Permit I
CITY OF TIGARD WI JM ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2012 00139
T I G A R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/14/2012
Parcel: 1 S136DCO2504
Jurisdiction: TIGARD
Site address: 7275 SW DARTMOUTH ST 120
Project: Shell Subdivision: HUNTER POLLOCK NO.2 Lot: G
Project Description: TI
4/3/2012: REPRINT permit to correct site address. DLH 5/11/12 reprint to correct project name to SHELL.
Contractor: HILLSBORO ELECTRIC LLC Owner: LURIA, MARK T
21185 NW EVERGREEN PKWY#110 WHEELES, DOYLE E
HILLSBORO, OR 97124 BY PETSMART INC, PROPERTY MGMT
19601 N 27TH AVE,4TH FLOOR
PHOENIX,AZ 85027
PHONE: 503-439-9666 PHONE:
FAX: 503-601-3680
FEES
Quantity Description Date Amount
14 crt Branch Circuits wo/Purchase 03/14/2012 $152.64
Specifics: Service or Feeder
1 ea 12%State Surcharge- 03/14/2012 $18.32
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $170.96
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 OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
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 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.
CITY OF TIGARD ELECTRICAL PERMIT
1 1 11 11 " COMMUNITY DEVELOPMENT Permit #: ELC2012 -00139
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/14/2012
Parcel: 1 S 136DCO2504
Jurisdiction: TIGARD
Site address: 7275 SW DARTMOUTH ST 120
Project: Great Clips Subdivision: HUNTER POLLOCK NO.2 Lot: G
Project Description: TI
4/3/2012: REPRINT permit to correct site address. DLH
Contractor: HILLSBORO ELECTRIC LLC Owner: LURIA, MARK T
21185 NW EVERGREEN PKWY #110 WHEELES, DOYLE E
HILLSBORO, OR 97124 BY PETSMART INC, PROPERTY MGMT
19601 N 27TH AVE, 4TH FLOOR
PHOENIX, AZ 85027
PHONE: 503 -439 -9666 PHONE:
FAX: 503 - 601 -3680 .
FEES
Quantity Description Date Amount
14 crt Branch Circuits wo /Purchase 03/14/2012 $152.64
Specifics: Service or Feeder
1 ea 12% State Surcharge - 03/14/2012 $18.32
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
• Total $170.96
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 1 OAR
952 - 001 -0010 through 0 - 952 -0s •0. Y•u may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: At karat 1 - Permittee Signature: &/- ��PL /C_- 4-77
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 603.639.4176 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.
CITY OF TIGARD ELECTRICAL PERMIT
' COMMUNITY DEVELOPMENT Permit #: ELC2012 -00139
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/14/2012
Parcel: 1S136DCO2503
•
Jurisdiction: Tigard
Site address: 7500 SW DARTMOUTH ST 120
Project: Great Clips Subdivision: HUNTER POLLOCK NO.2 Lot: G
Project Description: TI
Contractor: HILLSBORO ELECTRIC LLC Owner: LURIA, MARK T
21185 NW EVERGREEN PKWY #110 WHEELES, DOYLE E
HILLSBORO, OR 97124 BY PETSMART INC, PROPERTY MGMT
19601 N 27TH AVE, 4TH FLOOR
PHOENIX, AZ 85027
PHONE: 503 - 439 -9666 PHONE:
FAX: 503 - 601 -3680
FEES
Quantity Description Date Amount
14 crt Branch Circuits wo /Purchase 03/14/2012 $152.64
Specifics: Service or Feeder
1 ea 12% State Surcharge - 03/14/2012 $18.32
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
•
Total $170.96
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 OAR 952- 001 -0090. You may obtai, = ... of th les or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: - Permittee Signature:
/Ago,
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 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.
From:Hillsboro Electric,LLC 5036013680 03/10/2012 16:20 #800 P.001/004
Electrical Permit Apalicati SEC
City of Tigard
VAR 1 3 2 12 Received Permit No
3
} • . ° 13125 SW Hbll Blvd., Tigard, OR 97223 Plan Review � •
I Phone: 503.718.2439 Fax: 503.598.1960 -TIGA�
Inspection Line: 503.639.4175 ct O F i1p Date / Re a Other Permit•
'f t C:.t G 1;1 Pa { t Date ResdytBy: kris. ®See Page 2 for
i - Internet: www.tigard or.gov B uiLpING DIVISION Nocifud the d: jr1",,, I Supplemental Information
TYPE OF WORK :'::
PLrW • ' '' iC �;;t: ; ' r
1 ❑ New construction er Addition /alteration /replacement Please check all that apply (submit; tab of plans wiitems checked below):
❑ Service or fader 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 a ricultural
❑ I- and 2- family dwelling ®'Commercial /industrial ❑ Accessory building amps for all other installations. buildings. g
❑Multi- family IJ Master builder 0 Other: 0 Fire pump. 0 Installation of 75 KVA or
AND LOCAT ❑ Emergency sys larger separately
JOB SITE INFORMA x a !n ro tely derived system.
CI Addition of TIM motor load of ❑ .. A" - E' "1.2". "1.3 '.
Job no.:79 .3g Job site adder r1outti . mote. accuracy. .
! it ❑ Si* o or r moere residential units. ❑ Recreational vehicle parks.
City /State/ZIP: 7/1 ; Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volb nominal.
- alt ,• Idg. /apt. no.: /) Project narne:4 l- (74 ❑ Service or feedu 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description i Qrr. I Fen 1 rout I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: i Lot no.: 1.000 sq. ft. or less 168.34 4
Ea. add'l 500 sq. R. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. R.) 75.00 2
Limited energy, multi - family
72 residential (with above sq. R.) 75.00 2
Services or feeders installation, alteration, and/or relocation
200 amps or leas _ 100.70 2
❑ PROPERTY OWNER ' ❑ TENANT 201 snips to 400 amps 133.56 2
Name:
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 A 2
Temporary services or feeders installation, alteration, and/or
City/State/ZIP: relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 am 125.08 2
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, ter panel
Owner signature: Date: A. Fax: for branch circuits with -
CI APPLICANT ..... .. 1 :'0 ,CONTACT 'PFRJ1SON ..:.••• above service or fccda fee,
each branch circuit 7.42 2 ;
Business name: B. Fee for branch circuits without
service Of feeder fee, first 56.18 5'6d? 2
Contact name: branch circuit
- Each add'l branch circuit - I S; 7.42 910.44 2
Address: Miscellaneous (service or feeder not Included)
Each manufactured or modular
City/State/ZIP: dwelling, service and/or feeder 67 2
Phone: ( ) Fax: : ( ) Recormect 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 limiter energy
Business name: Hillsboro Electric, LLC panel, alteration, or extension. Page 2 , 2
Each additional Inspection over allowable In any of the above
Address: 21185 NW Evergreen Parkway #110 Additional inspection (I hr min) 66.25/hr
Investigation (I In min) 66.25/ hr
City/State/ZIP: Tigard Industrial plant (I hr min) 78.18 / hr
•
Phone: (503) 439 - 9666 i Fax: (503) 601 - 3680 Inspections for which no fee is
- sp listed (Ys hr min)
CCB Lic.: 134481 90.00/ hr
Electrical Lic.: 4-4 C Suprv. Lic.: „'''la,;
3 99 Su ysy�s .. �.. h,iE1g�C[ RiCALSfER11ffI );FEES'iA".'a'�.`g„t'
Suprv. Electrician signature, required: ^ �r �-� Subtotal: WW1
1! Plan review (25% of permit fee):
Print name; r Ii . i cier Date:4/ / %� State surcharge (12% of permit fee): j g • 31
`/' •
TOTAL PERMIT FEE: I
Authorized signature: 70 . 9(4) Tbb permit application expires If a permit is not obtained witbio 180
days after It boa been accepted as complete.
not name: I Date: • Number of inspections allowed per permit.
InDuitdmgtPermm5LLC .PerathApp.aae 07101 4404615r( 11.avCUWwE6
From:Hillsboro Electric,LLC 5036013680 03/10/2012 16:20 #800 P.001/004
Electrical Permit A licati E ED
FOR O IiIC:`E U S O
City vi AR . Received fa Permit No
131 of Tigard SW Hall Blvd., Tigard, OR 97223— ,V1HR 01L 3 " � ' �� e � _,
.2 Phone: 503.718.2439 Fax: 503.598.1960 Plan Review
DaterBv: Other Permit •
r i Ct,�tt:. Inspection Line: 503.639.4175 GIy O F ' �` lD ISIO Dat ReadyrBy: ruris H See Page 2 for
Internet: www.tigard- or.gov B jii DI Notifie Method — Supplemental Information —
TYPE OF WORK : REVIEW ::.:._
❑ New construction Er 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 ISO volts or ❑ 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: ❑ Firc pump. ❑ Installation of 75 KVA or
JOB SITE INFORMA AND LOCATION ❑emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ". "F'. "1.2 ". "1 -3 ".
Job no.: 7 got Job site address: _ w S • • A mO 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State/ZIP,: � . ���3 0 Health -care facilities. ❑ Supply voltage for more than
(!� Hazardous locations. 600 volts nominal.
U lt Idg. /apt. no.: 42 Project name:4 — �" �z ns ❑ Service or feeder 600 amps or more.
�✓ FEE SCHEDULE
Cross street/directions to job Site: Description I Qtr. I Fee. I Tout I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 168.54 4
Es. add'l 500 sq. R. or portion 33.92 I
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. R.) 75.00 2
Limited energy, multi - family 75.00 2
TZ residential (with above sq. R.)
Services or feeders installation and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 1 33.56 2
Name:
401 amps to 600 amps 200. 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 i 2
City /State/ZIP:
Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59.36 I
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
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, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT I 10 :CONTACT PE[tSON .. •. above service or feeder fee,
each branch circuit 7.42 2
Business name: B. Fee for branch circuits without
service or feeder fee, first
branch circuit 56.18 5-6,1? 2
Contact name:
Each add'l branch circuit 1's; 7.42 9(naL}(p 2
Address: Miscellaneous (service or feeder not included)
City/State/Z1P: Each manufactured or modular 67 84 2
dwelling, service and/or feeder
Phone: ( ) I Fax: : ( ) Recormect 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: Hillsboro Electric, LLC panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 21185 NW Evergreen Parkway #110 Additional inspection (I hr min) _ 66.25/ hr
Investigation (I hr min) 66.25/ hr
City/State/ZIP: Tigard Industrial plant (I hr min) 78.18 / hr
Phone: (503) 439 - 9666 I Fax: (503) 601 - 3680 Inspections for which no fee is
secci fically listed ('b hr min) 90.00 /hr
CCB Lic.: 134481 I Electrical Lic.: 34 -499C I Suprv. Lic.: ' F i5 . l , ,,,'F-, , ?' E1�C1'ItI CAL= pER111QT;;FEF.S ";z' :-;J�� ,
I Subtotal:
Suprv. Electrician signature, required: n � , se�•�D�
)� "` [ � � /� 1! J� `'�'1 Plan review (25% of permit fee):
Print namey • A Vi Date: State surcharge (12% of permit fee): ii.la.
TOTAL PERMIT FEE: e
Authorized signature; This permit application expires if a permit Is not obt red within 180
days after it has been accepted as complete.
Print name: Date: • Number of inspections allowed per permit.
I:iauildmr.Pennds\ELC- Peanut App, 07 /01'10 440.46151( I Ir05 /CUM'WEB