Permit (99) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit#: ELR2019-00025
Date Issued: 02/11/2019
T[ t1.1 D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S102AA00903
Jurisdiction: Tigard
Site address: 12090 SW MAIN ST
Project: McDonald's Subdivision: PAYLESS SHOPPING CENTER Lot: 4
Project Description: Audio and stereo system for drive thru.
Contractor: VICTORY SYSTEMS LLC Owner: MCDONALD'S CORP 036/0041
2050 BEAVERCREEK RD 101-313 BY DOUBLE K VENTURES INC
OREGON CITY, OR 97045 8255 SW HUNZIKER ST#101
TIGARD, OR 97223
PHONE: 503-956-9801 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Restricted Energy Permit 02/11/2019 $75.00
12%State Surcharge-Electrical 02/11/2019 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio&Stereo: 1 Boiler Controls: 0
CCTV: 0 Clock Systems: 0
Data&Telecommunications: 0 Fire Alarm: 0
HVAC: 0 Instrumentation: 0
Intercom/Paging: 0 Landscape/Irrigation: 0
Landscape Lighting: 0 Medical: 0
Nurse Calls: 0 Protective Signal: 0
Security Alarm: 0 Other: 0 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 themes adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain. copy of the rtt-.or direct questions to OUNC by calling 503.232.1987 or 1.80 332.2344.
Issued By: Permittee Signature:
ioOr
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 FOR OFFICE USE ONLY
• City of Tigard Received
ETIII
Date/B , /f 1 i�
13125 SW Hall Blvd.,'I'igard,OR 97223
Phone: 503.718.2439 Fax: 503.598.1960RECERelated Permit 8:
Inspection Line: 503.639.4175 I L i dy Date/By: � El See t age 2 for
TIGARD
® Internet: www.tigard-or.gov FEB ,otified/Method: sf Supplemental Information
TYPE OFWORK EB 1 1 2019 PLAN REVIE\V
❑New construction k2 Addltloll/alteration/rep6affv I Ie ise check all that apply(submit 2 sets of plans sditeins checked):
til I 1 cor TIGARD ❑Service or feeder 400 amps or more ❑Building over three stories.
❑ Demolition ❑ Other: ROI( DING DIVISION where the available tkult current 0 Marinas and boatyards_
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
I-and 2-familydwelling Commercial/industrialless to ground,or exceeds 14,000 0 Commercial-use agricultural
❑ g ❑ Accessory building amps for all other installations, buildings.
❑ Multi-family ❑ Master builder ❑ Other: ❑Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
❑Addition of new motor load of system.
Job 6: Job site address: 12o1/0 SIN M 644 S 1001IPP or more. ❑ A `E 'I ,
City/State/ZIP: `,(iv ri 1 tie 9722.1— ❑Six or more residential units. occupancy.
❑Health-care facilities- 0 Recreational vehicle parks.
Suite/bldg./apt.6: Project name: Meliorat is 0 Hazardous locations. ❑Supply voltage for more than
0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description ! Qiv. I Each I 'total I "
New residential single-or multi-family duelling unit.
Subdivision: Lot 6: Includes attached garage.
1.000 sq. ft.or less 16854 4
Tax map/parcel 6: Ea.add'I 500 sq ft.or portion 33.92 I
DESCRIPTION OF WORK Limited energy,residential 75 00 2
LV 44711 1'- Or ve . . I tp 34if (with above slit)-- — — - --
Lim lied energy.multi-family 75 00
residential(with above sq ft.)
Renewable Energy 0 See Page 2
❑ PROPERTY OWNER E 'TENANT g
Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less I 100 70 2
Address:
201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: —
601 amps to 1,000 amps 301.04 2
Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 f— 2
Temporary services or feeders installation,alteration,and/or ,
Email:
relocation
Owner installation: This installation is being made on property that I own which is not 200 amps or less 50.36 1
intended for sale, lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps I 68 54 2
❑;APPLICANTS CI CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
A Fee fix branch circuits with
Business name: above service or ceder fee, 7 42
each branch circuit
Contact name: It Fee fix branch circuits trlthottt
service or feeder fee,first
Address: 56.18 2
brunch circuit
Each add'I branch circuit 7.42 2
City/State/ZIP:
Nliscellaneous(service or feeder not included)
I gone:( ) Fax: : ( ) Each manulaeutred or modular 67.8-1 2
dssellilne.,service and/or feeder
Email:
Reconnect only 67.84
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: 6:119 315 eM la Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address: 2650 Pettliteu bl iD1 -313 panel,alteration,or extension. 0 See Page 2 1 2
Each additional invection over allowable in anv of the above
City/State/ZIP:: iOf — -
Additional inspection(I hr min) 66.25/hr
Phone:(5 3 ) 115ibbil Fax: ( ) his estitauon(l hr min) 90.00/hr
Email: Industrial plant(I hr min) 78.18/hr
VItibr �., items°,Ilea
.1 Industrial I
Inspections for which no fee Is I
p g specifically listed(% hr min) 90.00/hr
CCB Lic.: liq$ !Ili Electrical Lie.: V 4-34.0 Suprv. Lic.: 383/LOQ p
ELCC7`RICAL:PERMIT FEES
Suprv. Electrician signature,required: — Subtotal 15"-
Print name: A r (y� Date: hi 11 _❑Plan Review Required(25%of permit Ice)_
L Stale surcharge e(12%of permit fee) / -
Authorized signature: NOTAL PERMIT FEE: p!�--
-- , This permit application expires if a permit is not obtained within ISf)
Print name: Date: days alter it has been accepted as complete.
* Number of inspections allowed per permit.
IABuildingA Penn its\ELC_Pennii App_ELR_ERE.doe Rev 06/17/2015 440-4015T(II/05/C051/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLYc FEE SCHEDULE
Description I Qty. I Each I Total I
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less l 00.70 2
5.01 to 15 kva 133.56 2
Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 Icva:
I Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
Garage Door Opener*
>100 kva(fee in accordance
with OAR 918-309-0040) 552.26 2
Heating, Ventilation and Air Conditioning Solar generation systems in excess 01'25 kva:
System*
Each additional kva over 25 7.42 3
Vacuum Systems* >I00 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
Other: Each additional inspection is 66-25/hr
char5cd at an hourly(I hr min)
Inspections for which no lee is 90.00/hr
specifically listed(%hr min) -
COMMERCIAL WORK ONLY:
ELECTRICALPERMITFEES
Subtotal(Enter on Page 1):
Fee for each commercial system: $75.00 * Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
1KAudio and Stereo Systems
I Boiler Controls
I I Clock Systems
I Data Telecommunication Installation
Fire Alarm Installation
HVAC
Instrumentation
I 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
i.ABuilding V Pet mits\ELC_PermitApp_ELR_ERE.doe Rev 06/17/2015
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
12090 SW MAIN ST, TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Electrical Limited Energy ELR2019-00025
Inspection Type: Inspector:
198 Low voltage final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor