Permit C ITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
PERMIT #: ELR2006 -00189
DEVELOPMENT SERVICES DATE ISSUED: 8/9/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 -639 -4171 PARCEL: 1S136DB -00600
SITE ADDRESS: 11635 SW PACIFIC HWY ZONING: C -
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: Data/Telecommunication.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: X NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: : HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
TYSON, ALFRED J + A + ELECTRICAL SERVICES INC
LARSON, RAYMOND K PO BOX 1270
BY TACO BELL #16600 SCAPPOOSE, OR .97056
LOUISVILLE, KY 40232
Phone: Contact #: PRI 503- 284 -7300
FEES Reg #: ELE C161
LIC 16989
Description Date Amount SUP 3305S
[ELPRMT] ELR Permit 8/9/2006 $75.00
[TAX] 8% State Surcha 8/9/2006 $6.00 REQUIRED ITEMS AND REPORTS
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. 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 more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or direct questions to OUNC at 503 - 246 -6699.
Issued By: ,/ f/� 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'N: DATE:
LICENSE NO:
•
Call 503 -639 -4175 by 7:00 a.m. for an inspection that business day.
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 ADDlicatioIRE I:OR Or FICF IiSF ONLY Ci of Tigard R ea 'I/ Pemat No. ■ A
13125 SW Hall lvd, Tigard, OR 97223 AU G 9 200 Nan Revie "7� 6 _ — A '� . Phone: 503.639.4171 Fax: 503.598.196Q Date • Other Permit:
TI c n i:1)
Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: SS See Page 2 for
Internet: www.tigard- or.gov BUILDING DIVISION Notified/Method , Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction 01 Addition /alteration/replacement Please check all that apply (submit a sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stones.
❑ Demolition ❑ Other: where the available fault aurent ❑ 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 RI Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: OG IO (o 3 Job site address: // 635 /� � 1 Six oP or more. occupancy.
.5 �4CfFi0 1� , — 7 ❑ Six or more residential units. ❑Recreational vehicle parks.
Gin /$tatf/Z)P r(ty�y,p "71.2- ❑Health-care facilities. ID Supply voltage for more than
r r t Oft 3 ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt- no.: Project name: T co 27,15Y..t... ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Ihsarlption I 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'I 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.)
1 Limited energy, multi - family 75.00 2
?DS t 4j'Ae�4DE - Li....) VaLrAt -4 1..0 ',cam, 'To /Y (Ls.) residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
I•AN RoA.s Si 01 .6&i9TEAS 200 amps or less 80.30 2
❑ PROPERTY OWNER I 14 TENANT 201 amps to 400 amps 106.85 2
Name: GD 6E.-.1—t—• 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: ra 1G AS Ago ✓t1- Over 1,000 amps or volts 454.65 2
City/ State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I 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, per panel
A. Fee for branch circuits with
y iti APPLICANT I Pik CONTACT PERSON above service or feeder fee, 6.65 2
Business name: /� ; c� each branch circuit
t/ ELEc-_fx IC.k t_. c�C e t41GE s B. Fee for branch circuits
Contact name: n without service or feeder fee, 46.85 2
t 11 ra' COt�. ?O4 El, first branch circuit
Address: Po 3D / 2.10 Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State/ZIP: S C4P /70SE. f /. 9701-4 Each manufactured or modular 90.90 2
/ dwelling, service and/or feeder
Phone: (5p3 ) 7 3"(_ 7300 Fax: : ($b ) Zu— 42057 Reconnect only 66.85 2
E -mail: (; p. P ,-PLs E(,�IiJc4i. . j3) Z Pump or irrigation circle 53.40 2
� CONTRACTOR Sign or outline lighting 53.40 2
Signal circuit(s) or limited -
Business name: i�t. EGT21i:stt_ CEJLOIGC S energy panel, alteration, or
•
Address: extension. Describe: i Page 2 2
City/ State/ZIP: Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( ) I Fax: _
( ) Investigation per 50
hour ( I hr min) 62.
CCB Lic.: /G 94 p 9 Electrical Lic.: Ci / Suprv. Lic.: 3505-5 Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: - �� ,0 ; Subtotal:
Print name: DAJ 4 Date: r_,...414 Plan review (25% of permit fee):
State surcharge (8% of permit fee):
Authorized signature: TOTAL PERMIT FEE:
Print name: Date: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
• Number of inspections allowed per permit.
I: Building \Pennits\ELC- PermitApp.doc 0523/06 440-4615T(11/05/COM/WFB
4
• f,
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- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
cRi Data Telecommunication Installation
❑ Fire 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
I: Building\PamitAELC- PamitApp.doc 03/23/06
. ,
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2006.00189
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/9/2006
Phone: (503) 639 -4171 / �r�mU�, F' illi
Inspection Requests (24 Hrs.): (503) 639 -4175 ..
INSPECTION WORKSHEET FOR DATE: 8/11/2006 TIME: 7:06AM PAGE: 12
SITE ADDRESS: 11635 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: TACO BELL
DESCRIPTION: Data!Telecommunication.
OWNER: TYSON, ALFRED J +, PHONE #:
CONTRACTOR: A + ELECTRICAL SERVICES INC PHONE #: 503 - 284 -7300
Inspection Request Scheduled For: Date: 8/11/2006 Pour Time:
C 1nsPesti escription Confirm # Contact # Message
199 Electrical final 034836-01 503 - 2847300 Y
`Corrections /Comments /Instructions:
Q
/1 (0
A PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector Date: 4 4 U` do Phone #: (503) 718 - v 1 •