Permit `` `,�� I'' a CITY OF TIGARD
ELECTRICAL PERMIT
` a ': COMMUNITY DEVELOPMENT Permit #: ELC2010 00129
T A
IGRD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 03/19/2010
Parcel: 1 S 134BC00300
Jurisdiction: Tigard
Site address: 12240 SW SCHOLLS FERRY RD
Subdivision: Lot: 0
Project: Rite Aid
Project Description: Add /alter (5) branch circuits for new rooftop units.
Owner: FEES
FW OR- GREENWAY TOWN CENTER LLC Quantity Description Date Amount
PO BOX 790830
SAN ANTONIO, TX 78279 5 crt Branch Circuits 03/19/2010 $85.86
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 03/19/2010 $10.30
Electrical
Contractor:
ATLAS ELECTRICAL CONTRACTORS
4403 SE ROETHE RD
MILWAUKIE, OR 96267
PHONE: 503- 659 -2212
FAX: 503 - 659 -4944
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $96.16
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 952-001-0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: v �l Y V �� �� ��n Permittee 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 INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' ` ( 2_Q ,p Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
Mar. 18. 2010 3:28PM Atlas Electrical Contractors Inc No. 7438 P. 1
Electrical Permit Applicatio `, L FOR Of DICE USE ONLY
71 City of Tigard Received Pen»i1No. i(1� '�
13125 SW Hall l Blvd., Tigard, OR 97223 i \ � Date/By: Z�'1I� . COI
g Plan Review Other Pennil:
1 , ' Phone: 503.639.4171 Fax! 503.598.1960 _, Date/By:
T I r,
R Line: 503.639.4175 Date Ready/By: Jurii: tl See Page 2 for
Internet: www,ti and -or. ov �'" '' ''' Notified/Method rental Gtfo
g 6 . ' , ` l G Supplemental rmotio4
. :: ; • . : TYPE 01? . ....k„ . . , ., : .. p Lnx I eTVI W
II New ConStruC(ion ❑ Additionlalteration/replaeement Please check all that apply (submit a sets of plans w /items checked below):
['Service or feeder 4 00 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: `! ' where the available fault current ID Marinas and boatyards.
• ' CATEGORY OF' COINS I tUCCIOi�h' .. exceeds 10,000 amps al 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
0 I- and 2- family dwelling ® Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑Fire pump. ❑ Installstion of 75 KVA or
JOB SITE INFORMATION: AND 'LOCATION Emergency system. larger separately derived system.
❑ Addition of new motor lond of ❑
lob no.; 19097 i Job site address: 12240 SW SCHOLLS FERRY ROAD 10011P or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP; TIGARD, OREGON 97223 [Imam-care facilities. ❑ Supply voltage for more than
❑Hazardous locations. 600 volts nominal,
Suite/bldg. /apt. no.: Project name: RITE AID 5353 ❑ Serviee or feeder 600 amps or more.
FEE SCH
Cross street/directions to job site:
job Drrcnpli0n I Qty. I pee 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
En. add'I 500 sq. R. or portion 33.92 l
Tax map /parcel no.; Limited energy, residential 2
LIE$CRRiPTlON OP WO$YC (with above sq. (1. • 67,84 -
Limited energy, multi family 67 84 2
REMOVE AND REPLACE (5) EXISTING DISCONNECTS WITH NEW residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
DISCONNECTS FOR (5) NEW ROOF TOP UNITS. 200 amps or leas II 1 2
I
❑' PROPERTY 0 !NER. , ° .. ® TENANT amps to 400 amps 133.56 2
Name: RITE AID 115353
401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301,04 2
Address: 12240 SW SCHOLLS FERRY ROAD Over 1,000 amps or volts 552.26 2
City/State/ZIP: TIGARD, OREGON 97223 — Temporary services or feeders installation, alteration, and /or '�
relocation
Phone: ( ) F ax: ( ) 200 amps or Is 59.36 I
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 l0 599 am 168.54 z
Brand] circuits — new, alteration, or extension, per panel
Owner signature: Dale: A. Tee for branch circuits with
_w above service or feeder f ee,
®:A
' .. ... C 7,42 2
each branch circuit
-
Business name; ATLAS ELECTRICAL CONTRACTORS, INC. B. Fee for branch circuits without
service or feeder fee, first 1 56.18 56,18 2
Contact name: TY SHEPERSKY branch circuit .
w Each add'i branch circuit 4 7,42 29.68 2
Address: 4403 SE ROETHE ROAD — Miscellaneous (service or feeder not included) - ,
Each City /State /ZiP: MILWAUKIE, OREGON 97267 dwelling, s a or r feeler 67,84 2
dwelling, service ocelot feeder
Phone: (503) 659 - 2212 Pax: : (503) 659 - 4944 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail:
Sign or outline lighting 67.84 2
CONTRACTOR....
- Signal circuits) or limited- energy
Business name: ATLAS ELECTRICAL CONTRACTORS, INC. ,,,panel, alteration, or extension. Page 2 2
Each additional inspection over allowable In any of the above
Address: 4403 SE ROETHE ROAD Additional inspection (I hr thin) 66.25/ hr
City/State /ZIP: MILWAUKIE, OREGON 97267 Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone; (503) 659.2212 — 1 flax: (503) 659.4944 Inspections for which no fee is 90,00 / hr
-- speciRcally listed ( hr min)
CCB Lic.: 1532 Electrical Lie.: 3 -2C I S pai Lic.: 5009S ELECTRICAL PERMIT.FEES
Suprv. Electrician signature, required; 1 f — Subtotal: 85.86
`� J` _ Plan review o
(25% /o of permit fee)
Print name: TY SHEP RSKY I . 3/18/10 State surcharge (12% of permit fcc): 10.30
I TOTAL PERMIT FEE: 96.16
Authorized signature: -s.1 I Ali This permit application expires Ifa permit Is not obtained within Ia0
days after It has been accepted as Complete.
Print name: TY SHEPERS I Date: 3/18/10 • Number of inspections allowed per penvit.
iAnuildingMermiLaLC- PermitApp.doe 10 /01/09 445 -4615yT /COMAVea