Permit CITY OF TIGARD ELECTRICAL PERMIT
t /,,.. COMMUNITY DEVELOPMENT Permit #: ELC2011 00715
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/22/2011
Parcel: 1S126CB00500
Jurisdiction: Tigard
Site address: 9300 Washington Sqaure RD
Project: Macy's Generator Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: 108
Project Description: Electrical for replacement generator.
Contractor: TRI STAR ELECTIC INC Owner: MACY'S INC.
PO BOX 231175 7 WEST SEVENTH ST.
TIGARD, OR 97281 CINCINNATI, OH 45202
PHONE: 503 - 860 -5249 PHONE:
FAX: 503 - 590 -2302
FEES
Quantity Description Date Amount
2 ea Services or Feeders - 200 12/22/2011 $201.40
Specifics: amps or less
2 crt Branch Circuits w /Purchase 12/22/2011 $14.84
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 12/22/2011 $25.95
Electrical
Type of Const:
Occupancy Grp:
Total $242.19
Required Items and Reports (Conditions)
This permit is iss subjec • the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in ac rdance with appr• ed • -ns. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days ATTE ION: Oregon law _ uirgs y to follow the rules adopted by the Oregon Utility Notific- '•n Center. Those rules are set forth in OAR
952- 001 -001 thr• gh OAR 952 -01 -0t90. Yo ma, obtain a copy of the ules or direct questions to OUNC by calli ! 2.1987 or 1.800.332 44.
Issued B / 40 (� f Permittee Signature _a!
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' 4111111111WMWW ( e, Date: Air
LICENSE NO. 3T
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 - - . FOR ONF10E USETONLY
— R eceived
City of Tigard / /� Permit No: G 6
ate /Bv. ��!!
n 13125 SW Hall Blvd., Tigard, OR 97223 . _ 4° ,. Phone: 503.718.2439 Fax: 503.598.19 0 Eiwr � Ot her Permit. a j Q Q ��/ J 2
T.IGARD Inspection Line: 503.639.4175 Date Ready /By: luris• 53 See Paget for
-. Internet: www.tigard- or.gov DEC 2 2 2011 Notified /Method: Supplemental Information
TYPE OF WO PLAN REVIEW • �
t OF U l VISION Please check all that apply (submit 2 sets of plans w /items checked below):
❑ New construction ® Addition /altera i
'+' 'S�N ❑ 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 ", "1 -2 ", "1 -3 ",
Job no.: 11054 Job site address: 9300 SW Washington Square Rd IOO or 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: Macy's Generator Pad ❑ Service or feeder 600 amps or more.
' - FEE SCHEDULE.
Cross street/directions to job site: Description i Qty. I Fee. I Total
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'l 500 sq. ft. or portion 33.92 1
Tax map /parcel no.:
Limited energy, residential 75.00 2
' DESCRIPTION OF WORK . (with above sq. ft.)
Limited energy, multi - family 75.00 2
Replace Back - Generator residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
200 amps or less 2 100.70 201.40 2
El PROPERTY OWNER ' . ►:1 TENANT 201 amps to 400 amps 133.56 2
Name: Macy's 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
City/State/ZIP: Temporary services or feeders installation, alteration, and /or
y 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
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits - new, alteration, or extension, ler panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT ❑ C PERSON " above service or feeder fee, 2 7 42 14 84 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'l branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular
dwelling, service and/or feeder 67.84 2
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: Tri - Star Electric, Inc. panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: PO Box 231175 Additional inspection (I hr min) 66.25/ hr
Investigation (1 hr mitt) 66.25/ hr
City /State /ZIP: Tigard, OR 97281 -1175
Industrial plant (I hr min) 78.18/ hr
Phone: (503) 860 -3838 7 r Fax (503) 590 -230 Inspections for which no fee is 90.00 / hr
� specifically listed ('V hr min)
CCB Lic.: 153559 1�'�U ( Electrical Lic - 34 - 620C 10 S uprv - Lic -: 3 V�l ELECTRICAL PERMIT FEES
f � Subtotal:
Suprv. Electrician signature, required: �Y
s Plan review (25% of permit fee): 216.24
Print name: Richard Metzler ate: 12/22/2011 State surcharge (12% of permit fee): 25.95
TOTAL PERMIT FEE: 242.19
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Date: * Number of inspections allowed per permit.
I: 1Building \PermitslELC-PermilApp.doc 07/01 /10 440- 4615T(I 1/05/CO54 /WEB