Permit (100) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
1' 2v COMMUNITY DEVELOPMENT Permit#: ELR2019-00024
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/11/2019
TIGARD Parcel: 1 S136DB02600
Jurisdiction: Tigard
Site address: 11201 SW 72ND AVE
Project: McDonald's Subdivision: None Lot: None
Project Description: Audio and stereo system for drive thru.
Contractor: VICTORY SYSTEMS LLC Owner: STEWART/BARI PROPERTIES LLC
2050 BEAVERCREEK RD 101-313 STEWART TRUST
OREGON CITY, OR 97045 BY US BANK
BOX 64142
ST PAUL, MN 55164
PHONE: 503-956-9801 PHONE:
FAX:
FEES
Description Date Amount
Specifics:, Restricted Energy Permit 02/11/2019 $75.00
12%State Surcharge-Electrical 02/11/2019 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio&Stereo: 1 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 $84.00
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 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. Th,se rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a cop be-rules_or direct questions to OUNC by calling 503.232.1987 or 1.8/0.332.2344.
Issued By: Permittee Signature: V
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 FOR OFFICE USE ONLY
r Received
City of Tigard Date/B ' A,Apr
" 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
1 Phone: 503.718.2439 Fax: 503.598.1960 ik Date/B : Related Permit 6:
TIGARD Inspection Line: 503.639.4175 E' �R Ready Date/By: El See Page 2 for
Internet: www.tigard-or.gov RECEI� Notified/Method: Supplemental Information
ELM
TYPEOF WORK cement FEB11 2019 PLAN REVIEW
❑New construction Addition/alteration/rep z
D Please check all that apply(submit 2 sets of plans w/items checked)
ID Demolition ❑ Other: GIT`11
OF T1GAR� ❑Service or feeder 400 amps or more ❑Building over three stories.
DI''vwhere the available fault current 0 Marinas and boatyards.
CATEGORY OF eilikRING exceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑ I-and 2-family dwelling C.4 Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑ Multi-family ❑ Master builder ❑ Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: Job site address: I i2CE Sig 724 Sf 10011P or more. ❑ A 1�' 'I-7'
y �i9rrr�Vd I �7�2 — — occupancy.
City/State/ZIP: ❑Six or more residential units- I a 5"
R 3 0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: ireponai d is 0 Hazardous locations. 0 Supply voltage for more than
0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. I Each I Total
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1.000 sq. Ii-or less 16854 4
Tax map/parcel 4:
Ea.add'1 500 sq ft or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
11-1/411V11
(with above sq.ft.) 75.00 2
1-101L �1I 1 IOvi t kn4 i td�'eY Limited energy,multi-family
residential(with above sq.ft.) I
75-00 2
Renewable Energy 0 See Page 2
❑ PROPERTY OWNER ❑ TENANT '' Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 1(10.70 2
201 amps to 400 amps 133.56 2
Address:
— 401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( ) Fax: ( ) Over 1,000 amps or volts 552.26 2
Temporary services or Iceders installation,alteration,and/or
Email:
relocation
Owner installation: This installation is being made on property that I own which is not 200 amps or less 59.36 I
intended for sale,lease,rent,or exchange,according to ORS 447,449,670.and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
APPLICANT CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee Or branch circuits with
Business name: above service or feeder fee, 7 42 2
--- each branch circuit
Contact name: B-Fee for branch circuits without
Address: sen ice or feeder fee.first 18 2.
56
branch circuit _
City/State/ZIP: Each add'I branch circuit 7 42 2
;Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular 1
2
dwelling,service and/or feeder 67.84
Email: Reconnect only 67.84 2
—
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: We torl iiisteiirs LIC
Sign or outline lighting 67.84 2
�3� �z�der� aspa _3i3 Signal circuit(s)or limited energy
't
Address: panel,alteration,or extension. 0 See Page 2 I 2
,. Each additional inspection over allowable in any of the above
City/State/ZIP: Ora 411 CaliOQ Int45 Additional inspection(I hr min) 66.25/hr
Phone:(563 ) ci56 J q go i Fax:( ) Investigation(I hr min) 90.00/hr
Entail: yg4rraz�se9_lic�? Dniaa�.caf Industrial plant(I hr min)
Inspections
hrons for which no tee is 90.00/hr I
CCB Lie.: itig833 Electrical Lie.: cLE34-0 Suprv. I,ic.: 383/M1 sPecilioally listed(1/2 hr min)
ELECTRICAL PERMIT FEES
Suprv. Electrician signature. required — Subtotal. 15"
Print name: ff IN C13 Date: 2 1 v 1 9 0 Plan Review Required(25%of puma fee).
1 State surcharge(12%of permit fee): 1..c.11-
Authorized signature:
TOTAL PERMIT"FEE: 1
This permit application expires if a permit is not obtained within 1811
Print name: Date: J days after it has been accepted as complete.
* Number of inspections allowed per permit.
I.ABuildingAPermits\ELC_PermitApp_ELR_ERE.doe Rev 06/17/2015 440-4615T111/0s cost A4'GB
Electrical Permit Application—City of Tigard
• `Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLYc' FEE SCHEDULE
Description I Qty. I Each I Total I .
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: s kva or less 100.70 2
5.01 to 15 kva 133.56 2
I Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 I:va:
Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
I Garage Door Opener*
>100 kva(fee in accordance
552.26 2
with OAR 918-309-0040)
Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System*
Each additional kva over 25 7.42 3
Vacuum Systems* >100kva—noadditional charge 0.0 3
Each additional inspection over allowable in any of the above:
1 Other: Each additional inspection is 66.25/hr
charged at an hourly(I hr min)
Inspections for which no fee is 90.00/hr
specifically listed(V hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Subtotal(Enter on Page I):
Fee for each commercial system: $75.00 Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
.15‹
Audio and Stereo Systems
I Boiler Controls
I Clock Systems
I Data Telecommunication Installation
Fire Alarm Installation
1 I HVAC
I Instrumentation
I I Intercom and Paging Systems
Landscape Irrigation Control*
I I Medical
I Nurse Calls
I I Outdoor Landscape Lighting*
I I Protective Signaling
II Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I'\BuildingAPermits AELC_Permit App_ELR_ERE.doe Rev 06/17/2015
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11201 SW 72ND AVE, TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Electrical Limited Energy ELR2019-00024
Inspection Type: Inspector:
198 Low voltage final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor