Permit If CITY OF TIGARD ELECTRICAL PERMIT
1 COMMUNITY DEVELOPMENT Permit #: ELC2011 -00317
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06!09!2011
Parcel: 2S103DD01100
Jurisdiction: Tigard
Site address: 13939 SW PACIFIC HWY
Project: Redbox DVD Rental Vending Machine Subdivision: MELROSE Lot: 7 -
Project Description: (1) branch circuit.
Contractor: ZAP PIONEER ELECTRIC LLC Owner: WALGREEN CO #5780
2909 WALLACE RD NW PO BOX 901
SALEM, OR 97304 DEERFIELD, IL 60015
PHONE: 503 - 409 -0407 PHONE:
FAX: 503 - 566 -5960
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 06/09/2011 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 06/09/2011 $6.74
•
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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 ma rain a copy of the r •uestions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: A S V 4/ -0•.o /a [ar
M 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 , ' F 0 1 1 CE s O N L Y
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City of Tigard - f �V Bee • / - Permit No.: • — S ^
• 13125 SW Hall Blvd., Tigard, OR 97223 JUN 8 Plan Review
Phone: 503.718.2439 Fax: 503,598.1960 ( l 2011 Date /B : Other Permit:
T 1 G .k RD Inspection Line: 503.639.4175
nF �'I
Date Ready /By: ® See Page 2 for
Internet: www.tigard or.gov C � Notified/Method: — Supplemental Information
0111 a 46?f?
TYPE OF WOI2IC` D!VOS(( PLAN REVIEW
❑ New construction Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ ther: 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
❑ 1- and 2- family dwelling 'Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION • ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E 1 -2 ", "l -3 ",
Job no.: Lie. 3 711 Job site address: J 3 7 3 7 5 pct c t t - C.. H ,, j u I ❑ Six or more. occupancy.
Six o or r more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: S t� 4 - L J 0 2 - g 7 2 73 ❑ Health -care facilities. ❑ Supply voltage for more than
I ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: CZ-c .1 3 - ❑ Service or feeder 600 amps or snore.
O FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee 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
Fa. add'/ 500 sq. ft. or portion 33.92 I
Tax map/parcel no.: Limited energy, residential
75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family
t 75.00 2
+v' ‘S +c+( 0 .4- Ci -Cvt cC k � k'I'Ug(� residential (with abovesq.ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER •❑ TENANT 201 amps 10400 amps 133.56 2.
Nye 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1.000 amps or volts 552.26 2 _
Temporary services or feeders installation, alteration, and /or
City/State /ZIP: 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 7.42 2
each branch circuit
Business name: l j B. Fee for branch circuits without
Ga t S t U ` it t' Q ( e ( t v t L l r service or feeder fee, first 56.18 2
Contact name: V CA c r J 1 5,k. _ branch circuit
Each add'1 branch circuit 7.42 2
Address: '� `Iv 9 1.-itA ii et C. e • lZ d , Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular
67.84 2
c,1 e v .- 0 12 9 7 3 U ` 1 dwelling, service and/or feeder
I /� // Reconnect only 67.84 2
Phone: ( Y 1 ~ U KG-3- Fax :: (5u ? r_
7) __fJ_IJ — `S G d -
^� Pump or irrigation circle 67.84 2
E -mail: V-1'„,,, „� ( O` 6 ci aG: C c, V ,..,,C. , j4 d V.t e_--i•- , Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
i panel, alteration, or extension. Page 2 2
Business name: I a? !
Z G � U�r C C v t (' t / Each additional inspection over allowable in any of the above
Address: 2, c7 r Wra 1 la Ce (ZC) ,- U Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: D. - e. O P._ eY 73 t J Industr l mm) 66.25/ hr
/ Industritdplant(1 hr min) 78.118/ hr
/
Phone: 6" - 1 L/ 0 C � _ G Li Fax: (9)3) S .. y 0 Inspections for which no fee is 90.00 / hr
specifically listed (h hr min)
CCB Lie.: I eLta Electrical Lie.: ( 7 U Suprv. Lic. : "..,V S ELECTRICAL PERMIT - FEES
/ — '7 / /2 Subtotal: 5(. I Es
Suprv..Electrician signature, required: J y _ 1 101 Plan review (25% of permit fee):
Print name: 0 Date:6 / /� 1 J State surcharge (12 %of permit fee): G ,. 7 ‘— / av e % •srv f l �
TOTAL PERMIT FEE: ri--� cI
Authorized signature: This permit application expires if a permit is not obtained within 180
\ f days after it has been accepted as complete.
Print name: VG U k^. t� ✓ k r'- Date: /b//i * Number of inspections allowed per permit.
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