Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2010 -00062
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 02/05/2010
Parcel: 2S115BA02500
Jurisdiction: Tigard
Site address: 16200 SW PACIFIC HWY X
Subdivision: Lot: 0
Project: Marshalls
Project Description: (15) branch circuits for TI.
Owner: FEES
SN PROPERTIES PARTNERSHIP Quantity Description Date Amount
1121 SW SALMON ST 15 crt Branch Circuits 02/05/2010 $160.06
PORTLAND, OR 97205 wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 02/05/2010 $19.21
Electrical
Contractor:
ACCESS ELECTRIC & CONSTRUCTION
2870 SE 75TH AVE SUITE 108
HILLSBORO, OR 97123
PHONE: 503 - 642 -4333
FAX: 503 - 642 -9699
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $179.27
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 accordan = 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. ATTE N: Orego law .. uires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set, forth in OAR
952- 001 -00 through OAR 95 '11-011 r. may obtain a of the rules or direct questions to OUNC by calling-863116.6699 or 1.800.332.23'4.
Issued 624 /IAA- 3 . Permittee S i g n a t u r e • ' ••. , %� I
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 I TALLATION ONLY
SIGNATURE OF SUPR. ELEC' lLJ, Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
•
' . 02 14:32 1 ACCESS ELECTRIC PAGE 03/03
Electrical Permit Application FOR OFFICE uSl; ONLY
City of Tigard EIVED D`t a « /0 Q'� Permit No.: ac k, .. 0,040.2 It 13125 SW Hall Blvd., Tigard, plan Review \ w� J
Phone: 503.639.4171 Fax: 503.598,1960 Date/By: Other Permit:
TIGARD Inspection Line: 503.639.4175 FEB 0 4 2010 DateReidyBy: lure' El Sec Page 2 TOT
interact www.tigard- or.gov Notified/Method: -li Supplemental Information
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. m • ..va,•,''. �a. a . ; ., •R y � . !�1 .N'''va -•I �i ? ,5' - ".' i "' ca "• yrt..�r-;et:r..r; „ is ' e .,,...m r, r,,, .rx .' "i"b' ;: .i,.
❑ New construction Addita h/�tuir f3CC Cttt Plwse check all that apply (Submit ? setc of plans w /items checked below):
❑ Demolition ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Other: where the available fault current ❑ Marinas and boatyards.
1, , m, T ; 3 1g r , � g. - i iti r,,WF- ell;fi A :.r'r 150 Its ttt
('; r ''I : 't tl:;d"'+ ,,f;a �1 � ��'1�. C �{�,� qty �.' , �5 r'e,zti ..>r �:i�' �ll�l' ;M exceeds 10.000 amps al va ❑ floating buildings. .. ! S'";:";'•, : °'•� ,iei ;:f; . :; •S -1•-'. i ,- i`. J< . • .. r 13 W:a'!� it 'a 51 �SWh l c gli "!v.. .
.1 J. 6' I:• r" ,t :,, ,,:-�: v x. c •; ..,,:; r.�..._ h, at.,wlYlnl,meR mtaKn' ?t:*• d less to Rround, or exceeds 14,000 ❑ Commercial•use agricultural
❑ 1 - and 2- family dwelling Commercial/industrial ❑ Accessory building amps for all other installations. buildinto,
❑Multi- family U Masterbuilder ❑Other: 0 tire pump. O Installationof 75KVA or
ll.= ",q• ' ` •; yy r....� ry •• i]Emmx
larger tel derived stem.
� lr,. r4 ;r� iiItti s ;l .� • okli iyyt tAti (te'.g.i/ iarri' iiii.allAIIP gar separa y system.
.. '`r�¢��{'�ta... 1'' t`,,,; •1. -..1 G+:�- :;' ;'• -„nm �•1irt�.. M+x•ry �; yy�. t,• rv••, �' a-. 4 � L'"' R,,!' tMt,,G •!`Sr?4.01'q}'6b5f'fS„2!S?i!l 1,4 Addition of new motor load of ❑ ••A � ••E , ••t •Z••, - 1-3".
100tW or more. Occupancy.
Job no.: 51 Z7 Job Site address: 1 (o/.p() St..) PACT ❑ Sit or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: ¶ 4- �Q a -f C ` � ❑ Healthcare facilities.
ID Supply voltage for more than
v 1 l ❑Hazardous Iowlions, 600 volts nominal.
Suite/bldg./a no•: Projec name: VA � .{r) t[t��/� t I ❑ Service or feeder 600 amps ormore.
rTK� ,t ' ir♦f lm. I �r�! . ..
Cross street/directionsto job site: ;�' i ll ' " "`J "" � Fee. 1 T `'t >''Nr.: ^!1'';'
...... Description , Fes J Tolnl
New residential single- or mule- family (welling unit.
Includes attached garage. _
Subdivision: I Lot no.: 1,000 sq. ft. or less 145.15 • 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no„
..r �t'�in ;r ;!i'L"Su ti G t° 4 ,y / ! w � ,
w,( �,'.�. M Limited energy, residential
lil 1 44 . k it u f : ' .;a 'd y 1� . 1u't"T 1 1t ! R i l' Q"1'41 d r;s( 1 i__.C t� ''':,,M,,,.:. Ti” �{' �� ' a`' T (with above ft) 75.00 2
:7 .�. ':`I,I..re1� .�rr ,g .• . e, ! 4, /-, ' n - ' ;d•..J 1• t t 7, . ( sq.
«�' Limited energy, multi - family
.L-- . C..004efv Q.t Ji tstwi* residential (with above sq. it,) 75.00 2
p , Services or feeders installation, alteration, and/or relocation
IAe.t .. t.b - lam LA � . 200 amps or Ics. 80.30 2
Ali :ti a�i (i:i S ��' m' c !q:. ! ;'kip: n 17r•:i)mr`U'. 1 �mAa:d�.¢n,,.q � k r.., '
41 !.'t I _.01 1 ;.f ,M , . rlTr rw iii ��r I".J
uY.! ��- ! �'' a. ;. t�.;,w:, � , +f,�. r�;�: 201 amps to 400 amps lo6.R5 2
Namc: t 401 amps to 600 amps 160.60 2
Li. L•r �t y' ..
601 amps to 1,000 amps 241.1.60 s 2
Address: Over 1,000 amps or volts 454.65 2
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City/State/ZIP: Temporary services or feeders Installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 I
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2 -
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 _ 2
_ Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: _ _ _ A. Fee for branch circuits with
i:S�l' ',:gl I'glLga i'i '�' G¢s: ; l ? ,,. ra �:C ui i '
C l'S: Ifl '
a,� i, i 4.'PM ?, e1:0011"° ; 4' : "': ' is ;!! ;` +'= i „: �,.. . ' 41 i-, t a service or feeder fee,
v: „ 6.65 2
each branch circuit
Business name: 34,,% �.!`�
B. Fee for branch circuit;
without service or tee(er tee, S 2
Contact name: 4G,8'
first branch circuit
Address: Each add'I branch circuit i yA
Miscellaneous (service or feeder not Deluded) p ,/. ��
City /S1ato /ZIP: Each manufactured or modular
dwelling, service and/or feeder 90,90 2
Phone: ( ) I Fax: : ( ) l
R econnect only 66.R5 2
E - mail: Pump or irrigation circle 53,40 2
..,.:... "•I g� t•: n , ilri ..Y,: ;tt yy ��,, ry,.,:l "i -
,- ..,..y ,. ,•.:,�t,:5.,� .. ., . . 1 ,��.,,. �`�' 1��i�'�,'V11Y::� ;,� ?; �..., i« ::'.1:.' ;�F� 1:':l, � i'r:” :- ::••:}:� outline lighting 53.40 2
....� -. ... .,- n .. .„ � :..................- „ ��...� , :H: Grua. �' 1lii:•, �.:� „vwt ;a'�JI” ;'iPi , :yK��GE
Sign at o
Business name: ' , .. ; ,.w�. signal circuit(s) or limited-
!♦ ce_L - 5 pc- f C•4, tl;;.. energy panel, alteration, or
Address: 7 4 e5 '7 AvF. ___...04.1 S D 2i cxtcnsion. i eseribe: Page 2 2
City/State /ZIP: 1 t t o �� Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (1 2 t_ i-r z , Fax: (5b (oy 2, _ 1 �q I
�{ ` uveStigotivn per hour p lu min) 62.50
CC:B Lie.: L 12V` 1 1 Electrical Lie.: C 1( Suprv. Lie.: t{ IN S Industrial plant per hour 73.75 ,,/�
Supry Flt t triuiw! signature, r V 6 (� --- C { ? ; )� ;,:4i: ;; x, 1� 1;l"tTFCCiII� I�E1l ; k' '.!• „': (/f
equired: '�1 a ..,' ..
Subtotal: w
Print name: Data: TA Plan review (25 %ofpemilt fee):
-• - -•- 0 State surcharge (12% of permit fcc): /-I '�
Authorized signature: TOTAL PERMIT FEE:
Print name: Date: This permit application expires if n permit L, not obtained within 15
days after it bete been accented as crimpleg_ .
• Number of inspections allowed per permit. V
t:\Buil sing \rermiIstel.C- Permltspp.Me nslz7mr 440 46157(1IJ05/COM/WEB