Permit p .. r
CITY OF TIGARD I ELECTRICAL PERMIT
IN , ° PERMIT #: ELC2007 - 00104
COMMUNITY DEVELOPMENT DATE ISSUED: 2/20/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S102AA - 00906
SITE ADDRESS: 12080 SW MAIN ST ZONING: CBD
SUBDIVISION: PAYLESS SHOPPING CENTER LOT : 002 JURISDICTION: TIG
PROJECT: RITE AID
Project Description: (6) exit signs & (4) bugeye's per fire marshall.
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: SIGNAUPANEL:
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: 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:
MONTCO ASSOCIATES TIMBERLINE ELECTRICAL CONTRACTORS
BY THRIFTY /PAYLESS INC #5354 PO BOX 298
PO BOX 8431 LAKE OSWEGO, OR 97034
HARRISBURG, PA 17105
Phone: ' Contact #: PRI 503 - 969 -8488
FAX 503- 254 -4227
FEES
Description Date Amount Reg #: ELE 26 -121 IC
[ELPRMT] ELC Permit 2/20/2007 $46.85 L1C 160037
[TAX] 8% State Surcharge 2/20/2007 $3.75 SUP 49575
Total $50.60 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 Notif cation Center. Those rules are set forth in
OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to' U' ' :t 03.2/1.6 C • • .800.332.2344.
Issued By: Permiftee Signature: i ' ( 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:
CONTRACTOR 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.
} Electrical Permit Applicatio ' - I c11( 01:F ICE t Sl1 ON
LY
City of Tigard DatdB . / 1 Permit No.: _ / 0 a) /d
° 13125 SW HaII Blvd., Tigard, OR 97223 L i "' 00 / 7
Phone: 503.639.4171 Fax: 503.598.196o 1 — pig ew . Other Permit:
TIGARD Inspection Line: 503.639.4175 Date Re /B . Juris:
Internet: www.ti d-or. ov �.r �r I d. N1� Y ® SeePage2for
g Cpl 111 ntmrA ��OII��0� Notified/Method Supplemental Information
TYPE OF WORK PLAN REVIEW -
❑ New construction ® Addition/alteration/replacement Please check all that apply (submit 1 sets of plans w/items checked below):
o Service or feeder 400 amps or more 0 Building over three stones.
1:3 Demolition El Other: •
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or o Floating buildings.
El 1- and 2- family dwelling ® Commercial/industrial El Accessory building less to or exceeds ons. ❑ buildings.
l use agricultural
for all other installations
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. 0 tnstallatim of 75 KVA or
JOB SITE INFORMATION AND LOCATION o Emergency system. larger separately derived system.
o Addition of new motor load of o "A ", "E ", 1-2 ", "1 -3 ",
Job no.: I D ii CI I Job site address: 12 Bo Sw MA IN Six oPormore. prey.
a ❑ Six or more residential units. ❑ Recreational vehide parks.
City /State/ZIP: - D r , Q ` q t/'� / Z 3 - 4 8 o Health -care facilities 0 Supply voltage for more than
1 - 0 Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: Project name: K, t , r� .A .( i t 4 y 41 ❑ Service or feeder 600 amps or more.
1 FEE SCHEDULE
Cross street/directions to job site: Deaipttxm I Qty. I Fns I 'rasa I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. it or less 145.15 4
Ea. add'I 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
Ai IL 1 (4 t ,� Limited energy, multi - family 75.00 2
IL l0 6� i f c l (f g (4 s c&� b u g t y f s j e i t� Q M (&V sG f residential (with above sq. R.)
I 1 1 Services or feeders Installation, alteration, and/or relocation
I 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 I
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
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
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
• without service or feeder fee,
Contact name: I 46.85 Y�G�'° 2
first branch circuit I
Address: Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: ( ) I Fax: : ( ) Reconnect only 66.85 2
E-mail: • Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
f,� �(( j Signal circuit(s) or limited -
Business name:
Ti M U'�v' v><, g lf? f: (L fA�ty C 6vS a G 0311 S . (1AC • energy panel, alteration, or
Address: 1) . D , aQ X q(t extension. Describe: Page 2 2
City/State/ZIP: 1, a` iw h D 1 f� ® ? J 1 Each additional inspection over allowable In any of the above
F Per inspection _ 62.50
Phone: (5U3 ) 115q I,� I Fax: (jO3) 514 x (221 Investigation per hour (1 hr min) 62.50
CCB Lic.: 1(0 0 31 I Electrical Lic.. A4'- D..l G I Suprv. Lic.: yy 51 Industrial plant per hour 73.75 _
k ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: (,1 (p. $ ij Print name: r v I D ate: Plan review (25% of permit fee): (j•
� u, Ec k. J J\. (1 t(f a
State surcharge (8% of permit fee):
Authorized signature: TOTAL PERMIT FEE: 5 -6, 6 0
This permit application expires if a permit is not obtained within 180
Print name: I Date: days after it has been accepted as complete.
• I:lBl disg\Pemits El.0 .PamitApp.doc 05/23/06 440.4615T(I1 /05/COMJWFB Number of inspections allowed per permit.
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK.ONLY: _. 7- 7
Fee for all residential systems combined $75.00
Check Type of Work Involved: .
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other._
— COMMERCIAL WORK ONLY:.:. -
Fee for each commercial $75.00
system
•
(SEE OAR 918 -260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
•
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
•
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
. ❑ Medical ,
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
•
I: \& dtn ramiukEtc- PamitApp.doc 0123/06
CITY OF TIGARD
` BUILDING DIVISION PERMIT #: ELC2007-00104
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/20/2007
Phone: (503) 639 -4171 ' kti
Inspection Requests (24 Hrs.): (503) 639 -4175 i-1....
INSPECTION WORKSHEET FOR DATE: 2/23/2007 . TIME: 7 :01AM PAGE: 54
SITE ADDRESS: 12080 SW MAIN ST CLASS OF WORK:
SUBDIVISION: PAYLESS SHOPPING CENTER LOT #: 002 TYPE OF USE:
PROJECT NAME: RITE AID
DESCRIPTION: (6) exit signs & (4) bugeye's per fire marshal).
OWNER: MONTCO ASSOCIATES, PHONE #:
CONTRACTOR: TIMBERLINE ELECTRICAL CONTRACTORS PHONE #: 503- 969 -B4M
Inspection Request Scheduled For: Date: 2/23/2007 Pour Time:
Code # Inspection Description Contact # Message
199 Electrical final 043791 -01 503 -969 -8488 N
Corrections /Comments /Instructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: c , Iv 66 Date: 2 2 '3109 o Phone #: (503) 718- 2 -