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Permit CITY OF TIGARD ELECTRICAL PERMIT js . ` COMMUNITY DEVELOPMENT Permit #: ELC2013 00031 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/16/2013 Parcel: 1S134BC00300 Jurisdiction: Tigard Site address: 12240 SW SCHOLLS FERRY RD Project: Rite Aid Subdivision: WINDSOR PLACE Lot: 32 Project Description: (14) branch circuits alter 14 ckts Contractor: ADVANCED ELECTRIC INC Owner: FW OR- GREENWAY TOWN CENTER LLC 21811 NE 58TH ST PO BOX 790830 VANCOUVER, WA 98682 SAN ANTONIO, TX 78279 PHONE: 360- 254 -6864 PHONE: FAX: 360- 254 -2854 FEES Quantity Description Date Amount 14 crt Branch Circuits wo /Purchase 01/16/2013 $152.64 Specifics: Service or Feeder 1 ea 12% State Surcharge - 01/16/2013 $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 / 5 -001-0090. You may obtain a opy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: � rl" " _. l t A ` Y T ��c. - t`Y( Permittee Signature: / v rTICAL f 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. JAN 15 - 2013(TUE) 09:11 Advanced Electric (FAX)360 2542854 P. 002/002 EIectrical Permit Application RECEIVE I FOR OFFICE USE ONLY City of T i g a r d u e e c i v e e (( / 40/13 sr Perm �L' Permit No.: 9 013 - 000 31 13125 SW Ilan Blvd., Tigard. OR 97223 J A N 1 5 2013 Dates Plan Review °tiler Pertni8 uP e j i a • VU J-3)-- � OIF V ' • ' Phone: 503.7182439 Fax: 503.598.19t � nateDate/Br Ti GAR!) Inspection Line: 503.639.4175 D Date Ready/By: 1u El See Page 2 f Internet www.tigard- or.gov BUILDINGDN[sin , Notified/Method: � l Supplemental Information — ❑ New construction ❑ Addition /alteration /replacement Please check all that apply (submit j sets of plans whims checked below): & PD (( A ❑ Service or fader 400 amps or more 0 Building over three stories. ED DCmoli gOlhcr: re IM.V Le whc,e the available atilt current 0 Marinas and boatyards. -- : -. n .Mr�r Zys , .r' a., mr.h _ +? ' ': exceeds 10,000 am at 15 U volts or eL= ��+;���+. K; �CO �- F cgl�`>rx��io . Its ❑ IYoating boitdingc less to grotrod, or exceeds 14,000 ❑ 1 - and 2 - family dwelling CI Commercial/industrial CI Accessory building amps fbr all other installations. ❑ buildings Commercial-use agrictdturnl ❑ Multi family ❑ Master builder 0 Other. El Fire pump. ❑ Installation of 75 INA or W Y— El Emergency system.. larger separately deri system. U tik '' �- 1d N 'M ❑ ArWitbm or pew motor toad ar ❑ °A ", -11"."i.2%"1-3". Job no.: lob site address. �1 �//�, �! a 100HP or mote. occupancy. �'+ p�`(v $4) - I m + ry /4i. ❑ Six or more residential units. ❑ Recreational vehicle parks. City/Stale/ZIP: -- - - e # - , ❑ I lealth.ro fatilIdes. ❑ Supply voltage far more than • ❑ Hazardous Iocattr s. 600 volts nominal. Suite/bldgJapt no.: Project name: t /4‘ 1 ❑ Service or feeder 600 amps or more. Cross street/directions to job site: � � a 1 1 / 1 7. J rats 1 - row 1• New residendal single- or muld- family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft or less 168.54 d Ea aril 500 sq. ft or portion 33.92 I Tax map /parcel no.: Limited energy. residential t . '— _DFk - . R '101.5.tW61 •' ;M.: (wish above sq. lt.) 75.00 2 A t- Limited enerT multi- family 75.00 2 [ ,1,1�, residential (with above sq. R.) Services or feeders installation, alteration, and/or relocation X 200 amps or less 100.70 2 a it_ . ;F : 4 F 4f 201 amps to400 amps 133.56 2 401 amps to 600 amps 200.34 2 Name: _ 601 amps to 1.000 amps 301.04 2 Address: Over 1.000 amps or volts 552.26 2 Temporary services or feeders installation, alteration, and/or City/State/ZIP: relocation Phone: ( ) I Fax: ( ) 200 limps or less 59.36 1 Owner installation: This installation is being made on property that 1 own which is not 201 amps to 400 amps 125.08 2 intended t 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 r • . net Owner signature: Date: A. 1'ee for branch circuits with Ar_ 1 . : e, - �r above service or feeder fcc, ((l�ls_ ©�I�A+ty 7.42 2 each branch circuit Business name: B. Fcc for branch circuits without service or feeder fee. first , 56.18 c I g 2 Contact name: branch circuit �• Each add'l branch circuit `3 7.42 151 tiegp 2 Address: Miscellaneous (service or feeder not included) City /Slate/ZIP: Each manufactured or modular 67,84 2 dwelling. service and/or feeder Phone: ( ) I Fax: : ( ) Reconnect only 67.84 2 E -mail: . Pump or irrigation circle 67.84 2 Sign or outline lighting 67.84 2 .eta=._s=ue-. :a''. .'.lS!'2? C:CORi T_ :'M — Signal ciccui M \.) t(s) or limited�nergy Business name: kv viz") £ e 1 r panel a or extension. c on Page _ 2 T Each additional Inspection over allowable In onto( the above Address: 2., 6 11 (k)k „-- 0 . f h A 3( {{ .- Additional inspection (1 hr min) 66.25i br City/State/ZIP: ( I/ � Q[ Tnvestigation (1 hr min) 66.25/ hr City/State/ZIP: coil v " _ 4 -' f'T ' r?�� Industrial plant (1 hr min) 78.18/ hr Phone: (360 2 .. G Fax: (W) Zay -Begs-y Inspections for which no fee is specillea4 listed 04 hr mint 90.00/ hr CCB Liu.: •, Electrical Lie.: 4 ;14 . Suprv. Lie.: ` : "a?,- :,= : c;'1GCzl;Eiimu pganiragasp; ww Suprv. El - i S rcqu ,i� Subtotal: (S'a2 , +QH _ ..., i i Plan review (25 %of permit f ee): _ 3 8, ( b Print name: , L , Date:, / 1 ` S1nte surcharge (12% at permit fee): f 8 ., '� 2 / TOTAL PERMIT FEE: A.09 1 Authorized signature: This permit appllndou expires Be penult in not obleined within IUD Print name UatC. days after It has been accepted as complete. • Number of inspections allowed per permit. 1: 113aildingUbrmits \P].GPennitApp.doc 07/0U10 440- 4615T(II/05 /C0M/WL0 1 Id