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Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT " ! COMMUNITY DEVELOPMENT Permit #: ELR2010 -00222 ( 13125 SW Hal Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/14/2010 T CARD Parcel: 1 S126CA01100 Jurisdiction: Tigard Site address: 9009 SW HALL BLVD 100 Project: Target Subdivision: Lot: 0 Project Description: Low voltage wiring for HVAC Contractor: AMERICAN HEATING INC Owner: DAYTON HUDSON CORPORATION 1339 SE GIDEON ST BY TARGET CORP T -0345 PORTLAND, OR 97202 PROPERTY TAX DEPT/TPN -0950 PO BOX 9456 MINNEAPOLIS, MN 55440 PHONE: 503 - 239 -4600 PHONE: 612 761 - 1588 FAX: 503 - 239 -7038 FEES Description Date Amount Specifics: Restricted Energy Permit 12/14/2010 $75.00 12% State Surcharge - Electrical 12/14/2010 $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: N Fire Alarm: N HVAC: Y 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 952- 001 -0090. You may ohtain a cosy oft direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By = _�_!! " Permittee Signature: `' / t � C " 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. C E � ,.. , FOR, OFFICG O NLY - _.- ` Electrical Permit Application , n p / � / (Cl r Permtt No.[����j�'l/4�� City of Tigard Receive 711 • 13125 SW Hall Blvd., Tigard, OR 97223 O 2 ®ZQ�O P1an Review OtherPermit:��C,2�f /O ' 00 .517.2_ 1 , Phone: 503.639.4171 Fax: 503.598.1960 that apply (submit 2 sets of plans w /items checked below): Date/By See Page for D Read By: : lurilri Inspection Line: 503. 639.4175 y Supplemental Information 1 "I 'TWA R D CIT OF TIG Notified/Method: Internet: www tlgard or g s " �t i l: -: s ir px t. n . r, -o - 4Z S P R . ° , ;` a ?� r- � � x` 2 -' -.. i 4 ? t L . s 4 s f4 � ' `,e"a .,:i . • •!uy -l 1 :s' ,. .�� _ Wi ,-7:., �. 1 v .... ._...a : "X,'":t- Sz • z . a.-fi+ :,..•', - ¢ w � , -�";- � 1 a _ 0 _._.�. .. �"�� � � Please check all ❑ New construction C Addition /alteration/replacement ❑ Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition ❑ Other: exceeds 10 000 available fault 150 volts or ❑ Floating buildings. boatyards. ❑ ,.r r ,, ly �f l ll t _ : e „ , .T less to ground, a exceeds 0 volts ❑ Commercial-use agricultural ❑ 1 - and 2 - family dwelling C Commercial/industrial ❑ Accessory building amps for all other installations. buildings. ❑ Fire pump. ❑ Installation of 75 KVA or ❑Multi Family El Master builder ❑Other larger separately derived system. ❑ Eme system. . n 4 g:ls ,�, 6 © ' r �'�a . = . ! L N ❑ Addition of new motor load of ❑ "A ••E "1.2 ••1 -3 •s - , 3 • ;8tv.�•�� g Job site address: q 0 0 9 5 W 1-1411 17 V ❑ 100HP or more. occupancy. Six or more residential units. ❑ Recreational vehicle parks. Job no.: ❑Supply voltage for more than ❑ Health -care oc thhes 600 volts nominal. . City/State /ZIP: � q et ref �� 3: ❑ HaTardous loco tons x`..11 2 ❑ Service or feeder 600 amps or more. Suite/bldg. /apt. no.: I Project name: T rq t Q�7 � • - ,t ;`max yes r :i s .t ' hip.,: I: - J ' "�'�"_ `, h Q. Fee Total . • Cross street/directions to job site: • Description New residential single- or multi- family dwelling unit. • Includes attached garage. 1,000 sq. ft. or less 168.54 4 Lot no.: Subdivision: Ea. add'l 500 sq..ft. or portion 33.92 1 Tax map /parcel no residential 67.84 2 Limited energy, g fi r' : zr tN'. � � r ; ,�,r� �, `' , # = � t �, (with above sq. ft.) r € ' 1 r� e 0� f ° ® °6 �' { ' •" Limited energy, multi - family 67.84 2 /O w V O / -/-.- 19 e • 1/ I r i el 1 residential (with above sq. ft.) V V Services or feeders installation, alteration, and/or relocation 200 amps or less 100.70 2 r r r ; ` t 4' 201 amps to 400 amps 133.56 2 ,� , `P IZ, *>r �nf;:.. r : ,... , 200. ;.•rsJ» -, 401 amps to 600 amps 200.34 2 Name: 601 amps to 1,000 amps 301.04 2 Over 1,000 amps or volts 552.26 2 Address: Temporary services or feeders installation, alteration, and /or City/State/ZIP: relocation Phone: ( ) I Fax: ( ) I 59.36 I 200 amps or less 201 amps to 400 amps 125.08 2 Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits - new, alteration, or extension, per panel Date A. Fee for branch circuits with • Owner signature � above service or feeder fee, 2 }a ,, � t •r t 4 ,:, - , � 0s r sS ,� �i ? ` 7.42 t ,s 4 'r. < I ,''' '''''''-'1 e... eac b circuit Business name: / r l e, I ca h H e� - f - ) n B. Fee for branch circuits without service or feeder fee, 56.18 2 Contact name: 8 r , M 11 G A e S e r first branch circuit - l c Each add'I branch circuit 7.42 2 Address: /33 p 5 �(/ ! (J e O ✓1 J Miscellaneous (service or feeder not included) + n d p � 7 2 02 Each manufactured or modular 67.84 2 City/State /ZIP: Pl� r - 1 I G OJ O dwelling, service and/or feeder Phone: ($O?j )231 � • /_ //..,, I Fax : : ( )Z 33../- g Reconnect only 67.84 2 • (� V Pump or irrigation circle 67.84 2 E-mail: , it . t or outline lighting 67.84 2 s name:A ; } .xg�� 'tx 0 ''i1 .. r�' V 4 t an 4: ma �,? '�a.,;i: S ig n ter •Y ... �, _ v , . , e L f. Signal circuit(s) or limited - Business m cr / l/� / + e.4, 7L / � energy panel, alteration, or Page 2 2 i Address: extension. Describe: g /�� 5 E 6O f d e o� s Z O Z Each additional inspection over allowable in an�of the above City/State /ZIP: �� r' f lG!/� O/ ` p / / Per inspection 66.25 G� _ L/ 0 Q (o Fax: (co 3 ) Z3 °1—'7 03 e In vestigation per hour (1 hr mi 66.25 Phone: ($03) 23 I 78 18 3313 5 2 0 993 2 4, Ho LE I plant p hour El ectrical Lic.: LR� I Sup Lic.: er s 6; _ t�' \ __ Subtotal I 7 5 r ail Suprv. Electrician signature, required�� Q''� plan review (25% of permit fee). T S C V Date: I9 State surcharge (12% of permit fee): 1 r U� Print name: e y C7 V '/� 9 0 nc2 �S TOTAL PERMIT FEE: y . irt Authorized signature: 'Re �� f i This permit application expires a permit is not obtained within 180 /l c 4 es./ -ey I Date: /D /4 0 days after it has been f a it as complete. Print name:r9� / V / * Number of inspections allowed per permit. 440-4615T(1 1 /05 /COht/WEB IA BuildingTermits \E.LC- Permitiwp.doe 10/01/09