Permit CITY OF TIGARD ELECTRICAL PERMIT
° COMMUNITY DEVELOPMENT Permit #: ELC2012 00373
T LGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/19/2012
Parcel: 1S 134BC00300
Jurisdiction: Tigard
Site address: 12282 SW SCHOLLS FERRY RD
Project: Boardwalk Burger Subdivision: WINDSOR PLACE Lot: 32
Project Description: (1) service and (8) branch circuits for TI
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Contractor: WELL DONE ELECTRIC Owner: FW OR- GREENWAY TOWN CENTER LLC
17045 SE ROYER RD PO BOX 790830
DAMASCUS, OR 97089 SAN ANTONIO, TX 78279
PHONE: 503 - 209 -4006 PHONE:
FAX: 503 - 558 -1297
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 06/19/2012 $100.70
Specifics: amps or less
8 crt Branch Circuits w /Purchase 06/19/2012 $59.36
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 06/19/2012 $19.21
Electrical
Type of Const:
Occupancy Grp:
Total $179.27
Required Items and Reports (Conditions)
This perm' s issued subj. to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be don in accordance with a— rove. .lans. This permit will expire if work is not started within 180 days of issuance, or if work is sus• - -•ed for more the 180
days. ATTENTION: Oregon law equi : s ou to follow the rules adopted by the Oregon Utility Notification Center. Those nil ' are set forth in OAR
952 1 -0010 thro gh OAR 952-'0 109 ay obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.23 4
Issu By: ��IL� Permittee Signature:
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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' i ��A �� J Date:
LICENSE NO. �/A# y
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.
Electrical Permit Application ioli orrici.: usi; tlNl.Y
City of Tigard DD Received Bp
Permit No.: f ao1a� 6037 ° 13125 SW Hall Blvd., Tigard,OR 97223 Plan Review I� J
G Phone: 503.718.2439 Fax: 503.598.1960 DateBv: Other Permit: o ),04? _00/g0
I' I G A R D Inspection Line: 503.639.4175 Date Ready/By: tuns: la See Page 2 for
Internet: www.tigard or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ 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
❑ 1 - and 2- family dwelling ❑ 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 ", "1 -3 ",
Job no.: Job site address: ®Z 2 � / , S� , I or more. occupancy.
❑ Six Six or or more residential units. ❑Recreational vehicle parks.
City/State /ZIP: �1 0 - ❑ Health -care facilities. ❑ Supply voltage for more than
�' r �1 � ❑ } HHazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: t[!�� / ,,eIl /4L/ j /C JC Je,rrvice 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 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 l
Tax map /parcel no.: Limited energy, residential
75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less / 100.70 a,9. ,T' 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name:
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
n relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7.42 2
each branch circuit 7 51, j
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67.84 2
ty dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail:
Sign or outline lighting 67.84 2
CONTRA OR Signal circuit(s) or limited- energy
Business name: a i9 P �% �� panel, alteration, or extension. Page 2 2
f+ Each additional inspection over allowable in any of the above
Address: ,/,(, '/ /� °' Q� f Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: ��' ' `^'`� / — D / , fr / 7D Investigation (1 hr min) 66.25/ hr
I / . Industrial plant (l hr min) 78.18/ hr
Phone: (,) ^,� ,,' I Fax: ( 33N / 2 - q _ /o/d /8 Inspections for which no fee is 90.00 / hr
specifically listed (V2 hr min)
CCB Lic.: /7 ftiA Electrical Lic.: '; 2-6, Suprv. Lic.:5O2 5 ELECTRICAL PERMIT FEES
c/ 7��fi1/ Subtotal: J "�j
Suprv. Electrician signa , r u red: 1 / _ Plan review (25% of permit fee):
State surcharge (12% of permit fee): .
Print nameo�� V �DOGI( Date:D ,../f.-24" 2__ -- State ( P ) �Q i
i � / TOTAL PERMIT FEE: / '1 9 ..2 7
Authorized signature: This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
Number o inspections allowed per permit.
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Electrical Permit Application - City of Tigard
. Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY: 1
Fee for all residential systems combined ... $75:00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
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❑ 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- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls •
❑ Clock Systems
❑ 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
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