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Permit ,-CITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC2003 -00369 • iii DEVELOPMENT SERVICES DATE ISSUED: 8/4/03 ,.� II 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S 102 CC- 00500. SITE ADDRESS: 13500 SW PACIFIC HWY 17 OLD CNTRY SUBDIVISION: BUF ZONING: C -G BLOCK: LOT : JURISDICTION: TIG Project Description: Electrical work associated with remodel of dining & buffet area. Limited energy is for intercom /paging system. Job No. 10312 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: 1 MANF HM/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10): SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS 0 - 200 amp: 1 W /SERVICE OR FEEDER: 27 PER INSPECTION: 201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR: 401 - 600 amp: EA ADD'L BRNCH CIRC: 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: OCB RESTAURANT CO. NORTHWEST ELECTRICAL SPECIALT 1460 BUFFET WAY ROYAL EDWARD STEARNS II • EAGAN, MN 55121 2130 NE GRIFFIN OAKS #200 HILLSBORO, OR 97124 Phone: 651 - 365 -2142 Phone: 844 -4788 Reg #: SUP 4622S LIC 121328 • FEES ELE 34 -450C Description Date Amount Required Inspections [ELPRMT] ELC Permit 8/4/03 ,$381.70 [ELPLCK] ELC Pln Rev . 8/4/03 $95.43 Ceiling Cover [TAX] 8% State Tax 8/4/03 $30.54 Wall Cover Low Voltage Inspection Total $507.67 Elect'I Service Elect'I Final This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more th. • e . . ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in % R 952 - 001 -• i 0 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699 or 1 -80' 32 -2344. / Iss ed By: a , 2,Id � / // � /� Permit Signature:. / // OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale, lease, or rent. OWNER'S SIGNATURE: DATE: CONTRACTOR INSTALLATIO ONLY SIGNATURE OF SUPR. ELEC'N: DATE: LICENSE NO: Call 639 -4175 by 7:00pm for an inspection the next business day _ r • 004 Electrical ernittApphcati urt ►ca: , 0\1.1' >l i �y of Tigard . — —o r Addttas: I3I2S SW Hall Blvd, � '`` 9 My of 7�gurd Phone: (S03) 6 39 -oI7l d ' mod 97223 - >bm issued: Fax: (S03) 598 B>�$.ceipc no.; • Land use approval: 1 PE 0I• P1 O I& 2 family dwelling Or accessory p O New coeatrpadoe 0 aMQla -family 0 malt improvement o JO(; SI11: 14\101.01.1110N ' Subdivision: - ' Bldg. no.: Suite no.: Tax ... lot/aceount . �ilf ' ?3�►:'. ,�:, ► j .lji1.. - W and load 4 Estimated date of completion/ �� ' On ofworlc on Prerlusb: , 1L� { OFD/ CO \'7 RAC! Olt 1 P1'LIC:1I ION Job not . ./ /_ FIE .sell r.0 r i Business flute: , ; ^ ' - g g0r, - 64n i s�ao>suu NIREMIR v �� state: Ws �:9 ?iF per Sv 41 :g ceya ne_ R. s8 Eta. bus. lie. no: a Cl metro li • • — 'Sa, sop so. it or 11.11.111111111111.11111 Q1'! .. a.... L—...mtic._ — —',_, ..... _ tMio711■..— aab ... -- ..,,,;�, _ >eee or �� sa, 11111111111. u ems8 Roz 40 1. sup. dem name (0 Pk01'EWI 101% n'ER alreratl,.� � i , Name (> t):F..L./ .... cal - .� 21 .... Appe 1 • . , ,_ - 0s� 1000 • . ot volt: Mir© �r mom which is not breaded installation is being made on property I own ra�ontrae kttet _��4 rCnT, Or �tc,)>wago g p rea,.ht,imillilbill oS 44f. ass, 49 6 /0. 7oI. ms's , ,•" D _ � . . a Brach einnelte-oewtalterntion, • �i ✓ r A. rce for hood di ,r menage of ergv , � y, ' z - . y . _ B. no for or ra 1 � 1=1,-.±,- a L -nail: •� I 1'L Rr \'II. \1' (1'Icacc el►eck Lift llui( .I ►� 2 O Stoic over 22! elel 0 Anl4 , �P , M•se . (Senlceorteiaermtlneln�k _r o Strrice'over 320 of 1&2 a to > 11111111111111 Each 4 ar CUM= Wang 111.1.111101111110110 I 0 SYgero ow 600 vote nonnnel roan noidnand dohs in 004 strutene &make,. or extension . Feeders. X00 imps a room r �� r Dom' 0 der. _ _ _ meahos > atble pp of Abort. _ Off Noc�p er Oviso �a aea�ie l mec.uiva.dledo.lbrmae . application fee Re>trremu , app if a permit b not obt Plan review (at _ 39 S r N.= •r Cans p1•wo m oedq and � � Within 180 days niter it bag hers Stan sarC1>arge <8° o /) S accepted as complete. TOTAL ._.,, - .. i ua I Mo Hers (&00 ne9 : 1 ' i l/l 'd�80L0' NMI £OOZ 'ti '911V' 07/29/2003 11:43 FAX el 003 • ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES: Complete Fee Schedule Below: T YPE OF WORK INVOLVED - RESIDENTIAL ONLY Restricted Energy Fee $75.00 Number of Inspections per permit allowed (FOR ALL SYSTEMS) Service included: Items Cost Total y Check Type of Work Involved: Residential - per unit ' 1000 sq. R or less $145.15 4 ❑ Audio and Stereo Systems` Each additional 500 sq. FL or portion thereof $33.40 1 ❑ Burglar Alarm Limited Energy 575.00. Each Manurd Home or Modular 1:1 Garage Door Opener' Dwelling Service or Feeder $90.90 2 Services or Feeders ❑ Healing, Ventilation and Ab Condklorilng System' _... . InstaAatlon,,alteratlon. or reloraton _ -- .._... _ =..------- 21 :Vamp s o r.le t� :.. . ..- / • - •$a0.30 • • � . - / 2 - 4.,...4.:,.:71:2.... .. • V . . 201 amps l0 400 amps $106.85 2 ❑ 401 amps to 600 amps $160.60 2 El amps to 1000 amps $240.60 2 Other - Over 1000 amps or volts $454.65 2 Reconnect only $66.85 2 • • Temporary Services or Feeders O TYPE OF WORK INVOLVED - COMMERCIAL ONLY Installation, alteration, or relocation Fee for each system__ $75.00 200 amps or less $66.85 2 (SEE OAR 918 -260 -260) 201 amps to 400 amps 1100.30 2 401 amps to 600 amps $133.75 2 Check Type of Work Involved: Over 600 amps to 1000 volts. ❑ see "b" above. Audio and Stereo Systems Branch Circuits El Bob, Controls New. alteration or extension per panel a) The fee for branch drub ' with purchase of service or ❑ Clock Systems feeder fee • Each branch cirwlt • Al $6 179' s 2 ❑ Data Telecommunication Installation b) The fee for branch circuit • without purchase of service ❑ Flre Alarm Installation branch or feeder fee. � First bran circuit / $46.85 / 6 .85 - T FAA HVAC �Ap�ING � y Each additional branch circuit $6.65 lijrf5 a me C li'E��+fl Miscellaneous ❑ Instrumentation . (Service or feeder not Included) Each pump or irrigation dicta $53.40 cid and aging Systems any 1.00k-Jr— SE✓N�o6 Each sign ul outline lighting • $53.90 �_ Wow 119 DI Nolc, !. Tw E& Le -coil a Signal dreuit(s) or a limited energy 7 Lands Irrigation Control' //ilG S ysram) panel, alteration or extension' I $75.00 El rd9a -rive EXIST Minor Labels (10) $125.00 . Each additional inspection over ❑ . Medical the allowable In any of the above Per Inspection $62.50 ❑ Nurse Calls Per hour $62.50 In Plant $73.75 • ❑ Outdoor Landscape Lighting` Fees: ❑ Protective Signaling Enter total of above fees $ n Other 8% State Surcharge $ Number of Systems 25% Plan Review Fee - • See 'Plan Review' section on $ No ticerxs - am required. Licenses are required for all other installations . front of application. es: Total Balance Due $ _ • E er • -1 o above fees $ ❑ Trust Account # 8 . State Su harge $ All New Commercial Buildings require 2 s s is of plan - Total Bala e Due $ i :\dsts\forms\elc- fees.doc 02/05/02 .............„:,77 07/29/2003 11:43 FAX 0 004 O CB HOMETo U 7V BUFFET 4 e' _‘, Old Country Buffet RES1'ALIJ RANT CO ..,i ROADI -LOUSE ii LL. D E V E L O P M E N T 1460 Buffet Way, Eagan, Minnesota 55121 (651) 365 -2142 FAX (651) 365 -2864 Date: 6/26/03 Fax To: Brian Blalock - City of Tigard Building Services From: Valerie Belmonte Project: HomeTown Buffet- 13500 SW Pacific Highway Re: Plumbing & Electrical Clarifications Fax: 503/624 -3681 Phone: 503/639 -4171 x 2436 Pages: 5 (including cover) CC: Comments: Please call me (651/365 -2142) as soon as possible if your reviewers require additional information. Please note that, si the work piste . the Electrical section) being done is so minor I VAC nd ntercom, I as not sure if we would be charged the $75.00 fee or not. you so much for your help. v ti4 4 .4 Val Belmonte 07/29/2003 11:42 FAX R16102 Electrical Permit Application OFFICE USE ONLY Date received: Permit no.: ; '�' -,i City of Tigard Project/app . no.: Expire date: City of Tigard Address: 13125 5W Hall Blvd Tigard, OR. 97223 Date issued: By: Receipt no.: Phone: (503) 639 -4171 Fax: (503) 598 -1960 Case file no.: Payment type: Land use approval: TYPE OF PERMIT _ 0 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi-family 0 Tenant improvement 0 New construction = • ddition/alteration/replacetnent 0 Other: _0 Partial .NOR SITE INFORMATION )... - . , .. . - . ,_.. - — . . ' - lotrccount -no lob addic- s:' - — / 1/l� �'}! •�i/RaHVIl Bldg. nll.: Suite no.: Tait titap /fair.: A Lot: Block: Subdivision: #�`�� Project nam , w 1- •■ -(9W x .47 - � �' - sescripti. and location of work on premises: ' &v1��— OFr)/N�o /N Estimated date of completion/inspection: c9� CO CONTRACTOR APPLICATION _ FEE SCIIEDLLE Job no: Fee Description A Diption Qty. (es) Total no. leap Business name: l�J Y GT New residedbi- >�aeormuld- faelityper Address: T dnettiagtmll .r■ctodeastfachedpnge. City: [State: I ZIP: Sery celadeded: Phone: I Fax: 1E-Mail: _ 1000 sq. ft or less 4 Each additional 500 sq. ft. or portion thereof CCB no.: 'Elec. bus. lie. no: Limited law,D, residential 2 City/metro lie. no.: Limited mangy, non-residential 2 Each manufactured borne or modular dwelling Signature of supervising electrician (required) Date Service and/or feeder . 2 Sup. elect. name (print): License no: Serricesorfeeden— iaslalladLicense alt erati o e or reloatloa PROPERTY OWNER 200 amps or less I Y0.. HOW 2 201 amps to 400 amps 2 Name (print): /� / S, / /�/G • 401 amps to 600 amps 2 Mailing address:sO, /N - • : - ✓ dy 601 amps to 1000 amps 2 Ciryj D StateOL Z ' : 97R0'� Over loon amps or volts 2 Phonet�3 4,79/I Fax: I E - mail: Reconnect only 1 Ow ' l lai ion: The installation is being made on property I own ' Temporary services or reedits - which is not intended for sale, lease, rent, or exchange according to Installatron,alteratiortiorreloeatioo: 200 amps or less 2 ORS 447, 455, 479, 670, 701. 201 amps to 400 amps 2 Owner's signature: ' Date: 401 to 600 amps 2 ENGINEER Branch circuits -new, alteratioe, or extension per panel: Name: f c tVc • A. Fee for branch circuits with purchase of . Address:743(',0 10, ate. ° .• .,l/ 76 /5_5" service to feeder fee, each branch circuit A 7 (td P5 /1 2 City 7' ; , , 99ie ' State:ft/NI ZIP: 59/A 4, B. Fee for branch circuits without purchase ' f of service or feeder fey first branch circuit I +f 2 Phont 6 -err/. ` Fat ! 4-7f majl: Each additional branch circuit _ PLAN REVIEW (Please check all that apple) Mist .(Service feeder not Included): ❑ Setvim over 225 amps-commercial 0 Health-care facility . Each pump or irrigation circle 2 ❑ Service over 320 amps -rating of l&2 ❑ Hazardous location Each sign or outline lighting 2 family dwellings O Building over 10,000 square feet four 1� or Signal circuit(s) or a united energy panel, �� i ❑ System over 600 volts nominal more n'sidential units in „ • tendon, or extensions 70j 2 ❑ Icing over three slants ❑Feeders, 400 amps or more ti i s '. ion: / ccupant load over 99 persons ❑ ,, :.u(actured sbuctutes or It i 9 ' additional tsped1on over (be allowable `any if the ab' v e: I ❑ Egress/lighting plan ■Other. Per 'nspection Submit _ sets of pla , with any of tb I . •A Inv -- , gatiop fee , The above are not applicable to , mporary co , 1 : . Other • etmit fee $ Not all jurisdictions actspt aedit nerds, please moll j ' iclion fbr nun in • -lD 1 , T e: This permit ' . plication %) $ O Visa ❑MasterCard p s if a permit is n obla Plan review (at o /o Credit card number: ' ith 180 days alter it en State surcharge (8%) $ E ' tp ' Ccep ; as comp TOTAL $ Name of cardholder as shown on credit card . S 1 Cardholder signanue Am• •nt 440-4615 (6/00/COlvr) CITY OF TIGARD 24 -Hour BUILDING In 'Spectian Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP Received Date Requested 'f - / 5 AM PM BUP Location LSD , Suite MEC Contact Person .,�..12r— Ph ( ) $ PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner LID& cam► Via ' - ELC 3 - a o 347? Footing Foundation ELC Access: Ftg Drain ELR • Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear • Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final PASS PART FAIL PLUMBING Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final PASS PART FAIL MECHANICAL Post & Beam Rough -In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Service Rough -In UG /Slab Low Voltage C / Fire Fire ::; PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. SITE Please call for - inspecti• RE: n Unable to inspect - no access Fire Supply Line ADA Approach/Sidewalk Date Inspe — Other: 40 - Final DO NOT REMOVE this inspection record fro the J i , site. PASS PART FAIL