Permit CITY OF TIGARD ELECTRICAL PERMIT
2 " COMMUNITY DEVELOPMENT Permit #: ELC2010 -00724
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/30/2010
Parcel: 1 S 126CA01100
Jurisdiction: Tigard
Site address: 9009 SW HALL BLVD 100
Project: Target Subdivision: Lot: 0
Project Description: Electrical for TI.
Contractor: AC & E ELECTRIC Owner: DAYTON HUDSON CORPORATION
3535 DEL WEBB AVE #100 BY TARGET CORP T -0345
SALEM, OR 97303 PROPERTY TAX DEPT/TPN -0950
PO BOX 9456
MINNEAPOLIS, MN 55440
PHONE: 503 - 363 -2301 PHONE: 612- 761 -1588
FAX: 503 - 363 -2302
FEES
Quantity Description Date Amount
5 ea Services or Feeders - 200 12/30/2010 $503.50
Specifics: amps or less
1 ea Services or Feeders - 201 to 12/30/2010 $133.56
Type of Use: COM 400 amps
Class of Work: ALT 164 crt Branch Circuits w /Purchase 12/30/2010 $1,216.88
Service or Feeder
Type of Const: 1 ea 12% State Surcharge - 12/30/2010 $222.47
Occupancy Grp: Electrical
Total $2,076.41
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 52-001-0090. You may o of the s or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: v % �rt��I�� 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' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection data.
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 ` 13125 SW Hall Blvd.. Ti Date /By: '�f 0 l Pennit No.: 'E L ' ) / U— ., ,l,�
1, .
Tigard. OR 97223 r ! p
g Plan Review
/� t O d I -
3 Other Permit t Y OKJ �p
P hone: 503.718.2439 Fax: 503.598.I �O Date/Bv:
TIGARD Inspection Line: 503.639.4175 Q Date Ready /By: � turis: -- IRI See Paget for
Internet: www.tigard or.gov ` c5 j e A (��l ,iotifted /Method: 17:& Supplemental Information
(S
TYPE OF WORK ,- — <, ` PLAN REVIEW
❑ New construction ® Addition /alteration /rep s eW Please check all that apply (submit 2 sets of plans w /items checked below):
VV�� o\\v ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: �� where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ I- and 2- family dwelling ® Commercial /industrial .❑ Accessory building amps for all other installations, buildings.
❑ Multi- family ' ❑ Master builder ❑ Other: • ❑ Fire pump. ❑ Installation of75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A "E ", "I - ", "I - ",
Job no.: Job site address: 9009 SW Hall IOOHP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: Tigard OR 97223 ❑ Health - care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: Target ❑ Service or feeder 600 amps or more.
FEE SCHEDULE '
• Cross street/directions to job site: Description I Qty. I Fee. I Total f "
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: . Lot no.: 1,000 sq. ft. or less 168.54 4
. Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.:
Limited energy, residential 75.00 2
. DESCRIPTION OF WORK (with above sq. II.)
Limited energy, multi - family
75.00 2
Remodel residential (with above sq. ft.)
. . Services or feeders installation, alteration, and /or relocation
. 200 amps or less 5 100.70 5 St 2
❑ PROPERTY OWNER . ❑ TENANT 201 amps to 400 amps I 133.56 /33.S6, 2
Name: I 401 amps to 600 amp 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) 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 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
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee, ��y 7.42 /,1jt Esc 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
' Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular 67.84 2
City /State /ZIP: dwelling, service and /or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail: -
Sign or outline lighting 67.84 2
. CONTRACTOR Signal circuit(s) or limited - energy
Business name: AC &E Electric panel, alteration, or extension. Paget 2
Each additional inspection over allowable in any of the above
Address: 3535 Del Webb Ave Additional inspection (I hr min) 66.25/ hr
City /State /ZIP: Salem, OR 97301 Investigation (I hr min) 66.25/
Industrial plant (1 hr min) 78.18 / hr
Phone: (503) 363 - 2301 Fax: ( ) Inspections for which no fee is 90.00 / hr
specifically listed (V2 hr min)
CCB Lic.: 591 Electrical Lic.: 24 C Suprv. Lic.: 5387S ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: a Subtotal: � 8 j , f r�
• Plan review (25% of permit fee):
• 4./ t •
Print name: Carl Duncan Date: 12/23/10 State surcharge (12% of permit fee): L24, �f7
TOTAL PERMIT FEE: 07� ��
Authorized signature: h
. This permit application expires if a permit is not obtat ed within 180
Print name: Date: days after it has been accepted as complete.
N um b er of inspections allowed per permit.
I: \ Building \Permits\ELC- PermitApp.doc 07/01/10 440- 46t5T(11/05 /COM/WEB