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Permit CITY OF TIGARD ELECTRICAL PERMIT '• COMMUNITY DEVELOPMENT Permit#: ELC2019-00799 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/07/2019 TIGARD Parcel: 2S102AA00903 Jurisdiction: Tigard Site address: 12090 SW MAIN ST Project: McDonald's Subdivision: PAYLESS SHOPPING CENTER Lot: 4 Project Description: (9)branch circuits for TI: Relocating receptacles. Contractor: ACCESS ELECTRICAL LLC Owner: MCDONALD'S CORP 036/0041 13525 SW FARMINGTON RD BY DOUBLE K VENTURES INC BEAVERTON, OR 97005 8255 SW HUNZIKER ST#101 TIGARD, OR 97223 PHONE: 503-642-4333 PHONE: 425-577-0415 FAX: 503-430-5966 FEES Quantity Description Date Amount 9 crt Branch Circuits wo/Purchase 11/07/2019 $115.54 Specifics: Service or Feeder 1 ea 12%State Surcharge- 11/07/2019 $13.86 Type of Use: COM Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $129.40 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 952-001-0090. Yo obtain a c f-the rules or direct questions to OUNC by calling 50 .232.1987 o>n.800.332.2344. Issued 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 - FOR OFFICE USE ONLY CityofTigard Received g Date/By: 1/ 7 4 Permit#: _ 1 t, a 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review // t=C '.)� [ l Phone: 503.718.2439 Fax: 503.598.1960 ` \J Date/By: Related Pemut#: ffJ�/!7_ .)! TIGARD Inspection Line: 503.639.4175 �w U Ready Date/By: lung: See Page 2 for Internet: www.tigard-or.gov F ��Gp9 A` Notified/Method: upplemental Information TYPE OF WORK-A - . ' PLAN REVIEW ❑New construction g_Addition/alteration/ZIacement Please check all that apply(submit 2 sets of plans w/items checked): 0 Service or feeder 400 amps or more 0 Building over three stories. ❑Demolition ❑Other: where the available fault current 0 Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings. ❑ 1-and 2-family dwelling !S.-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: ❑Fire pump. 0 Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived i- ❑Addition of new motor load of system. Job#: Job site address: l Z©` O !.7 y�/�m 10011P or more. ❑"A", `E","1-2",`1-3", 4 ❑Six or more residential units. occupancy. City/State/ZIP: /� ^� v ( 2Z ❑Health-care facilities. 0 Recreational vehicle parks. Suite/bldg./apt.#: Project name: ,V%s,. Q is. M� ,N 4 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. Tax map/parcel#: 1,000 sq.ft.or less 168.54 4 Ea.add'l 500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential (with above sq.ft.) 75.00 2 C' k nl�Px'S fLC Limited energy,multi-family 75.00 2 i, ,...,G0 L C� t�5 r� , t 14' w �S residential(with above sq.ft.) 1"" F+ v, r+' "^' Renewable Energy 0 See Page 2 ❑ PROPERTY OWNER TENANT Services or feeders installation,alteration,and/or relocation Name: 200 amps or less 100.70 2 Address: 201 amps to 400 amps 133.56 2 401 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 feeders 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 1 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 0 ❑ CONTACT PERSON Branch circuits—new alteration,or extension,per panel APPLICANT �`,� � A.Fee for 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: service or feeder fee,first branch circuit 56.18 5 r ty, 2 City/State/ZIP: Each add'l branch circuit S 7.42 5-1,`'3 2 Miscellaneous(service or feeder not included) Phone:( ) Fax: :( ) Each manufactured or modular 67.84 2 Email: dwelling,service and/or feeder Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name: /CUSS v�1 �-M f/ n w ► ( c Sign or outline lighting 67.84 2 �� '� "" �'��i��•- l� Signal circuit(s)or limited-energy Address: 5 51,3 F w -r.v/\ lia.,6, panel,alteration,or extension. 0 See Page 2 2 City/State/ZIP: �Z,�pti v L,�—�_ 0 9 7 s Each additional al inspection over allowable in2 any of the above JCS �� / Additional inspection(1 hr min) 66.25/hr Phone:(9)2)) UJ4 Z U slS2 Fax:(95) f Q r—,/_ Investigation(1 hr min) 90.00/hr u/ ` J t0 Industrial plant(1 hr min) 78.18/hr Email: Z . ae c esg�le.�Ar i E. • Cr):Z.— l-/f 1L. Inspections for which no fee is 90.00/hr CCB Lie.: 70(1(�1 Electrical Lic.:G I(5 Suprv.Lic.: LI 9 i s specifically listed(/hr min) V L'SELECTRICAL PERMIT FEES Suprv.Electrician signature,required: �—""_ !/' i,S zj f�_ Subtotal: Print name: kLeyjc- ZA IAA 1A4 Date: 1 (I 1 0 Plan Review Required(25%of permit fee): I State surcharge(12%of permit fee): /3,if-4, Authorized signature: TOTAL PERMIT FEE: /��,kQ This permit application expires if a permit is not obtained within 180 Print name: Date: days after it has been accepted as complete. — * Number of inspections allowed per permit. 1:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440.4615T(11/05/COM/WEB