Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
•
1111 a C OMMUNITY DEVELOPMENT Permit #: ELR2013 00128
T E G AA O 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/12/2013
Parcel: 2S102AA00906
Jurisdiction: Tigard
Site address: 12080 SW MAIN ST
Project: Rite Aid Subdivision: PAYLESS SHOPPING CENTER Lot: 4
Project Description: Data telecommunications system for new register area.
Contractor: AUXIUM SYSTEMS INC Owner: BSM REALTY LLC
P.O. BOX 755 BY RITE AID
FAIRVIEW, OR 97024 PO BOX 3165
HARRISBURG, PA 17105
PHONE: 503 - 512 -0870 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Restricted Energy Permit 06/12/2013 $75.00
12% State Surcharge - Electrical 06/12/2013 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: Y Fire Alarm: N
HVAC: N Instrumentation: N
Intercom/Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N Total $84.00
Other Desc: 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: _ � �� Permlttee 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.
06/11/2013 13:39 5032562193 FEDEX OFFICE 5153 PAGE 01
Electrical Permit ApplicaUCEIVE
D ,..,,,,, OFFICE 1.1S1 ()NIA
City of Tigard EffillriiffAr li• 1=117ME'M .•
1 111 4 .- .I 13125 SW Hall Blvd., Tigard. OR 97g3 1 1 2013 Plnn Emileve
• Phone: 503.7113.2439 Fax: 503.598.1960 Date/B : Other Penn& p g • / _ 0 I
TIGARD InspectiCm Lino: 503.639.4175 CITY OF TIGARD Mille Ready/By; MI Eg Sc c P n Re 2 for
Internet: www.tigard-or.gov BUIT DING DIVISION Notified/Mobil& SupplementnlInformation
...•,,, 4f1t,t l' rjetlElty,wtir,
,,. :;%'7.4 • ; 4 r .......ts:: ;•:: , 4- ..;• „,.4,-- c '!„ •.:-t...,.., .;=.1'1,-.4:,‘4,1..-;:.Az4_,, ,, .4 . . • • . ,•• - +. • • .- --• - — - - • • -
Please check all that ripply (submit Z Bog of plans w/itcms checked below);
0 New construction g
Cl service or feeder 400 amps or more 0 Building ever three stories.
1:1 Demolition ID Other: where the imitable fault current 0 Marines end boatyards,
-
.....!::;,:...,..:Z,.):-.;:r•::::.-ii.',!,.,;:6-.:..7...;?:-:;■VicitreTtilliftitittiNgtailettel(N!;.0.;y;-,.i.:'*i..:.,e.:Y‘47'.??4". exceeds 10,000 amps at Isn volts or 0 Floating buildings.
. ,7i ,,,,....... ... . .. 7. ,....2,-,...-- „ ,,,- -,_ ..„ --,.. ..:i„.f...i,....4.._NL-ft.rg-:.: ....'?",. r,...t.' ICSP 90 itnnmil. or execods14.000 0 c ag ricultural
ID I - and 2-family dwelling TiTornmercial/industrial 0 Accessory building amps thrall other instnllatirMa. huildinen.
D Multi-family 12 Master builder 1:1 Other: 0 Fire pump. 0 installation of 1 50 KvA or
Z (urger SCprtrately derived system,
1, ..!; , ?•!....'-' 4 ",-AIR:1"..e''..':'ye-: .7 '001fttitigttitttiertIX:$ki i iiiikibbitifititf;;;: - '' 1 . 2 "ig ' s":" . V -21:: :'il":' 0 Addition of new motor lead
Job no.: 1 Job site address: i cx4.0 ,7c__..- /714 ,...
,,,,,_ I nt114P nr more.
0 $il or more residential un 0 its. occupancy,
Recreational vehicle parka.
City/State/ZIP: -777 4 ase'10 C P grttor 2 2 -.3 0 tlealth-care facilitiei. 0 Supply vollnge kw mon thnn
-**$ 0 Hazardous !annum. 600 volts nominnl.
Suite/bldg./apt. no.: Project name: g I IT_ 4 ,Ne,i D Service or reviler MO amps or =Ire,
: .' 1 : ; : :. .. , '&r.; .'
Cross strcct/directions to job sitc: DOM t_ .0 • 11111132■111•BMMIN •
New residential single- or multi-family dwelling unit
Includes attached garage.
Subdivision: I Lot no.: i.000 sc. ft. or less 168.54 4
Es. ruld'I 500 sq. ft or portion 33.92 I
Tax map/parcel no.: umited energy, residential 75.00 2
1
::. ,.t :ir (- nivve mi. ft
Limited energy, multi-fnmtly
464 Cob/es residential (with above sq. ft,) 75.00 L. 2
— Renewable Energy . • - . -CI See Page2
7.- l ' - v - 4 71. 'Ke..., . services or feeders installation. alteration, and/or relocation
-1,14tottittivit •.:; :. ; ;Ii -it.• : •;;;:jatki5mvi:...7 . : - .., •.;.;. ,, It 200 amp ll Or 1CSS 100.70 2
201 amps to 400 amps 133.56 2
Name: A 4 : A/ 401 401 limps to (0f) amps 200.34 2
,
Address: 601 amps ho 1.000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation. alteration, and/or
Phone: ( ) I Fax: ( ) relocation
. 200 amps or lez.s 59.36 1 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 4011:imps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. -
401 amps to 599 imps 168.54 2
Owner signature: Date: _ Branch circuits new, alteration, or extension, per panel
'e-f;;:.4-:-:A.4-1,'",Aff7.70,111.1tatitri;z,);-,..-..:.,:+1,1..:J.7...:-27.,:kil4towAt.. ,fitittolt. A . Fee fOr branch circuits with
above service or feeder ibe,
Business name: . each branch circuit 7.42 2
B. Fee for branch circuits without
Contact name: service or feeder fbc, first
branch circuit 56.18 2
Address: E a dd.' bra TICheirC1,42
City/State/ZIP: Miscellaneous (service or feeder not included)
Each manufactured or modular
Phone: ( ) I Fax: : ( ) dwelling, service and/or feeder 67.114 2
Reconnect only 67.84 2
E Pump or Irrigation circle 67.84 2
,.....,,-,.■,,„...,,.,,,,., p.,;,,, z .,,„:.„,,,..%t ; , .,..., ..„.- ., ,,.. , .. , , ;•,,, 0 ,,,,...,.. ,-,,? r. - •.,......- .., ...: - -- ;-C: ....., .... Elfm or outline lighting 67.84 2
..-
Business name: j 4 L ,../ ... ,‘.--, 4 4 €47 S 1,4,07 .. - L., 0 Signai circuir(s) or limital-cncrgy 1 Scc - _ cc!
' ---v i _ panel, alterntion. or extension. I Pap 2 f :-.. 2
Address: r 0 0, A (..;,,,..- 775--- Each additional inspection over allowable in any of the above
Additional inspection (1 hr min) 66.25/ hr
City/State/ZIP; P: 4 2 vf .e. ,-,..., { OR ') 70z et Invcstigntion (1 hr min) 66.25/ hr
Phone: (",2 --- - 7 0 I Fax: ( ) Industrial plant fl hr min) 78.18/ hr
Inspectionn for which no *c is
CCB Lic.:IQ i 2.. 1/4/ Electrical Lic.:3 . ( >•`-' Sup . Lic.: ccr 2.77 ,.. specifiotlly listed VA hr min) _ 90.00/ hr
i 7/0 al is. A +.,- 1 ...... , _, • . - ' . ,......:.' . . 2 r
Suprv. Electrician gn / tu .required: t 0/t h . " i.,,sidi Subtotal: - 7 5', '
Print name: L,..t. ge.„./ ,)192:f r'' Da • : ..67/ V / 3 Plan review (25% of permit fee):
v..
State surcharic (12% of permit fee):
Authorized signature: ....,.././..--C.....---C- TOTAL PERMIT FEE: ?-; ,--
...,--- This p ermit pp
aendix' orplren if a permit Is not obtained within 180
Print name: ( ,..„ ' I:PC Date; 6 (// cluyt after it has been accepted no complete.
' Numbor of inspections allowed per permit.
littbi i !din EnPerralts \ 0 LC_ f ormit App..ELII....atta.ttne Rev 02/2 I /2011 4411 r(11103/COMAM
Pe 1i - -- itie - /6 --- 6 TD ,12.a u X / it A
............___
06/11/2013 13:39 5032562193 FEDEX OFFICE 5153 PAGE 02
Electrical Permit Application — City of Tigard
Page 2 — Supplemental information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
-.. :1., ,,r ���7: � ..: r naettntltm I Qt I Pee 1 ,; 1.0.1 .tal � .
Fee for all residential systems combined $75.00 Renewable electrical energy system.:
Check Typc of Work involved: s kva or less 100,70 2
5.01 to 15 kvn 133.56 2
❑ Audio and Stereo Systems* 1 5,01 to 11 kva 200.34 2
Wind generation systems in excess of 2 kva:
n Burglar Alarm 25.01 to 50 kva I 30104 2
S0.n1101n0 SS..zF
❑ Garage Door Opener'
>100 kva (fee in accordance wi th 552 26 -
OAR 919 - 309.00 ,
❑
Heating, Ventilation and Air Conditioning Solar gencrntion systemut in execs of 25 kva:
System* ,
Each additional kva over 25 7. 42 3
❑ Vacuum Systems* >100 kva - no additional charge 0.0 3
Each additional Inspection over allowable in any of the above:
❑ Other: Fach additional inepcction is 6615/ fir
char)tcd at an hourly (Lhr min)
lnapcctions for which no Fcc it 90,00/ hr
spccifictlly listed C/211: min)
0 E ORKON .. _. .,; : ;,:i ...:7' . : . .....';:l > LEC RICAt`PERhII'F'
Fee for each commercial system $75.00 subtotal:
(SEE OAR 918- 309 -0000) Plan review, if required (25% of permit fee): _
State s erchur<ge (12% of permit fcc):
Check Type of Work involved: TOTAL PERMIT FEE:
'flits permit application expire. if a pennit It not nhtulned within IRo
❑ Audio and Stereo Systems oiler It hn5 been neccpted ibt complete.
• Number arm: pee :one allowed per permit.
❑ Boiler Controls
❑ Clock Systems
Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting`
❑ Protective Signaling
n Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1,ouil2ia,:trr•wra L PvrrntAop ELR F.R ?.Jot Rvm n5 /2 1 /2x.13
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12080 SW MAIN ST, TIGARD, OR, 97223
Commercial - Electricial Limited Energy
199 Electrical final
06/24/2013 00:00
ELR2013-00128
PASS - No C of O
Violation Summary:
Inspector Contractor