Permit CITY OF TIGARD ELECTRICAL PERMIT
C° • COMMUNITY DEVELOPMENT Permit#: ELC2013 00576
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/26/2013
Parcel: 2S 102AA00906
Jurisdiction: Tigard
Site address: 12080 SW MAIN ST
Project: Rite Aid Subdivision: PAYLESS SHOPPING CENTER Lot: 4
Project Description: (1)branch circuit and low voltage for EMS HVAC system
Contractor: INDUSTRIAL COMMERCIAL ELECTRIC COMPANY Owner: BSM REALTY LLC
29030 SW TOWN CENTER LOOP E, STE.202 BY RITE AID
#159 PO BOX 3165
WIILSONVILLE,OR 97070 HARRISBURG, PA 17105
PHONE: 503-981-2383 PHONE:
FAX: 503-981-0053
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 09/26/2013 $56.18
Specifics: Service or Feeder
1 ea Signal circuit or Limited 09/26/2013 $75.00
Type of Use: COM Energy Panel
Class of Work: ALT 1 ea 12%State Surcharge- 09/26/2013 $15.74
Electrical
Type of Const:
Occupancy Grp:
Total $146.92
Required Items and Reports(Conditions)
This pe ' is issued subject to a regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be don in accordance with appro -d pl. . 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 ref es you • follow the rules adopted by the Oregon Utility Notification Center. Th. e rules are set forth in OAR
952-0 1-0010 thro gh OAR 952-001-6,90. Y•/m.y obtain a copy of the rules or direct questions to OUNC by calling 503. .2. 987 or 1.8 MD'
Issue By: L % I/I�i Permittee Signature: I . A
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' A 11011a /j 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.
•
Electrical Permit Application FOR OFFICE UNE ONLY
City of Tigard Received Permit No.: s
z_e#2U 5.60 57
13125 SW.Hall Blvd.,Tigard,OR 97223 Date/B 9 Oryi,
Plan Review
•
- el' `- Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Other Permit:
Ti ;ARD Inspection Line: 503.639.4175 Date Ready/By: Juris: El See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW _; a'
❑New construction Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked below):
❑Service or feeder 400 amps or more ❑Building over three stories.
❑ Demolition ❑Other: where the available fault current ❑Marinas and boatyards.
CA ECORY 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 Commercial/industrial ❑Accessory building amps for all other installations. buildings.
❑ Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system.
❑Addition of new motor load of ❑"A","E","I-2","I-3",
Job no.: 1 I I-7 Job site address: j2tx6o 5(A) m 1 00HPormore. occupancy.
Q Si-• ❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: �� ❑Health-care facilities. 0 Supply voltage for more than
1 ►3a C)� 7223
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: - -Project-name: h 6.-m S ❑Service or feeder 600 amps or more.
ry( - L 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: Lot no.: 1,000 sq.ft.or less 168.54 4
Ea.add'I 500 sq.ft.or portion 33.92 I
Tax map/parcel no.: Limited energy,residential
75.00 2
DESCRIPTION OF WORK (with above sq.ft.)
•
/ G / G �G Limited energy,multi-family 75.00 2
OW Cie. (-Q/ C�� y// C residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
❑ PROPERTY OWNER ❑ TENANT 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
Address: 601 amps to 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:( ) Fax:( ) relocation
200 amps or less 59.36 1
Owner installation:This installation is being made on property that I own which is not 201 amps to 400 amps _ 125.08 _ 2
intended for sale, lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 599 amps 168.54 2
Owner signature: Date: Branch circuits-new,alteration,or extension,per panel
APPLICANT ( CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee,
7.42 2
Business name: each branch circuit
B.Fee for branch circuits without
Contact name TO m C I- L '� service or feeder fee,first 1 56.18 fj 6, 2
11 branch circuit
Address: Each add-1 branch circuit 7.42 2
Miscellaneous(service or feeder not included)
City/State/ZIP: Each manufactured or modular
67.84 2
Phone:(SO?)°f Z 3 2j 3 (�3) 9 a 1— dwelling,service and/or feeder
�- Fax: 603
L Reconnect only 67.84 2
E-mail: 40 me lc e Le,e_i eC Tv i C ° Co Y "i Pump or irrigation circle 67.84 2
CONTRACTOR NTRACTOR Sign or outline lighting 67.84 2
Business name: d ti fr 1 J CO M nn erc,ct. e I e c - Co- Signal circuit(s)eru or limited-energy / See
r panel,alteration,or extension. Page 2 2
Address: ZGj 0 3v S(/J \ 0 n c•e rj ter^ L P c.1€202_ 14-(SI Each additional inspection over allowable in any of the above
City/State/ZIP: W 1 lsol�U 1 11€ DP- °l7o 7 b
Additional inspection hrimi(I hr min) 66.25/hr
Investigation(I hr min) 66.25/hr
-
Phone:(.5;03) 9 g l-23 c6_3 Fax:( ) Industrial plant(I hr min) 78.18/hr
k.p Inspections for which no fee is
CCB Lie.: (6y goy Electrical Lie.: G. Z Suprv. Lic.: 3 j ,C ill' specifically listed(%3 hr min) 90.00/hr
Suprv. Electrician signature,required: l� i , 10 ' ELECTRICAL PERMIT FEES .W 1
J �r Subtotal: /7 •t
Print name: .O 6 S 6 r L l th Date: 9 12 ) Plan review(25%of permit fee):
((((����,,,, [[[��� 1 State surcharge(12%of permit fee): 15.7 y
Authorized signature: �,�A/1„ )a TOTAL PERMIT FEE: /4/6. �q 2,
��JJ r This permit application expires if a permit is not obtained within 180
Print name: l h dY1/l Q s G G Date: J f 3 days after it has been accepted as complete.
` • Number of inspections allowed per permit.
I:\BuildingiPennits\ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013 440-4615T(I I/05/COM/WED
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY:
FEE,SCHEDULE •
Fee for all residential systems combined $75.00 neeripfinn I Qty. I Fee L Total I •
Renewable electrical energy systems:
Check Type of Work Involved:
•
5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* -
15.01 to 25 kva 200.34 2
❑ Burglar Alarm Wind generation systems in excess of 25 kva:
25.01 to 50 kva 301.04 2
❑ Garage Door Opener* 50.01 to 100 kva 552.26 2
• >100 kva(fee in accordance with 552.26 2
❑ Heating, Ventilation and Air_Conditioning OAR 918-309-0040)
System* Solar generation systems in excess of 25 kva:
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: Each additional inspection is
charged at an hourly(I hr min) 66.25/hr
Inspections for which no fee is 90.00/hr
specifically listed(%2 hr min)
COMMERCIAL WORK ONLY: _ ELECTRICAL PERMIT FEES
Fee for each commercial system $75.00 Subtotal:
(SEE OAR 918-309-0000) Plan review,if required(25%of permit fee):
State surcharge(12%of permit fee):
Check Type of Work Involved: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
❑ Audio and Stereo Systems days after it has been accepted as complete.
• Number of inspections allowed per permit.
(1 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 J
Total number of commercial systems: /
*No licenses are required. Licenses are required
for all other installations
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12080 SW MAIN ST, TIGARD, OR, 97223
Commercial - Electrical
199 Electrical final
2013-10-28 (null)
ELC2013-00576
PASS - No C of O
Violation Summary:
Inspector Contractor