Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00725
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/29/2011
Parcel: 1 S 136CD00100
Jurisdiction: Tigard
Site address: 11701 SW PACIFIC HWY
Project: Arby's Subdivision: 2006 -016 PARTITION PLAT Lot: 3
Project Description: Replace existing gas rooftop unit.
Contractor: ERIC OLSON ELECTRIC COMPANY Owner: PACIFIC CROSSROADS PROPERTIES IN
10013 NE HAZEL DELL AVE PMB 432 BY WYSE INVESTMENT SERVICES CO
VANCOUVER, WA 98685 1501 SW TAYLOR ST STE 100
PORTLAND, OR 97205
PHONE: 360 -609 -4901 PHONE:
FAX: 360 -693 -2980
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 12/29/2011 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 12/29/2011 $6.74
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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 - -2- 001 -0090. You may ob -'. - . : • •ect questions to OUNC by calling 503.232.1987 or 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.
• EilectiriCall Permit ApjaliCatiOn •
li:Olt USE ONLY .
City of Tigard ')I-S`q°) Reuntved
Dateil5v: id/' ; Li 477 P N°
..---. II 13125 $W hall Blvd., Tigard, Oh .
1111
1%\\ Plan Review
' • '`. • Phone: 503,718.2439 Fax: 50S09 • 960 , c, ,... Date/By: Other Permit: nr1 , $1 ( 7
TIGARD IIISPeOlion Lin 503,639.4175 CC, . ' , Dote Ready/13y: furls: 0 See Page 2 for
Internet; WWW.tigurd-Or.goV : - \3°\10V4 Notified/Method, .77-- Supplemental inforinallen
Firftnliiiiikg.14 atMi("*:'":0.21':=1Trakil..*.. ....................................................... , .. !.;4411,,. . " ..T. 7 14NSION f aittig, '-----m 77. 7"754) 5214
0 INivv eoristructiOn 1: - 4ddition/altera6 ' - Meat Please clock all that apply (submit 2 etii of plans w/itcrue cliecked below):
ition El Other: R)‘' El Service ur feeder <100 amps or inore El Building ever Max
0 Demol stories.
where the available fault eurreiu 71 Ivlarinte and boatyards.
7.7r7,7/..,,. ie 4 i-bittegi'iM'AilkW777.712:1t :4l'l; el' exceeds 10,000 ;imps at 150 volts or 0 Floating, buildings,
. '!!'1"1,.:•i''...7 .-.'n.r.:` -' , ...:.' , „,. .T.iir/eKl.....4*,.. ft',E;L:.."l',1.1li•ll;.-1:..:7 •
less to grow id, or exceeds 14,000 0 Commerelul-use agricultural
0 1.- and 2-tamily dwelling 'ommercial/industrial 0 Accessory building amps fora other installations. buildiass,
0 MtlIti•Parnily aster builder El Other: 0 1 palm. El Installraion of 75 KVA or
--'31777.7777.777 .' . ",'',.. ":i.; "' 9l1.2' . ' "K1' ,.` ., \.. - "Wei . . ,,.: , Vr t '5.,:ir ;. 1 - , tw :„. 0 Emergency system, larger eeparately derived syste
e.'4%7Aglil.kvil'0.4 ['Addition dome motor
Job no,: Job site address: / 7i, „•& r 1001 or illure,
1
. 0 Six or more residemi.,41 units. ocouPanoy.
0 Recreational vehicle parks.
- ..
'
Ci ty/State/Z1P! '
n Health-care facilities. 1.3 Slipply voltage for more than
- .. 0 Haz0rdous locatiuns. 000 volts nominal
Suite/bldg./apt. no, Project name: j I j 0 Sorvicc or ibedar 600 amps or more.
7 17Z3;7 - LenTriaN.0:440 77 *:75.bgr p.
Cross street/directions to job site:
Ihacri Idol/
---,
IraMMEZIM 'NW ^
----------- New residential single- or multi-funnily dwelling unit.
____ includes attached garage,
Subdivision:
Lot rio.: 1.000 sq. It or less 168.54 4
----. La, add '1500 sq. ft, or portion 33.92
fax map/parcel no.:
-
1,iinited energy, residential
,`..117,1,27.7F.FL4,~446.0i0W;Afil*If fiWragrri will' above s , ft, 11111 2
Limited energy, multi-family
residential (witti above sq, ft,) 75.00 2
lerviees or feeders installation, alteration, and/or relocation -
—
- _
200 amps or less 100.70 ---
_
'„„ „1:: . ii ? 5h .v,... L . . :,,.! 10 m a ). to 400 a mps 133.56 2
. re*
.ittom..-i tomelit . , • . me.tr .-*..: r, .' Lquetot . '' .. - a mps s
— 1
.401 amps to 600 amps 200,34 2
Name: . . .
1 1 /.... 601 amps to 1,000 amps 301,04 2
_
_.„
Address;
• .' ' ... ' Over 1,000 amps or volts _ 1 552.26 2
_
Temporary services or feeders installation, alteration, and/or
City/Statc/Z1P: • 'Al'.. relocation
V ' ' . —....
Phone: ( ) Fax; ( ) 200 amps or less • 59.36 I
11111 = 125,08 2
Owner installatiOn: This installation is being made on property that I own which 201 amps to 400 amps is not -
t EMMEMIIIIII
intended for sale, lease, rent, or exchange, according according to ORS 447, 449, 670, and 701. 401 amps o 599 amps
ltranch circuits - new. alteration, 2
on, or extension, per panel
Owner signature: Date: 71,7i for branch circuits with
\ iiii iiirrigg43 above service Or feeder fee,
7.42 2
each brunch circuit
-__
Business name: 13. Ceti for branch circuits withoia
service ur feeder fee, first
. ( , 56.18 s 6 2
Contact name: 4 . . 1 ,7. 4 „, , , branch circuit
.. ,iia. '
- •
, Each add' I branch circuit 7.42 2
Address;
Miscellaneous (service or feeder not included)
Each manufactured or modular 67. 84 2
City/State/ZIP:
LvisLigas&e aralr feede ... _ -
P130110; ( ) Fax: ; ( ) Reconnect only 67.84 2
--
Pump or irrigation circle 67.84. 2
E-mail:
, sign or outline lighting 67.84 2
4".t7i.),17..0;11.■:4 0.;.. Si ' • I ' ' I \ I . ' ."
, gnu, cc or ,irnit,...,-energy
_Land. alteration or extension. Page 2 1
-
BusineSS name: 4,4 at ,d1 ,
Each additional inspection over allowable in any of the abov
,
Address' /..7 . i ' i 7 • ' •
25/
....., ,, / Zof . _,, Additional inspection (1 hr nun) 66. hr - —
" lovcstigation (1 hr ITI ill) 66.25/ hr
---
City/State/ZIP; , ,I. .._..
-
sr ■-,,_-:..7.-.... _ ..d"..d.,de J _, ' . 1.(,),1 1 .." industrial plant (I hr min) 78.18/ hr -
Phone: 4,' . ) ...- Fax: ( ..,,, . ... __ Thispitctions for which no fee is
90 hr
.1.4 4, si - air i r ..t. sj2cisificalty listed (1/2 hr mitt) .00/ , ....
. „
CCB Lie,: t s viiisuprv, Lic.: " ' • .!:::.''.;gAlXiArtarillrOACIRAINUVAngai„,.riaett
Subtotal: _g
,
S upr v. Electricia# A , LOrthltlired:
Plan review (25% of permit fee):
-
Print___ Dtt / 04 State surcharge (12% of permit ate): Or
• TOTAL PERMIT FEE! 47 q
. .
Authorized signature; 1
•I.Ss 170'1111f application expires it'll permit is not obtained within LSO
days oriel. it has been accepted as complete.
12:int natr.11_6_61..._,thauL I Date; E2(40
4 ltilinW of inspeetion$ allowed per permit.
lilBeildiankPeriolts\BLC.Petnatiipp.do 07/01/10 4,10-40151(11/05/C0m/wEE
ZO/Z0 3Ed . On1103 NOS OBSZEHOSET TO:TZ TTOZ/LZ/ZT