Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00057
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/25/2011
Parcel: 1 S126CA01100
Jurisdiction: Tigard
Site address: 9009 SW HALL BLVD 100
Project: Target Subdivision: Lot: 0
Project Description: (3) branch circuits to reconnect RTU's.
Contractor: BOBS ELECTRIC Owner: DAYTON HUDSON CORPORATION
2700 NE BURTON ROAD STE A BY TARGET CORP T -0345
VANCOUVER, WA 98662 PROPERTY TAX DEPT/TPN -0950
PO BOX 9456
MINNEAPOLIS, MN 55440
PHONE: 360 - 254 -7200
PHONE: 612 - 761 -1588
FAX: 360 - 254 -8219
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo /Purchase 01/25/2011 $71.02
Specifics: Service or Feeder
1 ea 12% State Surcharge - 01/25/2011 $8.52
Type of Use: Electrical
Class of Work:
Type of Const:
Occupancy Grp:
Total $79.54
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 S e ' • 52- 001 -0090. You rrt ay obfaira 2 copy of r direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued /�� L'T 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 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.
FROM (TUE)JAN 25 2011 0:12 /ST. 0:11/No. 83O2925441 P 1
Electrical Permit Applicati n C 0 , r 0 1 4 FOR OFFICE USE ONLY
City of Tigard Received r Permit No.: _
a 13125 SW Hall Blvd., Tigard, OR 9722 N 2 4 2011 Date /By: I ) " Lt,
Plan Review Other Permit:
Phone: 503.639.4171 Fax: 503.598.1960 DateJB
Inspection Line: 503,639.41'15 CITY OF TBCARD Date Read /B luris:
TLGAI {U Ready /By: See Page lI - U 7
Internet: www.tigard or.gov Notified/Method: S upplemental Information
of lhl nimn nmeinN1 —
- •. . PLA
-' :: ':.::.- ::. ,. PREVIEW: , i k:
❑ New construction IX( Addition /alteration/replacement Please check all that apply (submit 2 sets of plans w/irerschecked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other where the available fault current ❑ Marinas and boatyards.
•- - : - . < :: -' exceeds 10,000 amps at 150 volts or Floating buildings.
- A:TEG :OI ;;CONSI RUCI ION '`' = = ` r ex
less to ground, or exceeds 14,000 ❑ Commercial-use agricultural
❑ 1- and 2- family dwelling ® Commercial /industrial ❑ Accessory building amps for all other installations. building.
❑ Multi - family ❑ Master builder ❑ Other: El Fire pump. ❑ Installation of 75 KVA or
...', . ' •. 7 : �:. - "�..'.., --...�; ".:w: =: = a' - Emergency system. larger separately derived system.
�,="- :i•` ;` ,`7O$ SITE;;IN ANII LOCATION merge
F.ORMATIO "
:.... -, •' �.r � <. : - _,;,` �'; ;..:.r. new motor load of I
: :� _. .r. .:; .: Additional .. �• _3
Job no.: 11 -125 Job site address: 9009 SW Hall Blvd. more. c r eation.
❑ Six x o or r more residential units. ❑ Recreational vehicle parks -
City/State /ZIP: Tigard, OR 97223 ❑ Health -care facilities. ❑ Supply voltage for snorethan
❑Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: 1 UC( Project name: ❑Service or feeder 600 amps or more.
-;' ,,:: -: ,- ;, . `<FEE 'SCHEDUt . c. , . :-:=
: `-- s:, :::%
Cross street/directions to job site: Description ; + i Qtv. I Fee. 1 Total . .
New residential single- or multi - family dwelling unit.
Includes attached garage,
Subdivision: Lot no.: 1,000 sq. ft. or less 16854 4
Tax map /parcel no.:
Ea add'I 500 sq. ft. or portion 33.92 1
Limited energy, residential
67. 84 2
..:. .. ._ .
- _...: ... ' � = O. �tIP- T
.' C t "I IONOF.;:WOR[': _ .- - - (with abovesq.h.)
Limited energy, multi- family 67 84
Reconnect 3 HVAC rooftop units. residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
PROPERTY:= - 201 amps to 400 at I 2
- Q ..Q4YNER' amps 3356 _
P P
401 amps to 600 amps 200.34 2
Name: Target Store #0345
601 amps to 1,000 amps 301.04
Address: 9Q09 SW Hal 1 B1 vd - Over 1,000 amps or volts 552.26 12
Temporary services or feeders installation, alteration, and /or
City /StateJZtP: Tigard, OR 97223 relocation
Phone: ( ) Fax: ( ) 200 amps or less 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 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 '
.`..... - . _rr . -:� _, .;CON s EERSON : #; ;, >:;
above service r feeder fee,
each branch circuit 7.42
_
Business name: B. Fee for branch circuits without
service or feeder fee, first 1 56 . 1 t 56.18
Contact name: branch circuit
Each add'I branch circuit 2 7.42 14.84 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular
City /State/ZIP: 67 - 84 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
E -mail:
Pump or irrigation circle 67.84 2
Sign or outline lighting
67,84 2
::,: _.:::. -- - - --- -. -. . -.' -- CQNTRAI'OR`: —:i: ': , ..:s ': i _:i: i ><'. :::
' - -� C '' - - Signal circuit(s) or limited- energy
Business name: r panel, alteration, or extension. Page 2 2
Bobs Electric Each additional inspection over allowable in any of the above
Address: 2700 NE Burton Rd., Ste. A Additional inspection (1 hr min) 66.25/hr
Investigation (1 hr min) 66.25/ hr
City /State/ZIP: Vancouver, WA 98662
Industrial plant (I hr min) 78.18/hr
-
Phone: ( 360 )254 -7200 Fax: ( 360 )254 -8219 Inspections for which no fee is
90.00/ hr
CCB Lic.: Electrical Suprv. Lic.: specifically listed( %hr min)
53136 l Li 37 31 p 4322S :'-EbECTRICAt. PERMIT FEES ;: :_:_
Subtotal: 71.02
Suprv. Electrician signature, required: Plan review (25% of permit fee): '
Print name: Kevin Broselle Date: 1/24/11 State surcharge(I2% of permit fee): 8.52
Authorized signature:
TOTAL PERMIT FEE: 79. S4
This permit application expires if a permit is not obtained within 18U
days after it has been accepted as complete.
Print name: Date:
` Number of inspections allowed per permit.
I II • Community Development
Request for Permit Action
TIGARD
TO: CITY OF TIGARD
Building Division Services Coordinator
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov
FROM: n Owner ❑ Applicant n Contractor City Staff
(check one)
REFUND OR Name:
INVOICE TO: (Business or Individual)
Mailing Address:
City /State /Zip:
Phone No.:
PLEAS TAKE ACTION FOR THE ITEM(S) CHECKED (1): V 0 1 D
CANCEL PERMIT APPLICATION. g/ ///
❑ REFUND PERMIT FEES (attach receipt, if available).
❑ INVOICE FOR FEES DUE (attach case fee schedule and explain below).
❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit)
Permit #: ii-000 / s7: 1141/1
Site Address or Parcel #: g005 J. // 43 1( /do
Project Name: G�Vq .(jj—
V
Subdivision Name: Lot #:
EXPLANATION: C l �e f , f r _ Pe ✓'M' + ,-/( tr'a
bc J e--vu =/R (Ea 9-0l/ - c'._1
Signature: E Date: / /o2s`/
Print Name: g(7jef\J
Refund Policy
1. The Director or Building Official may authorize the refund of
a) any fee which was erroneously paid or collected.
b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.
c) not more than 80% of the land use application fee for issued permits.
d) not more than 80% of the building plan review fee when an application is canceled before any plan review effort has been expended.
e) not more than 80% of the building permit fee for issued permits prior to any inspection requests.
2. Refunds will be returned to the original Payer in the same method in which payment was received. Please allow 1 -2 weeks for processing refunds.
FOR OFFICE USE ONLY
Rte to Sys Admin: Date s / B jy Rte to Bldg Admin: Date 1 0443 B .;e
Refund Processed: Date ,4r ' By . Invoice Processed: Date By
Permit Canceled: Date . y By , Parcel Tag Added: Date By
Receipt # Date Method Amount $
I:\ Building \Forms \RegPemutAction.doc Rev 07/26/07