Permit CITY OF TIGARD ELECTRICAL PERMIT
° COMMUNITY DEVELOPMENT Permit #: ELC2009 -00187
T I G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/29/2009
Parcel: 2S102BD01701
Jurisdiction: Tigard
Site address: 12830 SW PACIFIC HWY
Subdivision: Lot: 0
Project: Davidson's Casual Dining
Project Description: Repair panel.
Owner: FEES
DAVIDSON, WILLIAM G & DIXIE L Quantity Description Date Amount
8915 SW COMMERCIAL ST 1 ea Services or Feeders - 200 04/29/2009 $80.30
TIGARD, OR 97223
amps or less
PHONE: 1 ea 12% State Surcharge - 04/29/2009 $9.64
• Electrical
Contractor:
JD MILLER CONSTRUCITON CO
11070 SW ALLEN BLVD
BEAVERTON, OR 97005
PHONE: 503 - 649 -6991
FAX: 503 - 641 -1902
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $89.94
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 • • R 952- 001 -0100. You may obtain a py of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.23 4.
'I 41° ()) C
Issued B nn Permittee Signature: A1\
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.
Sent By: MIKE'S ELECTRIC; 591 7847; Apr -27 -09 7:33; Page 1/2
To: "f'IGARD At: 5035981980 O ^ ^ ��
RECEIVED v)1
Elt;ctrical Permit Application , ruIt orrici.; (:s); 0\1.1
City of Tigard APR 2 Received
g 2009 pate/By: T 27.(9 Pum i Nn.: t(' .CO 0
lig
'e 13125 SW Hall Blvd., Tigard, OR 97223 plan Review
Phone: 503.639.4171 Fax: 503. 'OQF TIGARD Date/By: Ober Permit:
1' I t e\ RI) Inspection Line: 503.639.4175 : Ume Reedy/By. la See Page 2 for
Internet: www,tigard- or BUILDING DIVISION Notified/Method: c) Supplemental Information
TYI OF ❑ N « construction El Addition/alteration/replacement � ta lapply(su i a yi£a w .:. ,. .
Plea check alt sets of plans /itnna checked below):
❑Scrvice or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other:
Demolition where the available fault current ❑ Marinas and boatyards.
exceeds 10.000 amps at 150 volts or El Floating buildings.
less to gnumd, m exceeds 14,000 ❑ Commercial-use agricultural
(71 I • and 2- family dwelling ® Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
0 M ulti- tatnily ❑ Master builder ❑ Other: Claire pump. O lnsdallation of 75 KVA Of
...t i,.,�.,7 i
C :
, f�B.$ � �. "!t�er..._..... 't,72t7111i! �YYC '1�r^. ..�_ '.y "_ ..r: ... :: •
.• ... ,• ., ,.. .. , ' -! , , : . . i, , . ...., anew yste n anger sepa,ale y ere +n .
a ❑ Addition motor load of ❑ °A" °F" - 1.2". " 1 1'
Job n.t•: 25712 Job site address]. 2830 SW Pacific Hwy. 100HPormore. occupancy.
0 Six or more residential emits. ❑ Recreational vehicle parka.
C'i l3 / Liui ' %.I f': ❑ health -care f cilitiw. ❑ Supply voltage for more than
-�_ Tigard i OR 97223
❑ HarnrdOt18 10eatlen5. 600 vglrR nominal.
Suite, bldg. /apt. no.: Project name: El Service or feeder 600 Dae,;riprlo. amps or snore.
SS strect'dil'ectInn j
$ to job she •- ,i. ,,_•�. :,. . T
. .
a M ...
. _ .• an . - Fee
CMS,:
residential single- or multi - family dwelling unit. _ _
Includes attached garage.
Subd vision: Lot no.: 1,000 sq. ft. or less 145.15 4
Dix map /parcel ne.:
•
• �` - -- P.a. add'I 500 sq. ft. or portion 33.40 I
Limited energy,
DESCRIPTION: -OF:. 2
IF; y' S,UO
r3 ytrq['... : ..e.:: .... ..:,: , . . , . ,. Sw above aq. R.)
Limited energy, inulli•ftuuily
Panel repair residential (wits, above aq ft 75. 2
Se�icee or feeders inatellation olteradon, and/or relocation
_.- .. -..- - amps 1 0 30
20 m ps or le 80.30 $ 2
❑PROPERTY OWNER
, . . • . , ?` - 201 amps to 400 amps 106.85 2
N"MC Davidson's Re lest C�cz`�tn.at •OCr„N11% 401 empsto600amps _ 160.GU 2
"" 601 amps to 1,000 amps 240.60 2
Address: 12830 SW Pa ci f Hwy. Over 1,000 amps or volts 454.65 2
City/S rate /ZIP: Tigard . OR 97223 ( Temporary services or feeders installation, alteration, and /or
Phone : ( 503 ) .5 16.5719 J r ( ) z000 a 2 a m ps or less 66.85 I
Owner installation: This installation is being made on property that 1 own which Is Ito( 201 amps to 400 amp 100.30 2
intent ed for sale. lease, rent, or exchange, according to ORS 447, 449, 670, and 701_ 401 amps to 599 amps _ 133.75 2
_
Branch circuits- new, alteration, or extension. per panel
()wile' signature: _ Date: A. Fee for branch circuits with
,C] APPL
..., ,... , ICAfi1T., . ��;, 9►i }'�`� n � -; . above service or feeder fee.
,
: ,._i, t "i ., : ,, , 66. 5 2
each branch circuit
Busin :55 name: B. Fee for branch circuits
without service or feeder fee,
Costa name: t first branch citcuil 46.85 2
Address: ( Each add•I branch circuit 6.65 2
- --° - Miscellaneous (service or feeder not included) _
Cil1• /Slale/ZlP; Each manufactured or modular 90,90 W Z
Phone ( ) Fax:: ( ) i dwelling- service and/or feeder ,. _
_• .� Reconnect only 66.85 . 2
E - mni : Pump or irrigation circle 53.40 2
.... ••. :. - -; ............ : t i .:f -2 ; : A; 41Y.;;;; :;.4, J,. :,.. ,.. Sign or outline lighting 53,40 2
Busin :ss name: JD Miller Construction DBA Mike's Electric Signal circuit(s) or limited -
energy panel, alteration, or
Addrerss: 11070 SW Allen Blvd. extension. Describe: Page 2 2
City/State/ZIP; Beaverton, OR 97005 t Each additional inspection over allowable in any of the above
-
( Pcr inspection 62,50
Phone (503)649.6991 -r Fax: (503) 641.1902 ! lnvesligatlon per hour ti Ito min) 62,30
CCB Lic.: 050209 Electrical Lic.: 34 -18C Suprv. Lie.: 1230S Industrial p lant per hour 73.75
,. n
Supry Electrician signature, required: Subtotal: S0.30
Print i nine: Douglas J. Miller [ Date: 04, 27 .09 Platt review (25% of permit fee):
State surcharge (12 %ofpermit fee): • 9.64
Autho'izcd signature: '
„_ _ .�. • /..g � TOTAL PERMIT FEE: 89.94
Print rum - dir This permit application expires it a permit is out obtained within 180
• ...... Dal days after It has been accepted as complete.
• Number of inspections allowed per permit,
I NDoi Idine'e,miumtI.(•• Pe, ,,h,4pP clew 05'2)/06 440 -401 ST(1 11051COM/WEa