Permit CITY OF TIGARD ELECTRICAL PERMIT
! 2 COMMUNITY DEVELOPMENT Permit#: ELC2013 00540
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/12/2013
Parcel: 1 S 135DD02700
Jurisdiction: Tigard
Site address: 11963 SW PACIFIC HWY
Project: Falgfel Express Subdivision: METZGER ACRE TRACTS Lot: 28
Project Description: Relocate(4)branch circuits in kitchen
Contractor: ATHENS ELECTRIC INC Owner: TIGARD JOY CINEMA LLC
15917 NW LOGIE TRL BY DAVID EMAMI
HILLSBORO, OR 97124-8152 3380 BARRINGTON DR
WEST LINN, OR 97068
PHONE: 503-647-5823 PHONE:
FAX: 503-647-2531
FEES
Quantity Description Date Amount
4 crt Branch Circuits wo/Purchase 09/12/2013 $78.44
Specifics: Service or Feeder
1 ea 12%State Surcharge- 09/12/2013 $9.41
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $87.85
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 accordai _ • 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. ATTEN a : Oregon la, requir- you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-001'through OAR 952-001 i i:.. Y• m- obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued c t� `�/�%' i/� i Permittee Signature: n
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.
.�°�
, `, Electrical Permit Application 9/.A//5 t 9o/3-a650
3 ti< Washington County, 155 N. 1st AV,Suite 350, o r,r, 1'D.17124,
oREGO� Phone: 503-846-3470,Fax: 503-846-3993, ,
Inspection Requests: 503-846-3699,www.co.wastrriagtpnior2us2r,` _
TYPE OF WORK ' ' L on PLAN REVIEW _�
❑New construction Addition/alteration/replacement ❑ Othe I1 a OFTIGA J Please check all that apply:
BUILDING DNISIO� Service or feeder 400 amps ❑ Hazardous locations
or more where the available❑ Service or feeder 600 amps or more
CATEGRY OF CONSTRUCTION fault current exceeds 1=1 Building over three stories
❑ 1-and 2-family dwelling ,E "Commercial/industrial ❑ Accessory building 10,000 amps at 150 volts or❑ Marinas and boatyards
less to ground,or exceeds
❑ Multi-family ❑ Master builder ❑Other: 14,000 amps for all other ❑ Floating buildings
JOB SITE INFORMATION AND LOCATION installations. ❑ Commercial-use agricultural
buildings
_ ❑ Fire pump
Job no.: Job address: ❑ Installation of 150 KVA or larger
119 63 pR C i��i C. ����/ , w, ❑ Emergency system separately derived system
City/State/ZIP: r /� ❑ Addition of new motor ❑ "A,""E,""I-2,"'1-3"occupancy
I6.AQ.D 02 . load of 100HP or more
Project name: !! ❑ Recreational vehicle parks
Suite/bldg./apt.no.:
}'A L�FEL C, PQe5 , ❑ Six or more residential units ❑ Supply voltage for more than
❑ Health-care facilities 600 volts nominal
Cross street/directions to job site:
FEE SCHEDULE
Description Qty. Fee Total *
Subdivision: I Lot no.: Residential single-or multi-family dwelling unit.
Includes attached garage.
—- -Tax-map/parcel-no. 151_ a7QQ - 1,000-sq.ft. — - - -163:75 q
DESCRIPTION OF WORK . Ea.add'l 500 sq.ft.or portion 46.00
Limited energy,residential 105.00 2
RELDCR I tI' BRANCH CIRCUITS ICU it 11'0,16-4U (with above sq.ft.)
Limited energy,multi-family 105.00 2
residential(with above sq.ft.) _
❑ PROPERTY OWNER" I ❑ TENANT Services or feeders installation,alteration,and/or relocation
200 amps or less 105.00 2
Name:
201 amps to 400 amps 158.00 2
Address: 401 amps to 600 amps 210.00 2
City/State/ZIP: 601 amps to 1,000 amps 315.00 2
Over 1,000 amps or volts 630.00 2
Phone:( ) I Fax:( ) Temporary services or feeders installation,alteration,and/or
relocation
Owner installation:This installation is being made on residential or farm property owned by me or a member of 200 amps or less 105.00 2
my immediate family. This property is not intended for sale,exchange or rent.(ORS 479.540(1)and 479.560(1). 201 amps to 400 amps 158.00 2
Owner signature: Date: 401 amps to 599 amps 210.00 2
❑ APPLICANT I ❑ CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: above service or feeder fee, 9.25
each branch circuit 2
Contact name: B.Fee for branch circuits
Address: without service or feeder Is6,/�
fee,first branch circuit 1 2
City/State/ZIP: Each add'l branch circuit b --9.4 ,'e)
Miscellaneous(service or feeder not included)
Phone:( ) I Fax:( ) Each manufactured or modular
dwelling,service,and/or feeder 111'25 2
,
E-mail:
Reconnect only 105.00 1
CONTRACTOR . Pump or irrigation circle 105.00 2
Business name: F}l H�l� L u:c QlC nu C. Sign or outline lighting 105.00 2
_U Signal circuit(s)or limited-
Address: CJ-J 1 1 N IN LO V l L 1-R.f lL energy panel,alteration,or 105.00
City/State/ZIP: t-(1 L,c5 e OQO O((Z A7 12 4 extension.Describe: 2
Phone:(gyp)) 6(,)7 X823 Fax:( SO'� 6 11-7- 2,53 I Each additional inspection over allowable in any of the above
Per inspection 105.00
E-mail: rws bkowo 0 1401 ,,„„ .ChB lic.no.: /IOU W"I' �//4 Investigation fee(see compliance)
Electrical lic.no.: 34 ji,ci c -7// 15' City or metro lic.: Other:
Supervising electrician ELECTRICAL PERMIT FEES
signature,required: agar S Subtotal `78'.4/4/
Print name: VN '�- Date: a/ %3 Plan review(25°/a of permit fee)
Authorized v State surcharge(12%of permit fee) 9.yW
signature: TOTAL PERMIT FEE 8 7,�s
This permit application expires if a permit is not obtained
Print name: 1 Date: within 180 days after it has been accepted as complete
•Number of inspections allowed per permit. Revision 6/12