Permit (8) CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00071
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/28/2011
Parcel: 2S 115BA00102
Jurisdiction: Tigard
Site address: 16200 SW PACIFIC HWY P
Project: McDonald's Subdivision: Lot: 0
Project Description: (1) branch circuit for menu board
Contractor: PRAIRIE ELECTRIC INC Owner: ARCHLAND PROPERTY I LLC •
6000 NE 88TH ST BY DOUBLE K VENTURES INC
VANCOUVER, WA 98665 8255 SW HUNZIKER ST STE 101
TIGARD, OR 97223
PHONE: 800 - 573 -2750 PHONE:
FAX: 360- 573 -9866
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 01/28/2011 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 01/28/2011 $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 0* - 95-0091 You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ■ ' A Permittee Signature: 6r /V ff /WG / (i9
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.
01/28/2011 11:44 FAX 360 573 9866 Prairie Electric Inc. 21001/002
1- g E c F n n
Electrical Permit Application °'"' '' FOR OFFICE USE ONLY
City Ti and JAN 2 8 2011 Received / -, p �m '
`J g Date/B / O� �'`/ PermitNo� .2, /-21 7/
114 n 13125 S W Hall Blvd -, Tigard, OR 97223 � 7ry Plan Review
Phone: 503.7182439 Fax: 503.598.1 A OF TIGr� M Date/By: Other Permit:
.
TIGARb Inspection Line: 503.639 t Date Ready /By: ® See Page 2 for
Internet www.tigard- or.gov BUILDING DIViSI(J Notified/Method: WI Supplemental Information
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Please check all that apply (submit 2 sets of plans w /items checked below):
❑New construction 1�� Addition /alteration /replacem
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition • eth er: where the available Fault current ❑ Marinas mid boatyards.
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-.r. L!' °:'+” °' : PF'r-y..ey; ulir ,9 y - .:. _ °. r ; N ; iii i•...�gii exceeds 10,000 amps at 150 volts or Floating buildings
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• - -� ° - ''` ”' " " ""'"" ""' ""'"" ""'„"" less to ground, or exceeds 14,000 ❑ Commercial-use agricultural
❑ 1- and 2- family dwelling 11 Commercial /industrial ❑ Accessory budding amps for all other installations. buildings.
❑ Multi - family • aster builder ❑ Other: ID Fire pump. ❑ Installation of 75 KVA or
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Job no. $ C Q Job site address: /6�(j��j j� jl�' �`,(� � Six or mo e occupancy.
- - q -�� � ���•777 ❑Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: / - ,i-,..40 ox 17 Z 7 _ -z ❑ Health -care facilities. ❑ Supply voltage for more than
,�J ,/ ❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt- no.: (Project name /t1 4/ „.a ❑ Service or feeder 600 amps or more.
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job site: ” ` l ` 1
Cross street/directions to b i •
J Desc�tion �� Qty � F l Total
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. Ii. or less 168.54 4
Ea. add'l 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
...,gin: :"-• :c:.: : . u:.: - - - 75.00 2
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� �/J Limited energy, multi - family 75.00 2
C /�v/ �(/ /�� � residential (with above sq t3 )
L/ Services or feeders installation, alteration, and /or relocation
200 amps or less 100 70 2
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R '.t . , -r•�: °r r .; A, ! :: 201 amps to 400 amps 133.56 2
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Name: 401 amps to 600 amps 200.34 2
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 5936 I
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 - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
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Business name: Adfr //e �G /� B Fee for branch circuits without
/ bra t Feeder fee, i first 56.18 6 /19 2
Contact name: bra circuit V
MOO ` , Z 2 9 ( 6 2 9 ( 6 / Each a d d ' l 7 2
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Address: /(/ /'-"
miscellaneous (service or feeder not included)
City /State /ZIP: Ve 112'2 1/17EX ' ' g8‘ " Each manufactured or modular 67 84 2
dwelling, service and/or feeder
Phone: ( / e i ) — Z Fax: ' 5 '. 9864 Reconnect only 67.84 2
3 —.74 1 --
Pump or irrigation circle 67.84 2
E -mail: 01 4 /� / /e le /t C A
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, ., 67 B4 2
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or outline
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- ._. . .. . ,�:..._ .: :- ::1.1.1.1. -... _.. Signal circuit(s) or limited-energy
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Business name: /9� 7 p •• panel, alteration, or extension. Page 2 2
/ _ / —f / r' Each additional inspection over allowable in any of the abov
Address: 6, 0,06 /1 /' B Additional inspection (1 hr min) 66.25/ hr
City /State /ZiP: J / C�0 vi/t� //rW 98 6 „ 05 — Investigation (1 hr min) 66.25/ hr
lY� ff�� Industrial plant (1 hr min) 78.18/ hr
Phone:
l!/ ( ) ?.....7 gig) 5 3 9
,�� � ]� � Fax: g 90.00 / hr
1 t w hi h n f i
s cifi li sted / h
ns t o c o ce s
CCB Lic.: Elec Li � b 9 S � , LIC.. { � ::::::::.:.::.:..'::. .:r: �e
Suprv. Electrician signature, required. ` � ' Subtotal: r
/ 9 Plan review (25% of permit fee):
Print name: , // ¢ er d Date: // / / State surcharge (12% of permit fee): f
Authorized signature: //,4 ! TOTAL PERMIT FEE: g9 iff
This permit application expires if a permit is not obtained within 1 0
days after it has been accepte a o tp 1 3 0
Print name: Date: t,�Jy/ /� • Num r F s Ile , 6 � /JL/W` I' \nuitding\Permirs \ELC- PermiiApp doe 07/01/10 440 4615TO 1 /05 /COM/WEB /!W (, � .1 �� f � / � P - le-
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