Permit CITY OF T ELECTRICAL PERMIT
9` ' 'a " 1I' I DEVELOPMENT SERVICES PERMIT #: ELC97 -0487
..1 -_.. 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639.4171 DATE ISSUED: 08/22/97
PARCEL: 1S136DB -02600
SITE ADDRESS...:11201 SW 72ND AVE
SUBDIVISION • ZONING:C —G
BLOCK • LOT • JURISDICTION: TIG
Proj ect De scr i pt i on : Electrical permit for a restaurant with drive -thru service.
- -- RESIDENTIAL UNIT - - -- -- -TEMP SRVC /FEEDERS - - -- MISCELLANEOUS
1000 SF OR LESS • 0 0 — 200 amp • 0 PUMP /IRRIGATION • 0
EACH ADD'L 500SF...: 0 201 — 400 amp • 0 SIGN /OUT LINE LTG..: 0
LIMITED ENERGY • 0 401 — 600 amp • 0 SIGNAL /PANEL - 0
MANF. HM/ SVC /FDR..: 0 601 +amps -1000 volts.: 0 MINOR LABEL (10)...: 0
- - -- SERVICE /FEEDER - - -- - - -- BRANCH CIRCUITS -- -ADD'L INSPECTIONS-- -
0 — 200 amp • 4 W /SERVICE OR FEEDER: 93 PER INSPECTION : 0
201 — 400 amp • 0 1st W/O SRVC OR FDR.: 0 PER HOUR : 0
401 — 600 amp • 0 EA ADD'L BRNCH CIRC: 0 IN PLANT • 0
601 — 1000 amp • 1 PLAN REVIEW SECTION
1000+ amp /volt • 0 > =4 RES UNITS • ) 600 VOLT NOMINAL..:
Reconnect only • 0 SVC /FDR >= 225 AMPS..:X CLASS AREA /SPEC OCC.:
Owner: FEES
MCDONALDS CORPORATION type amount by date recpt
5000 SW MEADOWS ROAD, SUITE 230 PRMT $ 0.00 JD 07/18/97 97- 297312
LAKE OSWEGO OR 07035 PLCK $ 0.00 JD 07/18/97 97- 297312
5PCT $ 0.00 B 07/18/97 97- 297312
Phone #: PRMT $ 885.00
Additional fees not shown here
Contractor:
ST JOHNS ELECTRIC INC $ 1150.50 TOTAL
4415 NE MINNEHAHA
REQUIRED INSPECTIONS
VANCOUVER WA 98661 Ceiling Cover Underground Cove
Phone #: 360 - 693 -5100 Wall Cover Elect'l Service
Reg #..: 000431
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Oregon 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 sore than 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by
the Oregon Utility Notification Center. Th. e rules are set forth 'n OAR 952-881-0010 through OAR 952-881 -1987. You say obtain a copy
of these rules or direct questions to c." y calling 503)246 -1". 7 e- -"--
Permittee Signature: `ire ANgitha ' Issued By
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 639 -4175 by 6:00 p.m. for an inspection needed the next business day
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
To 7E 7-23-'11
la 99-T 08-69 -17
Community Development ELECTRICAL PERMIT APPLICATION
� ,�
13125 SW Hall Blvd. I,
Tigard, OR 97223 Permit # r�q1- 0`�7
Ap om Date Issued t �
, I1 Phone (503) 639 -4171 ��_ �g 9<(@"-- 5f
FAX (503) 684 -7297 �G -CS` i /
CITY OF TIGARD TDD No. (503) 684 -2772 0 � L_ / 0-q-(,(3/5•
�-
Inspection (503) 639 -4 J d '00‘-f '00‘-f cj' 7 .moo( c
1. Job Address: I r 7- 4. Complete Fee Schedule Below:
Name of Development ' S r Number of Inspections per per allowed
Address , PiA�.IAt� 4E04 1. $Ll, 12` -Ave , Service included: Items Cost(ea) Sum
t
City /State /Zip T1eritab i Dia 4a. Residential - per unit
1000 sq. ft. or less $110.00 4
Name (or name of business) Each additional 500 sq. ft. or $25 00
portion thereof
Commercial Residential ❑ Limited Energy $25.00 1
Each Manufd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
4b. Services or Feeders
p / Installation, alteration, or relocation
Electrical Contractor ,S 9„,,,,, (',X ,7 -n 200 amps or less # $60.00 ,240, 00 2
Address 5/y / Am yin,, ha.i1n..)/ 201 amps to 400 amps $80.00
401 amps to 600 amps $120.00 2
City �n.r1P nu StateU)X} Zip 9pGto 601 amps to 1000 amps T $180.00 1 2 0 ,ora 2
Phone No. 360 - 6. 93-5/00 Over 1000 amps or volts $340.00 2
Job NO. Reconnect only
$50.00 2
contractor's license NO. 37-3 ne; 4c. Temporary Services or Feeders
Contractor's Board Reg. No. / - Installation, alteration, or relocation
Signature of Supr. Elec'n `'g/��I/ ' 200 amps or less 2
License No. S02 '3
� 5 Phone No. n -6�- 201 amps to 400 amps $50.00 2
401 amps to 600 amps $75.00 2
Over 600 amps to 1000 volts $100.00
2b. For owner installations: See "b" above.
4d. Branch Circuits
Print Owner's Name New, alteration or extension per pane
Address a) The fee for branch circuits with 2
purchase of service or feeder fee.Q
City State Zip Each branch circuit `cf $5.00 //LS, Q0
Phone No. b) The fee for branch circuits without
The installation is being made on property I own which is purchase of service or feeder fee. 2
First branch circuit $35.00 2
not intended for sale, lease or rent. Each additional branch circuit $5.00
Owner's Signature 4e. Miscellaneous
(Service or feeder not included) 2
3. Plan Review section (if required): Each pump or Irrigation circle $40.00 2
Each sign or outline lighting $40.00
Signal circuit(s) or a limited energy 2
Please check appropriate item and enter fee in section 5B. panel, alteration or extension $40.00
4 or more residential units in one structure Minor Labels (10) $100.00
Service and feeder 225 amps or more
/ ` System over 600 volts nominal 4f. Each additional inspection over
Class area or structure containing special occupancy the allowable in any of the above
as described in N.E.C. Chapter 5 Per inspection $35.00
Per hour $55.00
In Plant $55.00
Submit 2 sets of plans with application where any of the above
apply. Not required for temporary construction services. 5. Fees:
5a. Enter total of above fees $ jril. 00
NOTICE 5% Surcharge (.05 X total fees) $ Pi, a5
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $ 9,29 • .2.S
5b. Enter of line A for
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Plan Review if required (Sec.3) $ .221. t5
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal $ /150.50
COMMENCED. word \comdev\eleo- ❑ Trust Account #
$
p.m.VPP
Balance Due $ 1/50.5 !'t