Permit (273) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
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COMMUNITY DEVELOPMENT Permit#: ELR2014-00069
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/20/2014
Parcel: 251 15BA00102
Jurisdiction: Tigard
Site address: 16200 SW PACIFIC HWY P
Project: McDonald's Subdivision: DOVER LANDING Lot: B.WILti
Project Description: Installation of(2)low voltage systems,data for POS&CCTV fur drive-up cameras
Contractor: VICTORY SYSTEMS LLC Owner: ARCHLAND PROPERTY I LLC
2050 BEAVERCREEK RD 101-313 BY DOUBLE K VENTURES INC
OREGON CITY. OR 97045 8255 SW HUNZIKER ST#101
TIGARD. OR 97223
PHONE: 503-956-9801 PHONE
FAX:
FEES
Description Date Amount
Specifics: Restricted Energy Permit 03/20/2014 $150.00
12%Slate Surcharge-Electrical 03/20/2014 518.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 0
Audio&Stereo- 0 Boiler Controls 0
CCTV 0 Clock Systems: 0
Data&Telecommunications: 0 Fire Alarm. 0
HVAC: 0 Instrumentation- 0
Intercom/Paging. 0 Landscape/Irrigation 0
Landscape Lighting: 0 Medical. 0
Nurse Calls. 0 Protective Signal: 0
Security Alarm: 0 Other. 0 Total 5168 00
Other Desc
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 ac -with approved plans. This permit will expire if work is not started within 180 days of Issuance, or it work is suspended for more the 18D
days AT TION. Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR
952-001 010 through OAR 952-001- 411,44--If mayobttain a opy of the rules or direct questions to OUNC by calling 503 232.1 87 or 1 800 2 2344
Iss ed By: � Permittee Signature: . /� --- -_____—
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 i li1 FOR OFFICE USE ONLY
City of Tigard Received v e� / —6�
Date/By: „,4 / / Petmit No.: J
• 13125 SW Hall Blvd.,Tigard,OR'91223 Plan Review
114 ' Phone: 503.718.2439 Fax: 503.598.1960 DateBy: Other Permit: /6_400,4.6)1/fL-' C 66)2
f 1 G A R U Inspection Line: 503.639A175, Date Ready/By: furs: ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑New construction Addition/alteration/replacement
Please check all that apply(submit 1 sets of plans w/items checked below):
❑Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition ❑Other: where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts in ❑Floating buildings.
less to ground,or exceeds 14,000 ❑Commercial-use agricultural
❑ I-and 2-family dwelling , Commercial/industrial ❑Accessory building amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Addition system. larger separately derived system.
❑Adddition of new motor load of ❑"A","E","1-2","1-3",
Job no.: Ee /��Q Job site address: I�2D o 1)k/fie'`�l Ct 414
10011P or more.
0 Six or more residential units. occupancy.
0
Recreational vehicle parks.
City/State/ZIP: '�� 611'22.-3 ❑Health-care facilities ❑Supply voltage for more than
pie t rf ❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name: Me��Ktiid(5 4- ,a f,j ❑Service or feeder 600 amps or more
u FEE SCHEDULE
Cross street/directions to job site: Description I qty. I Fee- I Total 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 energy,residential -
DESCRIPTION OF WORK (with above sq.ft.) 75.00 , . 2
(` 1 11 j�. Limited energy,multi-family 7500 2
l_bw -Whit i: rt2, -1)r Pc (ea ' /trvl erirl S fietii)i euvidt residential(with above sq.ft.) ,
/' Renewable Energy ❑ See Page 2
15Pl s r►re �n LLU 1 (�s Services or feeders installation,alteration,and/or relocation
PROPERTY'OWNER I ❑ TENANT 200 amps or less 100.70 2
201 amps to 400 amps _ 133.56 2
Name: 401 amps to 600 amps 200.34 2
Address: 601 amps to 1,000 amps . 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation,alteration,and/or
Phone:( ) Fax:( ) relocation
200 amps or less 59.36 1
Owner installation:This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 : 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 599 amps 168.54 2
Owner signature: Date: Branch circuits—new,alteration,or extension,per panel
❑ APPLICANT I ❑ CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee,
7.42 2
Business name: each branch circuit
B Fee for branch circuits without
Contact name: service or feeder fee,first
branch circuit 56.18 2
Address: Each add'I branch circuit 7.42 2
City/State/ZIP: Miscellaneous(service or feeder not included)
Each manufactured or modular 67.84 2
Phone:( ) Fax: :( ) dwelling,service and/or feeder
Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name: V e,tO r ) S t-eiM S L L Signal circuit(s)or limited-energy Z See
/ panel,alteration,or extension. Page 2 l 5 C — 2
Address: LU 5C ' f 1 (ti _ 3(; Each additional inspection over allowable in any of the above
r t,` Additional inspection(1 hr min) 66.25/hr
City/State/ZIP: �/I Q b I Tr1 I '��S Investigation(I hr min) 66.25/hr
Phone:(5-(),,3 ) 5 a Fax:( )\,\ iv/i// Industrial plant(1 hr min) 78.18/hr� Inspections for which no fee is
CCB Lic.: 1%813� it'll Electrical Lie.:04.346 +1\` Suprv. I.ic.:SR j? specifically listed('Vi hr min) _ �/ _ __
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: �� Subtotal: /D'� .c`�
Print name: ?A
/�¢ ,-----Plan review(25%of permit fee): ^
f t L el 14 Date: 3120
111/ State surcharge(12%of permit fee): /$.vU -
Authorized signature: TOTAL PERMIT FEE: /(p o°This permit application expires if a permit is not obtained within ISO —
Print name: Date: days after it has been accepted as complete.
• Number of inspections allowed per permit
I:\Building\Permits\ELC_PermitApp_ELR_EREdoe Rev 05/21/2013 440-46151(11/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Fee for all residential systems combined $75.00 Description I Qty. I Fee I Total I •_
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
(1 Audio and Stereo Systems* '
15.01 to 25 kva 200.34 2
111 Burglar Alarm Wind generation systems in excess of 25 kva:
25.01 to 50 kva 301.04 2
❑ Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance with 552.26 2
❑ Heating,Ventilation and Air Conditioning OAR 918-309-0040)
System* Solar generation systems in excess of 25 kva:
Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva—no additional charge 0.0 3
❑ Each additional inspection over allowable in any of the above:
Other: Each additional inspection is
66.25/hr 1
charged at an hourly(I hr min) _
Inspections for which no fee is 90.00/hr
specifically listed('A hr min) _
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system $75.00 Subtotal:
(SEE OAR 918-309-0000) Plan review,if required(25%of permit fee):
State surcharge(12%of permit fee):
Check Type of Work Involved: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
❑ Audio and Stereo Systems days after it has been accepted as complete.
• Number of inspections allowed per permit.
❑ Boiler Controls
❑ Clock Systems
Data Telecommunication Installation
I-1 Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
n Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
Other_ten/
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I,Bwlding'.PermitrFl.C_PermitApp_ELR ERE doe Rev 05121(2013