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Permit
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT ' . COMMUNITY DEVELOPMENT Permit #: ELR2009 -00290 Date Issued: 09/11/2009 IIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 parcel: 1S136DCO2503 Jurisdiction: Tigard Site address: 7501 SW DARTMOUTH ST 200 Subdivision: Lot: 0 Project: Petsmart Project Description: Limited energy for HVAC FEES Owner: Description Date Amount LURIA, MARK T AND WHEELES, DOYLE E BY PETSMART INC /PROP MGMT, 19601 N Restricted Energy Permit 09/11/2009 $75.00 27TH AVE 4TH FL 12% State Surcharge - Electrical 09/11/2009 $9.00 PHONE: Contractor: JH KELLY LLC 821 3RD AVE. LONGVIEW, WA 98632 PHONE: 360- 575 -3166 FAX: 360 -423 -9170 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 Total $84.00 Intercom /Paging: N Landscape /Irrigation: N Required Items and Reports (Conditions) Landscape Lighting: N Medical: N Nurse Calls: N Protective Signal: N Security Alarm: N Other: N Other Desc: 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 OA: 95 -.01 -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: � — Permittee Signature: �""� G /C � 0/ V 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 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. `- From:JH KELLY To:15035881860 09/09/2009 08:48 4044 P.003/004 Electrical Permit Applic' , CEIVED FOH OFFICE USE ONLY Cl of Tigard Q 9 2009 Received J ff o 44r.,411 PermitNo.:8- ,2 009 - oaa ' AP 111 City g Dates : Review l • ..� • 13125 SW Hall Blvd., Tigard, OR 91223 Plan L Other Permit: Phone: 503.639.4171 Fax: 503.598.1960 Date/B : 1' I G A R D Inspection Line: 503.639 CITY OF TIGARD Date Ready/By: ® See Page 2 for Internet: www .tigard or.gov R[jILDINO1 G DIVISION Notified/Method: Supplemental Information rs ac z S-:' : • ;Ile F.'WRIG a,'; }' .Y rtiR�.MUt -�h , ', r c'� , x ,; � L'AN'° RE �* ' �:3r. f . ": + ♦yN , .,' .", ..,s,- : ., m ., -4, "Jl '. _� wi ' . G� ....r..,.��! ..� .,. .•,�`. .-. ... .. �. M:..w ,.�xn +!._. T ...: �. r � i .�_: 7.' : .i ❑ 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 ❑ Other: - where the available fault current ❑ Marinas and boatyards. °• a "^ - " *"-• "' ' a t w `.` `- exceeds 10,000 amps at 150 volts or ❑ Floating buildin ga. xlry`` r'/ A`I1'' a O.IY f &.• + ''' 1 P 8 -� � � � _ �"'� �•" � '� "'�"" - /"""a"' ' "" -t ''�` t less to ground, or exceeds 14,000 ❑Commercial -use agricultural ❑ 1- and 2- family dwelling ill Commercial/industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi- family ❑ Master builder ❑ Other: El Fire pump. ❑ Installation of 75 KVA or r r 13 Emergency system. larger separately derived system. O.. FE'E I ORM AND L©G,�O1V� , . ` • ' .. " . as �d, �:: , .�.- •:or *.�.......na� - .: ...,.�. , ,,..k , of . =nra El Addition of new motor load of ❑ "A" "E" "1 -2" "1 -3" Job no.: Job site address: I 5 50 %.. 100HP or more. occupancy. R ! S W ' �riM ❑ Six or more residential units. ❑ Recreational vehicle parks. City/ State/ZIP: 1; & OR ❑ Health -care facilities. ❑ Supply voltage for more than ' ❑Hazardous locations. 600 volts nominal. • Suite/bldg. /apt. no.: A Project name: P 5 0 Service or feeder 600 amps or more. WAVirn ova ` . _E (3HEDIII: RWS' ''l''= a" a`,:`r °'' Cross street/directions to job site: Description I On'. I Fee. I Total 1 New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4 Ea. add'l 500 sq. ft. or portion 33.40 1 Tax map /parcel no.: Limited energy, residential t Wv t 75.00 2 t ' ''* " _ k ' 1,DES !JO u 7� , Q "!..-.;,1•:: :, , ;m.. (with above sq. ft.) • Limited energy, multi- family 75.00 2 �`vv�oe�5 residential (with above sq. R.) Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 •at0, it 1 ' -` • =1 .r.. ry t . wA., , FP• s .1 201 amps to 400 amps 106.85 2 Name: 401 amps to 600 amps 160.60 2 601 amps to 1,000 amps 240.60 2 Address: • Over 1,000 amps or volts 454.65 2 City/ State/ZIP: Temporary services or feeders installation, alteration, and/or _ relocation Phone: ( ) Fax: ( ) 200 amps or less 66.85 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2 Branch circuits - new, alteration, or extension, per panel Owner signature: Date: A. Fee for branch circuits with ' ''''':4t . ... '' ` . r, 't . 44 B .: az"r . ,t t M } QO ts;i r •' " , o ,.&.4,:i above service or feeder fee, each branch circuit 6.65 2 Business name: B. Fee for branch circuits Contact name: without service or feeder fee, 46.85 2 fast branch circuit Address: Each add'1 branch circuit 6.65 2 Miscellaneous (service or feeder not included) City/State/ZIP: Each manufactured or modular dwelling, service and/or feeder 90.90 2 Phone: ( ) Fax: : ( ) Reconnect only 66.85 2 E -mail: Pump or irrigation circle • 53.40 2 - ,r , 4"' zZ ', . sa' ° _ `� _.a4 el R :301 ;' . `.... „ i : Sign or outline lighting 53.40 2 or Business name: --SA `� - Signal circuit(s) alter limited - energy panel, alteration, or Address: S2.\ 3 , ,k A vcvlac extension. Describe: 11 Paget 15 2 City/ State/ZIP: Lrdvt1/412uj C JA C(37 Each additional inspection over allowable in any of the above Per inspection 62.50 Phone: (360 ) J "15 .. 3`( p ip Fax: (3 ) 4,2z3, 0( ,-I 0 Investigation per hour (1 hr min) 62.50 ,44/ CCB Lic.: IJ 4 , 1 • Ele trical Lic.: "31. -9 & uprv. Lie.: 52 $ Industrial plant per hour 73.75 `T 3 / . U r r � _ ita' �' ��?�1�-• r�EIL�R_ lC �`_ �1I� `�t z "F4SS "- � >ia'�- ;;• Suprv. Electrician signature, r aired: ` A „ � M , , , Id / / Subtotal: •"I5 Print name: Gi Gov Feet. Date: `1ltk(o9 Plan review (25% of permit fee): �+ + State surcharge (12% of permit fee): � Authorized signature: 1�1 1 �Q T aL� TOTAL PERMIT FEE: ✓' Print name: . �IQ �1 ��r Date: Stet/Ott This permit application expires If a permit is not obtained within 180 days after it has been accepted as complete. * Number of inspections allowed per permit. I.\ Bui lding\Permits \ELC- PermstApp.dec 05/23/06 440.4615T(I1 /05 /COM/WEB From:JH KELLY To:15035981960 09/09/2009 08:48 11044 P.004/004 Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: Fee for all residential systems combined ... $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* El Burglar Alarm • ❑ Garage Door Opener* . ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: Fee for each commercial $75.00 • system (SEE OAR 918- 309 -0000) • Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation El F e Alarm Installation • HVAC El Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls . ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other Total number of commercial systems: 1_ *No licenses are required. Licenses are required for all other installations . 1, 1Buildmg1PUmitsEELGPermi tApp.doc 03,23/06