Permit CITY OF TIGARD ELECTRICAL PERMIT
• COMMUNITY DEVELOPMENT Permit #: ELC2012 -00486
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/16/2012
Parcel: 2S110DCO2200
Jurisdiction: Tigard
Site address: 15660 SW PACIFIC HWY A -1
•
Project: Petco Subdivision: 1997 -016 PARTITION PLAT Lot: 2
Project Description: 10 branch circuits for cash wrap and misc. fixtues.
Contractor: BUILDERS NW LLC Owner: TRC MM LLC
20420 NE SUNNY CREST 5973 AVENIDA ENCINAS STE 300
NEWBERG, OR 97132 CARLSBAD, CA 92008
PHONE: 503 - 538 -7976 PHONE.
FAX: 503- 217 -1487
FEES
Quantity Description Date Amount
1 ea 12% State Surcharge - 08/16/2012 $14.76
Specifics: Electrical
10 crt Branch Circuits wo /Purchase 08/16/2012 $122.96
Type of Use: COM Service or Feeder
Class of Work: ALT
Type of Const:
Occupancy Grp: M
• Total $137.72
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: M' v Permittee Signature: S E, p) L i C A T�G .A J
OWNER INSTALLATION ONLY r Y
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.
08/15/2012 18:54 5032171487 BUILDERS NW PAGE 01/02
Electrical Permit Applieatio 1 , „r E K E D 1:01;01,1,1( 1 r. ().1.,
City o Tigard Re :: 1 ur. V. - P° PermitNO.: E1-C— 1 (02 - e 0/ 5
•
13125 SW Hall Blvd Tigard OR 972,23 "'
. pl • - 1 V � Y
Phone: 503.718.2439 Fax 503.598.19�QI,�j) 1 6 '� -'2 • 11s' r• ' t7� Fermis:
Inspection Line: 503.639.4175 v nate R eedyray kris: f to gee Free 2 for
v“.. ;..,.:).:•! Notificdililetbodi Suppleme Information
Werner. www•tigtmd-or,gov C 14,1) 1i ! f
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:`.� �d i- '�y;'y :..�%•.•y, ..u,. x..,..;�'lri,y- � i �•'�����4� Y' �d ,. ���li '� '' ,x .., ?<..
❑ New construction 4, ddition/alteration/ •.lacement 1 en that apply (submit a "a of pleas W /ieme chedaeueinw)t
Q Sash err !bider 400 mope or more ()Building o ea three stories.
El Demolition ❑Other ! were rho van* fault carrier ❑ Mari/PIS reed boatyaodS
'i �' f tl 1, " ;. t � r (.' a;'' . exceeds 10,000 amps at 150 volts or ❑ Floating buildings. .. w r rA;t4; :' � 11 2.,•: =� r ' ' 4 .'Y. i P .. y ...... •.. , C I i a i i 'e 1u ' r ' e �� . 1 11�.. G,* ; •�,`). 'l l'r..,ri. :''.,.4,:i;.... g exceeds agricultural
/, . S 'r:', ` .r li- : "r, ':'j.. :�: . ^. ry'r . . 1 .. , �r .. ._ ,N� _� - _. i�1.'t4.� ]. , . i.: ,:ti . ']'. � less to gtottad, or eroeeda 14, is °b"""""'°'
''•ai; 000 Commercial-use
❑ 1- and 2- family dwelling • onamer'cial/indust ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ! ON= pump. ❑ Installation of 75 KVA or
'S'4 r.'r :'r r te.' ; .. w.t r .. jr: y r . r . a ; I] leaarrCaaer system. larger separately derived system.
'' • � � � load of I
°:;4,`•..:, ::�.!;T >•ra .::�` .�;' . • - _ a `- �w,`;,;; � �i:� ❑ �Of fMwmOtar 0 1.2", -3 .
. , :,; ^.. ... '`?y'�1; -;:• •... tit,::;: ^ .
Job no.: Job site address: l 5t 0 b - 5 w ?acAt 4 k - � Elsie or mor residential wee. ❑ Recreational vehicle padre.
C' /Statv/ZJP: d 0 2 ` �` Z 2 j ❑ �e L3 Supply voltage bar more tarn
G[r ..f ` f ❑ Hazardous lomaoos 600 rolls nominal.
Suite/bldg. /apt no. • Project name: C 1 ❑ Service O feeder 600 amps or more.
,::., - .,. -, a:- :'
-i r ^ r ., a.a 4if, is > t: s A:
Cross street/directions to job site: y 1 D*aia_oa l ob. C
New resideutial single- or multi - family dwelling unit.
1 Includes attached garage. •
Subdivision: -- Lot no.: 1,000 sq. ft. or less 168.54 4
I---- 6a, add'l 500 sq. ft or portion 33.92 1
Tax map/parcel no.: _ ! Limited energy, residential
';:tin:- ' Y :c.':' • ;.c'.�.i':l1t "r ' } . ' t r: , R,q' + � • ` T ..MS1F' < t j ' ^Ftij1 "! . (with abovesq. 0 - 75.00 2
' ' � :'�;: • .:. /� '. Limited energy, multi-finally 75.00 2
Services or feeders installation, alteration, and/or relocation
Co (J 4A o -r C Q'L1 LP Gc,5 pc - d pV\ i 5 4. • . resideottal (with above sq. R)
}
200 amps or lass 100.70 2
``. ,, 'etM1'a 5``A t.,±;Y�, ..ti :::i .. ,%' 'A raw:: :R f,t .
't•
.. ,, 201 amps lu 400 amps 133.56 l 2
may, S • �'.' .• `4'
?k` > " • . 401 amps to 600 amps
200.34 2
Nauss: $ 601 amps to 1,000 amps 301.04 2
Address: 1 over 1,000 amps or volts I 552.26 _ 2
Temporary services or feeders installation, alteration, and/or
City/State/ZIP: relocation
Phone: ( ) j Fax: (• ) 200 amps or Ices 59.36 t
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made ' . property that I own which is pot 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according h ORS 447, 449, 670, and 701.1
Branch dtrcidts- new, alteration, or extcnaso*, per panel
Owner Signature: Date: A. Fee for breath circuits with
''.. ; ='^ * 4:i t `.'1Z P " 'tar• `rnt; . i 4'.; ::1,;r.''�i'. g�,i�y ^ .. • `i' . i y ,.i :,rub :';q above aerviccorfeederfee, 7.42 2
e "/'s:''�,...'� -'1' ,','. • . ` , D ' l'• • • x :. each branch mutt _
Business name: i B . Fee for branch circuits wrdwia
1 service Or tbeder fee, first 56. 18 2
Contact name: branch circuit
• 1 Each add'l branch circuit eal I 7.42 co _7y 2
Address: I miscellaneous (service or feeder noi included)
i 'r Each manufactured or modular .. ,_ ,
City/5taIc,Z1} dwelling, service. end/or feeder 67.84 2
Fax::` ) • Recce seat only 67.84 2
Phone: ( ) Pump or irrigation circle 67.84 2
E - mall: p• r.. � • _ Sign or outline lighting 67.84 2
w -{, 5:.. , ,e�`.:':b �'_�.ri,1P:k '�. f'&a JP.��: 1J: `•'r f.,:'. ±.::,: � ; r��'r. � �;.
.•.' ��Y. '.'' �1•'Y K Signal .........(S) Of llrNtetl' _
Business name: _ / ' I ryr,W panel, alteration, cc extension. Page 2 2
I ! Each additional inspection over allowable in any of the above
Address: 4 2 0 tt e, � LA. „ 11 ,, t s .e-,,, I Additional taspceticn (1 hr man) 66.25/ hr
City/State/ZIP: lmeni8ffiion (1 - br min) 66.25/ br
ity /Sta2c /ZIP:
/ [ 0,,,,f.2„,1_, 01 4 7 1 Industrial plant (1 hr min) 78.18/ hr
Phone: (e03) 5 3i5 75 7 fo I Fax: . 0' 7 - 4 7 — ( `'E 40'7 i in'pecria® for which an the is 90.00/ hr
ells listed (% br rain)
CCB Lic.. f (9 (.. 1 Electrical Lie.. C5- Suprv. LiC.. L f I 'i S '' °' ;�'; , "t` f
Suprv. Electrician signature, required: `I i 1 Subtotal. [ 1:2., 7 Is'
i � _ � �� Plan review (25% of permit fee): ._.
Print name: , L( L s � I State surcharge (12% of permit foe): l t { , 7
"�� TOTAL PERMIT FEE:
Authorized Signature: ' This permit application expires if a permit is rot *tibia 180
days oiler it has ewer accepted as co
Print name: Date: 1 • Number of inspections allowed per permit.
rteNzurenodt•ual cc Ramulnap aoa 07/01/10 . 440- 4813t(11ro5rc0Mnv71