Permit CITY OF TI GARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2007 - 00189
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 6/22/2007
PARCEL: 1 S135DD -03301
SITE ADDRESS: 11945 SW PACIFIC HWY 208 ZONING: C -G
SUBDIVISION: TIGARD PLAZA LOT: 002 JURISDICTION: TIG
PROJECT: DOLLAR TREE
Project Description: Low voltage for HVAC.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: HVAC: X PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
TIGARD PLAZA LLC PROTEMP ASSOCIATES INC
8320 NE HWY 99 9788 SE 17TH AVE.
VANCOUVER, WA 98665 PORTLAND, OR 97222
Phone: 360 -566 -8102 Contact #: PRI 503- 233 -6911
FAX 503- 238 -9767
FEES Reg #: ELE 26- 1063CRE
LIC 38868
Description Date Amount
[ELPRMT] ELR Permit 6/22/2007 $75.00
[TAX] 8% State Surcha 6/22/2007 $6.00 REQUIRED ITEMS AND REPORTS
Total $81.00
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 ' ork is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility . ification Ce -r. T • . - rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules • r direct questions • • U C 503.246.6699 or 1.800.332.2344.
/A41
Issue. = : —Alma � �� I Permittee Signature: y6z
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.
r.
EJA.trical Permit A licati V:1 1IIIk OFFICE: [SI: ONLY
City of Tigard Dales G /Z 0 7 l %z— - Permit No L aO p 7�4:70a7
: . iuei/2200 QOc2 6
Phone: 503.639.4171 Fax: 503.598.1960 Date/By.
- r I C . n li I) Inspection Line: 503.639.4175 q + ♦ �. / Dat Ready/By. Jurir 53 See Page 2 for
Internet: www.tigard- or.gov yy3] V 1 1i u �' Liu sed/Method Supplemental Information
TYPE G17�IDIN(L I V TSTOK PLAN REVIEW
❑ New construction El Addition/alteration/replacement Please check all that apply (submit 2 sets of plans wfitems 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
• ❑ 1 - and 2- family dwelling a.Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "1 -3 ",
Job no.: 9 f 2 / Job site address: C� /� /� ✓ J/ IOOHP or more. occupancy.
/ // / ` /,7 rQL/ /t t A/ ❑ Six or more residential units. ❑Recreational vehicle parks.
❑ Health-care facilities. 600 nominal.
❑ Supply more than
City/ State/ZIP'
S A c i al !/ � ❑ Hazardous locations.
Suite/bldg. /apt. no.: ✓ Project name: D, L4 /Ri ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 145.15 4
Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
7Iw', £ - 1 --- Ii- 41/ , f2 j residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER I ❑ 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 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, eer panel
Owner signature: Date: A. Fee for branch c with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 6.65 2
Business name: a p 4 -0c/��� B. F ee e h branch
branch ah circuit
Fee b circuits
without service or feeder fee,
Contact name: 60 /1 � first branch circuit 46.85 2
Address: 97$ SL - V /7 % ` Af/� Each add'I branch c 6.65 2
Miscellaneous (service or feeder not included)
City/ State/ZIP: A A La Each manufactured or modular
, 5� dwelling, service and/or feeder 90.90 2
Phone: (003 ) S7 9 _ c q9 Fax: : (S 6 3 ) 21 f" 2(2 Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: Signal circuit(s) or limited -
■ �/IA4c AS' .¢fgr / & energy panel, alteration, or Or) Address: tension. Describe: , Page 2 7 2
7 A tA/ N otfierd- - W/ ii
. City/ State/ZIP: Each additional inspection o %r allowable in any of the above
Per inspection 62.50
Phone: ( ) Fax: ( )
Investigation per hour (1 hr min) 62.50
CCB Lic.3 ' 't I Electrical Lic. ;(/ 0(3 c"4 Suprv. Lic.: e tile d Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: 761-00
Plan review (25% of permit fee):
Print name: Date:
State surcharge (8% of permit fee): (p •00
Authorized signature:6 ,e LLLttt, TOTAL PERMIT FEE: g' j ,!X
--rr — This permit application expires if a permit is not obtained within 180
Print name: tut
(�R. eti ..
Date: . /z.. days after it has been accepted as complete.
• Number of inspections allowed per permit.
1:\Building\Permits\EI-C- PermitApp.doc 05/23/06 440-4615T(11/OS /COM/WEB
Electrical Permit Application - City of Tigard may"
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*
❑ 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
• IABuildingTmoim \ELC- PamitApp.doc 03/23/06
r
t P ; r
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2007 -00189
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/22/2007
Phone: (503) 639-4171 �� A i i
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 7/10/2007 TIME: 7:00AM PAGE: 40
SITE ADDRESS: 11945 SW PACIFIC HWY 208 CLASS OF WORK:
SUBDIVISION: TIGARD PLAZA LOT #: 002 TYPE OF USE:
PROJECT NAME: DOLLAR TREE
DESCRIPTION: Low voltage for HVAC.
OWNER: TIGARD PLAZA LLC, PHONE #: 360-566 -8102
CONTRACTOR: PROTEMP ASSOCIATES INC _ v(.,E , PHONE #: 503-233-6911
Inspection Request Scheduled For: Date: 7/10/2007 Pour Time:
Code # Inspection Description ,Confirm - #. Contact # Message
199 Electrical final 051710.02 503-519-6199 Y
Corrections /Comments /Instructions:
PAS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: )" (INK)e) Date: 1`I 0101 Phone #: (503) 718- lit'36