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Permit CITY OF TIGARD ELECTRICAL PERMIT ° PERMIT #: ELC2007 -00676 COMMUNITY DEVELOPMENT DATE ISSUED: 9/27/2007 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 1S136CD-00102 SITE ADDRESS: 11685 SW PACIFIC HWY ZONING: C - G SUBDIVISION: LOT : JURISDICTION: TIG PROJECT: BAJA FRESH MEXICAN GRILL Project Description: (25) branch circuits for TI RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS 1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION: EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG: LIMITED ENERGY: 401 - 600 amp: SIGNAUPANEL: MANF HM/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10): SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS 0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION: 201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR: 401 - 600 amp: EA ADD'L BRNCH CIRC: 24 IN PLANT: 601 - 1000 amp: PLAN REVIEW SECTION 1000+ amp /volt: >=4 RES UNITS: > 600 VOLT NOMINAL: Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC: Owner: Contractor: WILLIAM & SALLY FLOWBERG MARK ADAMS ELECTRIC INC 834 SW ST CLAIR PO BOX 2748 PORTLAND, OR 97205 CLACKAMAS, OR 97015 Phone: 503 - 225 -0700 Contact #: PRI 503 - 557 -8543 FAX 503 - 557 -8508 FEES Description Date Amount Reg #: ELE C248 [ELPRMT] ELC Permit 9/27/2007 $206.45 LIC 174094 [TAX] 8% State Surcharge 9/27/2007 $16.52 SUP 4810S Total $222.97 REQUIRED ITEMS AND REPORTS 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 one ' 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 t n 180 days. • ENT • : Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 52- 001 -0010 throw ' :52- 001 -0100. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344. last, By: / / �� j 2���� '( j Permittee Signature: x 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 INSTAL ON ONLY SIGNATURE OF SUPR. ELEC'N: ' DATE: F/ LICENSE NO: .W/so 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 Application Q �J / FOR OFFICE. USE ONLY III City of Tigard Date/By: / O 7 v Permit No.: t�/ .9-067 - ° 13125 SW W Hall Blvd., Tigard, OR 97223 Plan Review Other Permit: • Phone: 503.639.4171 Fax: 503.598.1960 Date/By: TI G A R D Inspection Line: 503.639.4175 Date Ready /By: Ions' ® See Page 2 for Internet: www.tigard - or.gov Notified/Method: Supplemental Information TYPE OF WORK PLAN REVIEW El New construction ® Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below): ❑ Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition ❑ Other: 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 ❑ I - and 2- family dwelling E 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 ", "I -2 ", "I -3 ", Job no.: Job site address: 11685 SW Pacific Highway 100HP or more. occupancy. ❑ Six or more residential units. ❑ Recreational vehicle parks. City /State /ZIP: Tigard, Oregon 97223 ❑ Health-care facilities. ❑ Supply voltage for more than ❑ Hazardous locations. 600 volts nominal. Suite /bldg. /apt. no.: Project name: Baja Fresh ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: Description 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 I Tax map /parcel no.: Limited energy, residential DESCRIPTION OF WORK (with above sq. ft.) 75.00 2 Limited energy, multi- family 75.00 2 Remodel existing building into Baja Fresh Restaurant residential (with above sq. ft.) 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 I 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 g A. Fee for branch circuits with ❑ APPLICANT ❑ 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, 1 46.85 46.85 2 first branch circuit Address: Each add'I branch circuit 24 6.65 159.60 2 Miscellaneous (service or feeder not included) 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 Business name: Mark Adams Electric, Inc. Signal circuit(s) or limited - energy panel, alteration, or Address: P.O. Box 2748 extension. Describe: Page 2 2 City /State /ZIP: Clackamas, Or. 97015 Each additional inspection over allowable in any of the above ' Per inspection 62.50 Phone: (503) 557 -8543 q Fax: (503) 557 -8508 Investigation per hour (t hr min) 62.50 C il CCB Lic.: 174094 ill , Electrical Lic.: C248 7 ` Suprv. Li 4810S �d 6 - Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: e____ Subtotal: 206.45 Print name: Mark Adams Date: 9/27/07 Plan review (25% of permit fee): State surcharge (8% of permit fee): 16.52 Authorized signature: TOTAL PERMIT FEE: 222.97 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 t .\ Building \Permits\ELC- PermitApp.doc 05/23/06 4404615T(t t /OS /COWWEB CITY OF TIGARD BUILDING DIVISION PERMIT #: IELC2007.00676 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 912712007 Phone: (503) 639 - 4171 ' i Inspection Requests (24 Hrs.): (503) 639 -4175 `'' � INSPECTION WORKSHEET FOR DATE: 12/4/2007 TIME: 7 :01AM PAGE: 42 SITE ADDRESS: 11685 SW PACIFIC HWY CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: BAJA FRESH MEXICAN GRILL DESCRIPTION: (25) branch circuits for TI OWNER: FLOWBERG, WILLIAM & SALLY PHONE #: 503-226-0700 CONTRACTOR: MARK ADAMS ELECTRIC INC PHONE #: 503 557 - 8E43 Inspection Request Scheduled For: Date: 12/4/2007. Pour Time: Code # Inspection Description Contact # Message 199 Electrical final 060703 -0 971 - 67113094 N Corrections /Comments /Instructions: N \., trsimai_ PAS • ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: G `` '. NtES Date: 11 "II Phone #: (503) 718 - i-.'Lft>• CITY OF TIGARD BUILDING DIVISION PERMIT #: ELC2007- 00676 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/27/2007 Phone: (503) 639 -4171 o ' Inspection Requests (24 Hrs.): (503) 639 -4175 .�' !- F:_.. INSPECTION WORKSHEET FOR DATE: 12./312007 TIME: 7 :00AM PAGE: 16 SITE ADDRESS: 11685 SW PACIFIC HWY • CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: BAJA FRESH MEXICAN GRILL DESCRIPTION: (25) branch circuits for TI OWNER: FLOWBERG, WILLIAM & SALLY PHONE #: 503. 226-0700 CONTRACTOR: MARK ADAMS ELECTRIC INC PHONE #: 503557.8&13 Inspection Request Scheduled For: Date: 12/3/2007 Pour Time: Code # Inspection Description Confirm_ #� Contact # Message ' 199 Electrical final � 060655 -01 503 - 209-6534 Y Corrections /Comments /Instructions: QIN\ ?roJ., Ot rA�(ZovE� `fief IM I � a ' E bot. A Fes , ‘fy c.ibotkil . ❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS y l FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: 6—, NC* Date: 1 3101 Phone #: (503) 718 -1•114 CITY OF TIGARD BUILDING DIVISION PERMIT #: ELC2007 -00676 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/27/2007 Phone: (503) 639 -41711 Inspection Requests (24 Hrs.): (503) 639 -4175 I —. INSPECTION WORKSHEET FOR DATE: 11/20/2007 TIME: 7:00AM PAGE: 12 SITE ADDRESS: 11685 SW PACIFIC HWY CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: BAJA FRESH MEXICAN GRILL DESCRIPTION: (25) branch circuits for TI OWNER: FLOWBERG, WILLIAM & SALLY PHONE #: 503-226 -0700 CONTRACTOR: MARK ADAMS ELECTRIC INC PHONE #: 503557 - 8543 Inspection Request Scheduled For: Date: 11/20/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 130 Ceiling cover 060018 -01 503- 209-5634 N Corrections /Comments /Instructions: o Ff.1.T- Is A 04 1S w lam PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS in ' ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: \ ►645 te Date: /1 ‘101(.) Phone #: (503) 718 -M CITY OF TIGARD BUILDING DIVISION ` �`' PERMIT #: ELC2007.006 ?6 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9177120Q7 Phone: (503) 639 -4171 filth Inspection Requests (24 Hrs.): (503) 639 -4175 e_ .. INSPECTION WORKSHEET FOR DATE: 11/19)2007 TIME: 7:01AM PAGE: 4 SITE ADDRESS: 11685 SW PACIFIC HWY CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: BAJA FRESH MEXICAN GRILL DESCRIPTION: (25) branch circuits for TI OWNER: FLOWBERG, WILLIAM & SALLY PHONE #: 503. 225,0700 CONTRACTOR: MARK ADAMS ELECTRIC INC PHONE #: 503.557 -8543 Inspection Request Scheduled For: Date: 11/1912007 Pour Time: Code # Inspection Description Confirm # Contact # Message 130 Ceiling cover 059931 -01 503 - 209 -5534 N Corrections /Comments /Instructions: ' ‘r‘i )..)r.'1 s %51 11] \ PASS ❑ PARTIAL APPROVAL , CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: uG Date: V tAlial Phone #: (503) 718- _ 14 CITY OF TIGARD BUILDING DIVISION PERMIT #: EL.C2007- 00676 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/27/2007 Phone: (503) 639 -4171 M1' Inspection Requests (24 Hrs.): (503) 639 -4175 . INSPECTION WORKSHEET FOR DATE: 10/22/2007 TIME: 7:00AM PAGE: 27 SITE ADDRESS: 11685 SW PACIFIC HWY CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: BAJA FRESH MEXICAN GRILL DESCRIPTION: (25) branch circuits for TI OWNER: FLOWBERG, WILLIAM & SALLY PHONE #: 503-225-0700 CONTRACTOR: MARK ADAMS ELECTRIC INC PHONE #: 503.557 -8543 Inspection Request Scheduled For: Date: 10/22/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 125 Wall cover \ 058031 -01 503 -209 -5534 N Corrections /Comments /Instructions: \`.. • PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: G' Nr6 V Date: 11 1.1 to Phone #: (503) 718- VILA CITY OF TIGARD BUILDING DIVISION PERMIT #: ELC2007 -00676 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/27/2007 Phone: (503) 639-4171 Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 10/22/200 TIME: 7:00AM PAGE: 26 SITE ADDRESS: 11685 SW PACIFIC HWY CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: BAJA FRESH MEXICAN GRILL DESCRIPTION: (25) branch circuits for TI OWNER: FLOWBERG, WILLIAM & SALLY PHONE #: 5032250700 CONTRACTOR: MARK ADAMS ELECTRIC INC PHONE #: 503-557 -0 Inspection Request Scheduled For: Date: 10/27J2007 Pour Time: Code # Inspection Description Conti m_ # Contact # Message 130 Ceiling cover \ 058031 -02 \ 503. 209`5534 N Corrections /Comments/ Instructions: ilitAckt• 124D s 01\..■6 ❑ PASS % PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ] CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: t � v Date: 1 0 v (n Phone #: (503) 718-