Permit Ili ,� CITY OF TIGARD PERMIT
PERMIT #: ELC2007 -00396
COMMUNITY DEVELOPMENT DATE ISSUED: 6/12/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1S126CA-01100
SITE ADDRESS: 09009 SW HALL BLVD 100 ZONING: C -G
SUBDIVISION: WASHINGTON CIRCLE PLAZA LOT : JURISDICTION: TIG
PROJECT: TARGET
Project Description: Disconnect, reconnect (12) branch circuits for rooftop HVAC replacement.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL /PANEL:
MANF HM/ SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 11 IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
TARGET PREMIER ELECTRICAL SERVICES INC
9009 SW HALL BLVD 4548 SW TAYLORS FERRY RD
TIGARD, OR 97223 PORTLAND, OR 97219
Phone: 503 - 624 -0273 Contact #: PRI 503 - 293 -3060
FAX 503 - 293 -3061
FEES
Description Date Amount Reg #: ELE C53
[ELPRMT] ELC Permit 6/12/2007 $120.00 LIC 163299
[TAX] 8% State Surcharge 6/12/2007 $9.60 SUP 5142S
Total $129.60 REQUIRED ITEMS AND REPORTS
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws.
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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center.
Those rules tHforth in OAR 952 - 001 -0010 through OAR 952 -001 -0100. You may obtain copies of these rules or direct questions to OUNC at
503.246. 99 or 1 .800. . 44. C
Issued y: 4 4 1 / Permittee Signatur ,`� /i �_._.—
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:
ONTRACTOR INSTALLATION ONLY
/
SIGNATURE OF SUPR. ELEC'N: ,, , . 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.
I ,
I
Electrical Permit Application FOR Oh1.1('1: USE O \l.l
t ° . City g of Tigard Lry •Received /I�
>1 s "` •. `Date/B : li Permit No.: &_e
13125 SW Hall Blvd.. Tigard l) } tit _, Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date /By: Other Permit:
T I GA R D Inspection Line: 503.639.4175 Date Ready /By: rte' ® Sec Page 2 for
Internet: www.tigard or. guv JUN 11 2007 t`b[ified7vletttod: 6, Supplemental Information
'TYPE e
TVA PLAN REVIEW
❑ ® 1(jAR Please check all t apply (submit 2 sets of plans w /items checked below):
New construction Additio a t, a on laceme t
G V ISTO
ID Demolition ❑ C)th t -.) ❑ Service or feeder 400 amps or more ❑ Building over three stories.
where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 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", "1 -3
I00HP or more. occupancy.
Job no.: Job site address: 9009 SW Hall Blvd
❑ 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: Target HVAC Replacement ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qiy. 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 145.15 4
Ea add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family 75 00 2
Disconnect, reconnect (12) CKTS for rooftop HVAC unit replacement 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: ( ) Fax: ( ) 200 amps or less 66.85 l
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 ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: R. Fee for branch circuits
Contact name: without service or feeder fee, 1 46 85 46.85 2
first branch circuit
Address: Each add'1 branch circuit 11 6.65 73,15 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: Premier Electrical Services, Inc. energy panel, alteration, or
Address: 4548 SW Taylors Ferry Rd. extension. Describe: Page 2 2
City /State /ZIP: Portland, OR 97219 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (503) 293 -3060 Fax: (503) 293 -3061 Investigation per hour (1 hr min) 62.50
CCB Lie.: 163299 Electrical l,ic.: C53 Suprv. Lie.: 5142S Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature. required: i . - \-,------.,_ - '2 Subtotal: 120.00
—=. lam'✓ c -
Print name: Michael Rushing DabL� 6 -I I -07 Plan review (25% of permit fee):
. State surcharge (8% of permit fee): 9.60
Authorized signature: TOTAL PERMIT FEE: 129.60
This permit application expires if a permit is not obtained within 180
Print name: Date:
days after it has been accepted as complete.
T'd T90E- C6Z -EOS A.aaS Teot.11.oaT3 ..Jaiwa.,ld dea :EO LO TT uff'
CITY OF TIGARD
• BUILDING DIVISION PERMIT #: ELC2007-00396
13125 SW Hall Blvd., Tigard, OR 97223 - DATE ISSUED: 6/12/2007
Phone: (503) 639 -4171 i w l t
Inspection Requests (24 Hrs.): (503) 639 -4175 = 'I L .
INSPECTION WORKSHEET FOR DATE: 7/212007 TIME: 7:02AM • PAGE: 11
SITE ADDRESS: 09009 SW HALL BLVD 100 CLASS OF WORK:
SUBDIVISION: WASHINGTON CIRCLE PLAZA LOT #: TYPE OF USE:
PROJECT NAME: TARGET
DESCRIPTION: Disconnect, reconnect (12) branch circuits for rooftop HVAC replacement.
OWNER: TARGET, PHONE #: 503 - 624 -0273
CONTRACTOR: PREMIER ELECTRICAL SERVICES INC \`` C PHONE #: 503-283-3060
Inspection Request Scheduled For: Date: 7/2/2007 Pour Time:
Code # Inspection Description C- onfirm # 6on # Message
1 99 Electrical final 051296-0' 503-887 -7526 '' Y
Corrections /Comments /Instructions: /
C7s'\{\
PASS I I PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: `�' ) Date: d 01 Phone #: (503) 718- l-r 4,