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Permit CITY OF TIGARD ELECTRICAL PERMIT � COMMUNITY DEVELOPMENT Permit #: ELC2011 -00200 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04!15/2011 Parcel: 1 S136DA00700 Jurisdiction: Tigard Site address: 11530 SW PACIFIC HWY Project: King's Buffet Subdivision: Lot: 0 Project Description: TI Contractor: TRINITY ELECTRIC Owner: HI HAT INC 13422 SW 128TH PL 11530 SW PACIFIC HWY TIGARD, OR 97223 PORTLAND, OR 97223 PHONE: 503 - 235 -6481 PHONE: FAX: 503 - 579 -3929 FEES Quantity Description Date Amount 10 crt Branch Circuits wo /Purchase 04/15/2011 $122.96 Specifics: Service or Feeder 1 ea 12% State Surcharge - 04/15/2011 $14.76 Type of Use: COM Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $137.72 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 •:'_ . - 001 -0090. You may ob . 'I • • • e• es or •i - t questions to OUNC by calling 503.232.1987 0 1.800.332.2344. 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 Cl of Tigard Received Permit No.: —' _ , 111111 `J ` � Date/B I � � _, l .m . • 13125 SW Hall Blvd., Tigard, OR ' • t Plan Review • g . Phone: 503.639.4171 Fax: 5I ,•., ' . • . '. t. r Date/By: Other Permit: TI t i A R D Inspection Line: 503.639.4175 '1 O Date Ready/By: Juris: 0 See Page 2 for Internet: www.tigard or.gov P Q\ ��t: Notified/Method: `j Supplemental Information TYPE OF WORK v% IZIV PLAN REVIEW ❑ New construction Addition/alteratio ent Please check all that apply (submit 2 sets of plans w /items checked below): ❑ Demolition ❑Other: ❑ Service or feeder 400 amps or more ❑ Building over three stories. ��� where the available fault current ❑ Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. less to ground, or exceeds 14,000 ❑ Commercial -use agricultural ❑ 1- and 2- family dwelling `Commercial /industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ", Job no.: Job site address: J/, t 30 $ U /, act J: C NW Six or or more residential Recreational �� 0 or more residential units. ❑Recreational vehicle parks. n D ❑ Health -care facilities. ❑ Supply voltage for more than City/State /ZIP: / 1 g c r a O ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: t ❑ Service or feeder 600 amps or more. �Ci �� S D p u f �ef . FEE SCHEDULE Cross street/directions to job site: Description 1 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 145.15 4 Ea. add'l 500 sq. ft. or portion 33.40 1 Tax map /parcel no.: Limited energy, residential 75.00 2 DESCRIPTION OF WORK (with above sq. ft.) 4 Limited energy, multi - family 75.00 2 Lid 4 i-s- and p /uds . residential (with above sq. ft.) �J Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 ❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2 Name: 401 amps to 600 amps 160.60 2 — 601 amps to 1,000 amps 240.60 2 Address: Over 1,000 amps or volts 454.65 2 City/State /ZIP: Temporary services or feeders installation, alteration, and/or relocation Phone: ( ) Fax: ( ) 200 amps or less 66,85 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2 Owner signature: Date: Branch circuits - new, alteration, or extension, r panel A. Fee for branch circuits with ❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 6.65 2 each branch circuit Business name: B. Fee for branch circuits Contact name: without service or feeder fee, I 46.85 2 first branch circuit Address: Each add'l branch circuit tY included) 2 Miscellaneous (service or feeder of ed) City/State /ZIP: Each manufactured or modular dwelling, service and/or feeder 90.90 2 Phone: ( ) Fax: : ( ) Reconnect only 66.85 2 E -mail: Pump or irrigation circle 53.40 2 CONTRACTOR Sign or outline lighting 53.40 2 Signal circuit(s) or limited - Business name: T i'YJ; ,>/ E elyy)c energy panel, alteration, or Address: / 4 5. i v /2 em PL extension. Describe: Page 2 2 City/State /ZIP: T a Yd © R l'7�2 -3 Each additional inspection over allowable in any of the above Q Per inspection 62.50 Phone: (�' ,9/) �. S <(i '/ Fax: (p,3)_ 7 3 p_ Investigation per hour (1 hr min) 62.50 CCB Lie. : '33 Electrical Lic.:3 6�3 G Suprv. Lic.: / Industrial plant per hour 73.75 o / ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: ^ Subtotal: Print name: r /,� (� Date: ,41A Plan review (25% of permit fee): --- �'+r' f �` l State surcharge (12% of permit fee): f, -7Cp Authorized signature: !` ! " / TOTAL PERMIT FEE: /3 • This permit application expires if a permit is not obtained within 180 Print name. 1;2 S - »� Date: 44.0 days after it has been accepted as complete. T7 / • Number of inspections allowed per permit. J:\ Building \Permits\ELC- PermitApp.doc 05/23/06 440- 4615T(11 /05 /COM/WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for all residential systems combined $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* ❑ Burglar Alarm n Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: COMMERCIAL WORK ONLY: Fee for each commercial $75.00 system (SEE OAR 918 - 309 -0000) Check Type of Work Involved: ❑ Audio and Stereo Systems n Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation n HVAC ❑ Instrumentation n Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical n Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I: Building \Pennits\ELC- PermitApp.doc 03/23/06