �� ' -e
II ('hone: 503.639.4171 Fax: 503.598.1960 c \ Other Permit
• l I li A H 11 inspection Line: 503.639.4175 Cj l44! 1 Y11b' ® See Ptr> c Z Cnr
Internet: www.tigatd- or.gov 0 �'� tlied/Medied: . inrorowllon • ;411V II' rl4.ii,,,L'i,'ifileanaliMINOWE !li!!' 0 ° ;o 1, il;.lI11l ill 4, H II1 .1 i 4 : mismili , 'IWIg IAlhl :,i'il,f10l: `; , ':I '
[) New construction
® Addition/alteration/m.1$ cnt i'Iwtse check all that apply (submit facts of plans w /heirs checked below):
s or
❑ Service or feeder am
pa Demolition gyyp�'' ❑, Other: -�aq p more CI nuildina over tutee stories.
{I O ii " ' Loll � il' I ll' l' lI �I..'lln i 14 ,I' iii I,Ilil'nY�rf l` c:u:eede 10,11 11 amps t current Marinas bu d d imtda,
fault 0
;� )�; �,;, 14 mrtps nt 150 volts or [] Floadn buildings.
1 - 2 dwelling Commercial/industrial rev, to around, or exceeds 14.000 0 Comunetclul.tcte agrlcuhural
❑ y g ❑ Accessory building amps for all other Installations. buildings.
Q Multi - family ❑ Master builder 0 Other: ❑ Fire pump. ❑ Installation of 75 KVA or
�� ����llp�( ii n{ p q u ` a,,x �ny4 a a , a 1 w yIn p l q p� , ❑ Emergency System, r separately derived system.
tMIItJH i III ienti' ,40 01: i 6 tM llignad&�lU h ;iii l� t,-i Y YB
, � � Addition of new motor load of ❑ `a ", `F`, `1.2 ", "1.1 ",
Job no.: I Job site address: 16200 SW Pacific Hwy 100HP or more' nccup•ncy.
0 Six or more residential units. 0 Recreational vehicle parka
City /State/ZIP: Tigard, Or. 97224 D Health -core lacilities, ❑ Supply voltage fbr more than
❑ I lazuntota locations. 600 volts nominal.
Suite/bldg. /apt_ no.: I Project name: Add c ar fig( h j i w f ' ❑ Service or Teder 600 sprits Ur MOT!.
Cross street/directions to job site: SW Pacific Hwy south of Durham Rd , tNiEllg IfRlliflElfEiflUEltEl .1J1`�'l flNIfElEI I Eft la rl144t
J Y t t ch.. I Fee Total •
New residential single- nr multi - family dwelling unit
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ll. or less 145.15 4
Zia. add'l 500 sq. ft. or portion 33.41 1
Tax map /parcel no.:
Limited enetlry, residential
V :�, P ,� � }>�1,l ,i • ` 1311 1�� p(a. n.7°: l s i a i �l i .�,io 111, IV 1(l ill I la ' i+ h' film i,; i ,.11 i, j wllh rhnvr >ul, n,) 75.00 2
Limited energy, multi - family
Add 12 ckts residential (with above so. IL) 75.00 2
Services or feeders installation. alteration, and/or relocation
ANNI fl taµ,�,:; ";;. .._i _ lea i fie l'. i, ,.,l alit ii j 200 1 �s o400 1 0685 2
Name: McDonald's Restaurant CBB # 10928 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: 16200 SW Pacific Hwy Over 1,000 amps or volts 454.65 2
City / State/ZIP: Tigard, Or. 97224 'rcmpurary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 66.85 1 _
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 50') amps 133.75 2
Branch circuits - new. alienation, or extension, per panel
Owner signature: Date: A, Fcc for branch circuits with
PlitE ! , i ' S Aittal 1 i ERRII1 ''i 1 _ , rl l i ; . ' 1 i,i i above service nr feeder fee.
each branch circuit 6.45 2
Business name: 13. Fcc for branch circuits
without service or feeder fcc, 1 46
Contact name: 46.7{5 2 first branch circuit
Address: Each add') branch circuit 11 6.65 73.15 2
Miscellaneous (service or feeder not included)
City / State/ZIP: Each manufactured or modular 90.90 2
dwell in • . service and/or feeder
Phonc: ( ) l Fax: : ( ) Reconnect. only 66.85 2
E -mail: Plmlp nr irrigation circle 53.40 2
gfOfff ff l ' i 69 EM [11i " kfO gN OCONIM iICC MlEflfltilElf{eN1NtO lull l EililfM1 1Nlf Sign or outline lighting 53.40 2
Business name: Advanced Electric Inc
Signal circuit(s) or limited -
energy panel. alteration, or
Address: 21811 NE 58 St. extension. Describe: Page 2 2
City / State/ZIP: Vancouver, Wa. 98682 Each additional inspection over allowable in an of the abuvc
Phone: (360) 254 -6864 I Fax: (360) 254 -2854 Per inspection 62.50
per hour it hr min) 62.50
CCB Lic.: 117052 I Electrical Lie.: 17 -873C Suprv. Lic.: 3734S Industrial plant per hour 73.75
Suprv. Electrician signature, required / 7 S
�IN gi1l1E1(u tE Xaniii .. otal: 120 111101111111111111, 11111.
ubt
Print name: Kenneth H. Munger' Date: 10/21
Plan review (25% of permit tee):
State surchurge (12% of permit fee): 14.40
Authorized signature: TOTAL PERMIT FEE: . 134.40
This permit application expires it a pent& is nut uhtnlned within Istt
Print aurae: same Date: nays alter it bus been ncecpted as cantptete.
• Number of inspeaiona allowed per permit.
1: 11laildingUhvmia `II.C- PermitApp.dut: 05/23/00 4 5Ta l/05,COMnvEa
CITY OF TIGARD ,,
BUILDING DIVISION PERMIT #: ELC2008.00585
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/21/2008
Phone: (503) 639 -4171 W9•1V
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 11/14/2008 TIME: 7:00AM PAGE: 24
SITE ADDRESS: 16200 SW PACIFIC HWY P CLASS OF WORK:
SUBDIVISION: TIGARD 1OWNE SQUARE LOT #: TYPE OF USE:
PROJECT NAME: MCDONALDS
DESCRIPTION: (12) branch circuits for new beverage center.
OWNER: IBJ SCHRODER BANK & TRUST CO, PHONE #:
CONTRACTOR: ADVANCED ELECTRIC INC PHONE #: 360 - 254 -6864
Inspection Request Scheduled For: Date: 11/14/2008 Pour Time:
Code # Inspection Description on�rm # Contact # Message
199 Electrical final 078061 -02 \ S, 30.254 -6864 Y
Corrections /Comments /Instructions:
3 '
-- )w-367L
• A(ZI \c HK 1b
_ 10
1 !.■ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: N V e, L Date: 4 I Phone #: (503) 718- 14'7`b •
CITY OF TIGARD
BUILDING DIVISION PERMIT #:
w= LC2008-00595
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10121/2008
Phone: (503) 639 -4171 ° .*W
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 11/10/2008 TIME: 7 :02AM PAGE: 27
SITE ADDRESS: 16200 SW PACIFIC H1NY P CLASS OF WORK:
SUBDIVISION: TIGARD TOWNE SQUARE LOT #: TYPE OF USE:
PROJECT NAME: MCDONALDS
DESCRIPTION: (12) branch circuits for new beverage center.
OWNER: IBJ SCHRODER BANK & TRUST CO, PHONE #:
CONTRACTOR: ADVANCED ELECTRIC INC PHONE #: 364254 -6864
Inspection Request Scheduled For: Date: 11/10/2008 Pour Time:
Code # Inspection Description - Confirm # Contact # Message
1 99 Electrical final 077846 -02 360 -254 -6864 N
Corrections /Comments /Instructions:
to n01= `de, ggot.0 vi e I
CA LLRE)
2
WS0s- lrvA66- N1 Feld 1I MIA
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ACALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Gm 46 Date: - U Phone #: (503). 718- 1.14