Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
s • COMMUNITY DEVELOPMENT Permit s: ELR2012 -00125
T [GA RD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06118/2012
Parcel: 2S102BD00701
Jurisdiction: Tigard
Site address: 12785 SW PACIFIC HWY
Project: Burgerville Subdivision:RTH TIGARDVILLE ADDITION, AMENC Lot: 8
Project Description: Low Voltage (1) signal circuit for drive -thru communications
Contractor: OHM SYSTEMS LLC Owner: BENNETH, CATHERINE MCNICOL
PO BOX 86833 3830 ROBIN CREEK LN
PORTLAND, OR 97286 WEST LINN, OR 97068
PHONE: 503 -484 -5700 PHONE:
FAX: 503 - 258 -0382
FEES
Description Date Amount
Specifics: Restricted Energy Permit 06/18/2012 $75.00
12% State Surcharge - Electrical 06/18/2012 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: Y Fire Alarm: N
HVAC: N Instrumentation: N
Intercom/Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N Total $84.00
Other Desc: 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 OAR 9 2- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 50 ,, orr1.800.3332.2344 ► 4...
(lL.\ Issued By: Permittee Signature: 4 PPL/
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' Date:
LICENSE NO.
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.
From: chad baldwin Fox: (503) 258 -0382 RECEIVED Fax: +1 (503) 598 -1960 Page 2 of 3 6/18(2012 1:11
Electrical Permit Application �/ "„' i ,,,t ()III, I I '-I 0\1 :1
ill
City of Tigard 18 2012 Received PermitNo.: [a--,o
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.718.2439 Fax: 503.59 $/ A'-
)Z4' TJ?�� B Rt Othhz Permit: ei aID 0 ,
Inspection Line: 503.639.4175 i t� t A
Internet: www.tigardor.gov BUT; � ? � � � ' l, Si3)VLM1014 Da Re M et od: S See Pagel for
Supplemental Information
A
❑ New construction Addition/alteration/replacement Please check all that apply (submit 1 sets of plans w /items checked below):
❑Service or feeder 400 amps or more CI Building over three stories.
❑ Demolition ❑Other
where the available fault ascent ❑ Marinas and boatyards.
::' ` ' i**GORIV .O:i.,. .. ':.:1 ;.. `.,. r i • : :.::. _ = .. exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
ID 1- and 2- family dwelling El ❑ Accessory building less to ground, all other a exceeds ons. ❑ Commercial ngs
❑ Multi-family -tree agricultural amps for all other iastalFetioras. buildings.
Y ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 xvA or
. ; rr. , ❑ Emergency system. larger separately derived system.
"r- - .JOIg: :' . `' ;i:= ❑ Addition of new motor load of ❑ "A ", "E", "I -2 ", "1 -3 ",
Job no.: Job site address: f Z- 7 10014P a more. mmupamy.
� C • �h � ,..y'
❑ Sue or more residential units. ❑ Recreational vehicle parks.
City / State/ZIP: "'r' pr) 0 X l 7 . 3 CI Health-care fac�7itia m th
. ❑ Supply voltage for ore an
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt no.: I Project name: J t r y , h \ 1 L ❑ Service or feeder 600 amps or more.
Cross street/directions to job site: p - :. '. °J m. 6 � •o. .r �/` •
�rionoo I Ow. I � Fee. I � raw I •
New residential single- or mild -family dwelling unit.
_ Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
• Ea. add' 1500 sq. R or portion 33.92 1
Tax map/parcel no.: Limited energy, residential
.. { (with above sq. ft.)
75.00 2
Limited energy, multi - family
1j0■✓ Vo I +, f — ( 'ic -- .0% residential (with above sq. tt) 75.00 2
,,(( Services or feeders Installation alteration, and/or relocation _
Ctl.i✓t-� C '1 V a . S- 200 amps or less 100.70 2
- ,. ,. 'D . -OWE f l .... '. ,, 201 amps to 400 amps 133.56 2
Name: - 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/State/ . Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) f 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 p party that I own which is riot 401 599 amps 1 % 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. _
Branch circuits - new, alteration, or extension, r panel
Owner signature: 1 Date: A. Fee fiat branch circuits with -
' . F l qq . C' f above service or feeder fee,
s each branch circuit 7.42 2
Business name: B. Fee for branch circuits without
service or feeder fee, fust 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
dwelling, service and/or fender
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
E -mail:
Pump or irrigation circle 67.64 2
Sign or outline lighting 67.84 2
Signal t:ircuit(s) or limited-energy
Business name: D L 1 M S s + •- S - . L .. L panel, alteration, or extension. Page 7S 0 2
7 o / Each additional inspection over allowable in any of the above
Address: ?0 9 7� g kp - 3 Additional inspection (I hr min) 6625/ hr
i 0 v 1
n O V 78.18/hr - -
- City/State/ZIP: , -7 2.o / Investigation (I hr min) 66.25/ hr
1 Industrial plant (1 hr min)
Phone: (s63) 481 5700 ` v \ Fax: ($Z 5) z S g o - f2 for which no fee is
�, _ specifically listed eh hr min) 90.00 / hr
CCB Lic.: 16 t; g i 1 Electr Lic.: C LE 6 l Suprv. Lic.: L �;' . ,
Suprv. Electricianlignature, required: 7 -_._- ' lv� Subtotal: 7'S, d
C� ` Plan review (25% of permit fee):
Print name: . ^ Date: &/ t$ I 2., State surcharge (1 fee): 'j --
Authorized si TOTAL PERMIT FEE: $H . Q U
gnature: This rmit application pplication expires if a permit Is net obtained within 180
Print name: I Date: days after It has been accepted as complete.
Number of inspections allowed per permit.
Lh Buiding\PmaiuNELC•PennitApp.doc 07/01/10 440- 4615T(11/0S/COM/WE8
From: shad baldwin Fax: (503) 258 -0382 To: Fax: +1 (503) 598 -1960 Page 1 of 3 6/18/2012 1:11
•
FAX Date: 6/18/2012
Pages including cover sheet: 13
To: From: chad baldwin
ohm systems LLC
P.O. Box 86833
Portland
OR 97286
Phone Phone +1 (503) 484 -5700
Fax Number +1 (503) 598 -1960 Fax Number (503) 258 -0382
NOTE:
Please find the attached low voltage permit application. Please give
me a call with any questions. Thank you.
-Chad Baldwin
(503)484 -5700
•
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