Permit . f .
.> CITY OF TIGARD ELECTRICAL PERMIT
` COMMUNITY DEVELOPMENT Permit #: ELC2009-00471
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/10/2009
71AR17. Parcel: 1S 136DCO2503
Jurisdiction: Tigard
Site address: 7501 SW DARTMOUTH ST 200
Subdivision: Lot: 0
Project: Petsmart
Project Description: (8) branch circuits for reconnect of (8) roof top A/C units.
Owner: FEES
' LURIA, MARK T AND Quantity Description Date Amount
WHEELES, DOYLE E, BY PETSMART
INC /PROP MGMT, 19601 N 27TH AVE 4TH FL 8 crt Branch Circuits 09/10/2009 $93.40
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 09/10/2009 $11.21
Electrical
Contractor:
ROBERTS ELECTRIC INC
5759 SW 48TH ST
PORTLAND, OR 97221
PHONE: 503 - 244 -7754
FAX:
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $104.61
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 R 952-001-01$0. 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: 7
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:
iditA T , CONTRACTOR INSTALLATION ONLY
SIG ATURE 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.
Electrical Permit Applica ' c E FOR Icy usF ovl �r
City of Tigard I U LI Date/B Received? Ao O7 /1I77'� �j� Permit No.:� &: c-, O 9'7
13125 SW Hall Blvd., Tigard, OR 97223 Plan Revi -w
' Phone: 503.639.4171 Fax: 503.59 j@9 b 1 0 2009 Date /B : Other Permit:
T I G A R D Inspection Line: 503.639.4175 Date Ready/By: Ell See Page 2 for
Internet: www.tigard- or.gov CITY OF TIGARD Notified/Method NM Supplemental Information
TYPE lEitMiNG DIVISION 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 ❑ 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 of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑Addition of new motor load of ❑ "A ", "E ", "I - 2 ", "l - 3 ",
I00HP or more. occupancy.
Job no.: Job site address: 7 s fJ) S L„.) A D_T NhOt� ❑ Rec reational vehicle parks.
L / El or more residential units. P
Clty/State /ZIP: � ❑ Health-care facilities. El Supply voltage for more than
�� f `�N ❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
y � FEE SCHEDULE
Cross street/directions to job site: T G I "3l j - T Description f Qtv. I Fee. I Total
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Tax map /parcel no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (wills above sq. ft.)
Limited energy, multi- family 75.00 2
b {7evr■S2— E (A Lk, residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER ❑ TENANT 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: ( ) I Fax: ( ) 200 amps or less I 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
❑ APPLICANT I ❑ CONTACT PERSON 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
first branch circuit f
Address: Each add'I 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
CONTRACTOR Sign or outline lighting 53 -40 2
Signal circuit(s) or limited -
Business name: el Rai T ' S 1 L S,;) c energy panel, alteration, or
Address: 5'76-6/ 5, l zi- = extension. Describe: Page 2 2
City /State /ZIP: Q 05,, be., c7 2,Z-1 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( ) ,•� -►�(� ' 7� Fax: (S)3)
„IL/ �3 j � ` .� 4 - � S b a � Investigation per hour (1 hr min) 62.50
tfiS CCB Lie.: �Lf 1 q» ctrical Lie.: v 3if_ y ' 7 � Suprv. Lie.: 3gg� S Industrial plant per hour 73.75
ELECTRICAL PE
UUU f PERMIT FEES
/-`9
Suprv. Electrician signature, required: ' Subtotal: 93, y,0
Print name: y , vL Oj k _/) Date: �i /0/6 Plan review (25% of permit fee):
/ State surcharge (12% of permit fee): //, a
Authorized signature: TOTAL PERMIT FEE: A Y 6,
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
I \Building\Permits\ELC- PermitApp.doc 05/23/06 440- 4615T(1 I /05 /COM /WEB
Electrical Permit Application - City of Tigard •
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
H Burglar Alarm
n Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
H Vacuum Systems*
n Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
n Audio and Stereo Systems
n Boiler Controls
n Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
❑ Instrumentation
n Intercom and Paging Systems
n L • andscape Irrigation Control*
❑ M edical
❑ N urse Calls
❑ Outdoor Landscape Lighting*
n Protective Signaling
F7 O ther
Total number of commercial systems:
*No licenses are required. Licenses are required .
for all other installations
I. \Building\Permits\ELC- PermitApp doc 03/23/06