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Permit r1 CITY OF TIGARD ELECTRICAL PERMIT g COMMUNITY DEVELOPMENT Permit #: ELC2013 -00288 13125 SW H Bl Tigard OR 97223 503.718.2439 Date Issued: 05/22/2013 .1 . Parcel: 2S 102AA00906 Jurisdiction: Tigard Site address: 12080 SW MAIN ST Project: Rite Aid Subdivision: PAYLESS SHOPPING CENTER Lot: 4 Project Description: Interior remodel Contractor: ADVANCED ELECTRIC INC Owner: BSM REALTY LLC 21811 NE 58TH ST BY RITE AID VANCOUVER, WA 98682 PO BOX 3165 HARRISBURG, PA 17105 PHONE: 360 - 254 -6864 PHONE: FAX: 360 - 254 -2854 FEES Quantity Description Date Amount 14 crt Branch Circuits wo /Purchase 05/22/2013 $152.64 Specifics: Service or Feeder 1 ea 12% State Surcharge - 05/22/2013 $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 OA 5 90 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: o/V 4 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 603.639.4175 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. MRY 21 2013(TUE) 13: 16 Advanced Electric (FAX)360 25112854 P. 001 /002 Electrical Permit A lica h ti am_ . D r'.Orr oFnc : USE ONLY : ... City of Tigard ]�CC1`ei1 : Per ,5 2 24 mitN ^ 13125 SW IIall Blvd.,'1'i'ard, OR 972 ]t il�� — LC�'Y/'� p " „ • . Phone: �' �1Y 2 2013 Datc! Pali Review �j � / � ∎see t : SU3.718,2439 Fax: 503.598.1 • Penn' : �!/ ■i I]ae /nv: Other TIGARD Inspection Line: 503.639.4175 CITY OF Dab Ready /kiy: luris: ia See Page 2for Internee www.tigard- or.gnv Notified /Method: I . Snppinssentallnformntloa fi r A� � �'` -. '`..,';T„ •,= �'.:.1- '.... t.y,• ,,ei, ,+, D 'R. qtr ":2= - i . .l c-- ....cy.,..,. ,•Z`4 .-.' -'? i 4!', , :zPL, 4 '`i'_- q.w .::._�i'd.. ,d ?-a r! � ^ - :y"1, '. — +' t ❑ New construction 14 Addition /alteration/replacement Please check all that apply (submit 2 sets of puns w/items checked below): ❑ Demolition ❑ Other: ❑ Service or feeder 400 amps or more ❑ Duilding over there stories. where the available fault current ❑ Marinas arid boatyard& F4 �� i s �` `�;yt u� r' ti"; w "r " ,�?,� .',: tecceeds 10,000 am at 150 volts or ❑ Floating buildings. ��y�'y'�3��:.t s, t�, t�L,..n ..� a' r�liCU`�� 1�+! ! y . t �.r.'lrl. + ''I amps 8 u ' " '' ` less in ground, or exceeds 14,000 ❑ Commercial -use ogrlculturd 0 1- and 2- family dwelling Commercial /industrial ❑ Accessory building amps r)rall other installations buildings. .. 0 Multi -family ❑ Master builder ❑ Other 0 Fire pomp. ❑ Installation of75 KVA or { 's l •i ` a�� a 'rytigit f ps a t t " d O r t i,*.,,,&„ i t , fi r, Y r- CI Emergency system, larger separately derived system, r ❑ Addition of new motor load of ❑ "A ", "E", "1-2","1-3", Job no.: Job site address: 1 , r o . ` 0 = n 10011P or more. occupancy. i ❑ Six or more residential units. ❑ Recreational vehicle parks. City/State/ZIP: A N C ) ) • ❑ Healthcare facilities, ❑ Supply voltage Ibr more than i ❑ Hsanloe locations- 600 mills nominaL Suite/bldg. /apt. no.: Project flume: Q :� ❑Service or feeder 600 amps or more. , ;:$ nncrlrtl l' t . , 'ur l. I, , VA + i '1l.c l' t� :. -7 ' --it' Cross street/directions to job site: _-_... Description t rec. total • New residential single- or multi - family dwelling unit, Includes attached garage. Subdivision: Lot no.: 1,000 sq, ft. or less 168.54 4 Tax map /parcel no Ea midi 500 sq, ft. or portion 33,92 I y� ! _ G Limited energy, residential t M '. ,$i.:, SwlLi ∎: 4 , f featkl, TI lS 'Ci [ b IMU C+ ',1 ° +: i+':1�i (with above sq. ft) 75.00 2 `� Limited energy, multi•tatnlly f Y-1/3 residential (with above sq. tt) 75.00 2 l Services or feeders inataltatiou and/nr relocation 1 � t i E VP 200 amps or less 1 100.70 fir' i�S, G7 W o a e ar]g?q { +;1 2 s- ",,.atr'Gi,mi I' it It�a}r.c'flt� . " .+, 201 amps to 400 amps 133.56 2 Name: 401 amps to 600 amps 20094 2 601 amps to 1,000 amps 301.04 2 Address: - Over 1.000 amps or volts 552,26 2 City /StatdLIl': Temporary services or feeders installation, alteration, and/or relocation Phone: ( ) Fax: ( ) r 200 amps or less 59.36 1 201 amps to 400 amps 125.08 2 Owner instillation: This installation is being made on property that I own which is not 401 amps to 599 amps 168,54 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits- new, alteration or extension, perpanel Owner signature: Date: A. Fee for branch circuits with ` " ©',yi r M ";� 't 1 + - •; *uf1 ^ » above service or feeder fee, k:. ( "itirllr+D� j:idL'n� ° - t "tit �.i,` 2 s ° at* each branch eimuit 7.42 Business name: B. Fca for branch circuit without ""` service or feeder fee, first I 1 56,18 � o 2 Contact name: _ branch circuit Each add'I branch circuit I. 7.42 C1(12,ffel 2 Address: Miscellaneous (service or feeder not included) City /Slate/ZIP Each manufactured err modular 67.84 T 2 dweiling and /or feeder Phone: ( ) Fax :: ( ) Reconnect only 67.84 2 E -mail' Pump or irrigation circle 67,84 2 i •., � - Sign or outline lip.hting 67.84 2 ��rr'' x 41I�� 4� "i �' " - ' Jr�� -+ r Signal citcult(s) or limited Business name: /. :• r • ' r panel, alteration, or extension. Page 2, 2 r11C. Each additional inspection over allowable in any of the above Address: 2_1� G % �c - Additional inspection (1 hr min) 66.25/ hr I, City /State /ZiP: vajoctkA �f C� Y t + � i ( . gag 2, indIndustrial Indesti plant ati plant (1 hr min) _ n) 78.11 / 76. / hr hr 1 C� Y rig: ( � L �r� : J�1 �( v1f , �7 (n ` F oX: ('fin 7 � [ pcctinna for wh1Ch no fee is 90.00 / hr CC13 Lie.: q actin listed 'F. hr min �� Elecnical i ' ..u N IA( .'n ,411;:,12 ,411;:,12 n t1![Ii3il fit! h cl , Suprv. Electrician signature, requ 'T �W red. Subtotal: , • + • `� . r Plan review (25% of permit fee): Print name: r il Q., i i iMt tlu 1 ' ,, Date: Azi State surcharge (12% of permit fee): s / TOTAL PERMIT PEE: 1 t7 ✓ Authorized signature: i 1'1111 permit application expires Vet permit is not obtaluetl within 180 Print name: Date: • days after It has been accepted os complete. ,_ • Number of Inspections allowed pupa-ink 1: 10uildinpll 'ttrrlIsNELC- PermitApp.doc 07/01/10 440•1613T(It /u5 /f:6M /WIR