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Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT t r rt COMMUNITY DEVELOPMENT Permit #: ELR2011 -00246 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/09/2011 . G• Parcel: 1S136AD06000 Jurisdiction: Tigard Site address: 11437 SW PACIFIC HWY Project: Carl's Jr. Restaurant Subdivision: VILLA RIDGE Lot: PTS 1 -2 Project Description: Low voltage for HVAC Contractor: ADVANCED HEATING & AIR CONDITIONING Owner: EJM PROPERTIES INC & 5825 SE FOSTER RD MAVERICK DECATUR GEORGIA LLC PORTLAND, OR 97206 3633 E BROADWAY LONG BEACH, CA 90803 PHONE: 503 - 774 -0161 PHONE: FAX: 503 - 774 -4391 FEES Description Date Amount Specifics: Restricted Energy Permit 12/09/2011 $75.00 12% State Surcharge - Electrical 12/09/2011 $9.00 Type of Use: COM Class of Work: ALT Total Number of Systems: 1 Audio & Stereo: N Boiler Controls: N CCTV: N Clock Systems: N Data & Telecommunications: N Fire Alarm: N HVAC: Y Instrumentation: N Intercom /Paging: N Landscape /Irrigation: N Landscape Lighting: N Medical: N Nurse Calls: N Protective Signal: N Security Alarm: N Other: N 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 a - .r.ance - 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. ATTErTION: Oregon la requi - you to follow the rules adopted by the Oregon Utility Notification Center Thos rul s are set forth in OAR 952- 001 -0011 through OAR 952 -001 0r -0. out obtain a copy of the rule or direct questions to OUNC by calling 503 7 or 41I`d 432.,44:. Issued B ' 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_ City of Tigard Received / I / i Permit No.: a e // " ( 0 ° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review • C : Phone: 503.718.2439 Fax: 503.598.1960 Date /By: Other Permit: TI G A R D Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for Internet: www.tigard- or.gov Notified/Method: Supplemental Information TYPE OF WORK PLAN REVIEW Please check all that apply (submit 2 sets of plans w /items checked below): ❑ New construction ❑ Addition /alteration /replacement ❑ Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition ❑ Other: where the available fault current ❑ Mannas and boatyards CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. less to ground, or exceeds 14,000 t ❑ 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 ", q 100HP or more. occupancy. Job no.: Job site address: t f 37 �.� C , �/ GV 0 Six or more residential units. P ❑ Recreational vehicle parks. City /State /ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than /� ❑ Hazardous locations. 600 volts nominal. Suite /bldg. /apt. no.: Project name: 0A- /G f. f$- ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: Description I Qty. I Fee. I Total 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' 1 500 sq. ft. or portion 33.92 I Tax map /parcel no.: Limited energy, residential 75.00 2 DESCRIPTION OF WORK (with above sq. ft.) /� L energy, multi- family CO Q L / /-2,_ �Q/L 4 --e- residential (with above sq. ft.) 75.00 2 Services or feeders installation, alteration, and /or relocation 200 amps or less 100.70 2 ❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2 Name: 1 C CO ( 401 amps to 600 amps 200.34 2 601 amps to 1,000 amps 301.04 2 Address: Over 1,000 amps or volts 552.26 2 City/State/ZIP: Temporary services or feeders installation, alteration, and /or relocation Phone: ( ) Fax: ( ) 200 amps or less 59.36 1 201 amps to 400 amps 125.08 2 Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits — new, alteration, or extension, per panel Owner signature: Date: A. Fee for branch circuits with ❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee, 7.42 2 each branch circuit Business name: B. Fee for branch circuits without service or feeder fee, first 56.18 2 Contact name: branch circuit Each add'l branch circuit 7.42 2 Address: Miscellaneous (service or feeder not included) City /State /ZIP: Each manufactured or modular 67.84 2 dwelling, service and/or feeder Phone: ( ) Fax: : ( ) Reconnect only 67.84 2 Pump or irrigation circle 67.84 2 E - mail: Sign or outline lighting 67.84 2 CONTRACTOR Signal circuit(s) or limited- energy Business name: AD ✓�}� j € b (4 A-77 � r! " 4 /4/e panel, alteration, or extension. , Page 2 2 _ ` Each additional inspection over allowable in any of the above Address: 5 6,9,5 ., 4.) rr 4. Additional inspection (1 hr min) 66.25/ hr � 47 -,... 4 6 a 9 7 Investigation (1 hr min) 66.25/ hr City /State /ZIP: P yam/ /1 Industrial plant (1 hr min) 78.18 / hr Phone: (b95' ) 774 - 0/z, / ' Fax: ( 5) 77`7 " #/9 / Inspections for which no fee is 90.00 / hr specifically listed (%a hr min) CCB Lic.: q96 , Electrical Lie.: Suprv. Lic.: ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: o Subtotal: Plan review (25% of permit fee): Print name: Date: State surcharge (12% of permit fee): TOTAL PERMIT FEE: Authorized signature: // This permit application expires if a permit is not obtained within 180 Print name: JC Date: days after it has been accepted as complete. Number of allowed per permit. 1:\ Building \'ermits\ELC- PermitApp.doc 07/01/10 440- 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 ❑ 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 ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation 111 F Alarm Installation HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations L\ Building \Permits\ELC- PermitApp.doc 07/01/10