Permit Ali - ..
', ELECTRICAL PERMIT
CITY OF TIGARD E: , COMMUNITY DEVELOPMENT Permit #: ELC2010 00183
i 1 3125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/20/2010
f71G'AeR00 Parcel: 2S102AA00906
Jurisdiction: Tigard
Site address: 12080 SW MAIN ST
Subdivision: Lot: 0
Project: Rite Aid
Project Description: Remove and replace 5 existing disconnects with new disconnects for 5 new roof top units
Owner: FEES
BSM REALTY LLC Quantity Description Date Amount
3176 AMERICAN SADLER DR
PARK CITY, UT 84060 5 crt Branch Circuits 04/20/2010 $85.86
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 04/20/2010 $10.30
Electrical
Contractor:
ATLAS ELECTRICAL CONTRACTORS
4403 SE ROETHE RD
MILWAUKIE, OR 96267
PHONE: 503 - 659 -2212
FAX: 503 - 659 -4944
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $96.16
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 -0100. You may oobtain copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.8000.3
Issued By: 61 t�LC�I Permittee Signature: �� Q��I L 'd_r
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 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.
Apr. 16. 2010 1:46PM Atlas kttEtvCED actors Inc No, 8125 P. 1
Electrical Permit Application voR OFFICE USE ON1 ,Y
City of Tigard APR 1 6 2010 Received
, 4 13125 SW Hall Blvd., Tigard, OR 97223
1 I : PhOne: 503.639.4171 Pax: 503.598.1960crry
114 natenly: Permit No,:6 -061a3
Other Permit
Plan Review
Inspection Line: 503.6394175 n See Page 2 for
a: 1?1
TIGARD BUILDING DIVISI ID 1:14:17fiReedlactmre/Biz Io
:
Intoner Ivww.tigard•or,gov OF TIGAR li DateiBy
Supplemental information
in]L! '; ' ji:. irriir..::;':.:
L4 \ lt .':: .:'1 ,:: .0. ':.:::.".:.'fit: 'Ifa . ..:'"f'::,:;; . " •
0 New construction IM Addition/alteration/replacement Please check all that apply (submit 2 sets of plans whims checked below):
0 Service or feeder 400 amps or more 10 Building over three stories.
El Demolition 0 Other: where the available fault eunenl 0 Marinas and boatyards,
aiit .!,i::,;:•. exceeds 10,000 amps at 150 wits or 0 Floating buildings.
len to ground. or exceeds 14 nu
,000 0 Conercial.use agricultural
0 J- and 2-family dwelling El Commereiallindustrial El Accessory building amps for ell other installations. buildings.
0 Multi 0 Master builder 0 Other: (3 Fire pump, 0 Installation of 75 KVA or
d;=;,.,,":i• elr,L, "'■e''':;n IL .1 ' ' ' ' iii■ I' A ND ' ; ,4a.ki:i'..,::::.:,.. l:::F.i .:ff.. ° gYstem" larger separately derived system.
':'; 0 Addition of new motor load of CI
Job no.: 19096 Job site address: 12080 SW MAIN STREET i0OHP or more, occupancy.
__
ID Six or more residential units, 0 Recreational vehicle parks.
City/State/ZIP; TIGARD, OREGON 97223 ['Health facilities. 0 Supply voltage for More than
0 Ha2ardons locations. 600 volts nominal.
Suite/bldg./apt. no.: Project name: RITE AID 0 Service or feeder 600 amps or more.
' ,...:::; ' ,:; . ;:.■ : ,:.;,: : :: ' ,!, , ,'; : . ; :"j,:!qi!',*'0,,,;$.040):(41 iK;g
Cross street/directions to job site: DeleiptIon I 01v. I Fee. 1 Totot 1
New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq, fl, or less 168.54 4
Ea. add'1500 sq. ft. or ponion 33.92 1
Tax map/parcel no.:
Limited energy residential
Sititijirtjt(W]t) (with above sq.11, 67.84 2
Limited energy, multi
REMOVE AND REPLACE (5) EXISTING DISCONNECTS WITH NEW residential (with above sq. ft.) 67.84 2
Services or feeders installation, alteration, and/or relocation
DISCONNECTS FOR (5) NEW ROOF TOP UNITS. 200 amps or less 100.70 2
Piii,j0 '::: 201 amps 10 400 amps 133.56 2
Na 401 amps to 600 amps 200,34 2
me:
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, allera riot], and/or
City/State/ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or less 59,36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which Is not
intended for 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, per panel
Owner signature: Date; A. Fee for branch circuits with
above service or feeder fee,
A.,!14.PANT.':;1:::.!::.7. :'::::1' : ,:;.,.......1,17:,.:.q.,.„.:R...p......::::,...:7, each branch circuit 742 2
Business name: ATLAS ELECTRICAL CONTRACTORS, INC. D. Fee for branch circuits willow
service or feeder fee. !lilt 1 56 18 56.18
. 2
Contact name: TY SHEPERSKY branch circuit
- Each add'lbranch circuit 4 7.42 29.68 2
Addrcss: 4403 SE ROETHE ROAD Miscellaneous (service or feeder not included)
Each manufactured or modular
City/State/ZIP: MILWAUKIE, OREGON 97267 67.84 2
dwelling, service and/or feeder
Phone: (503) 659-2212 Fax: : (503) 659-4944 Reconnect only 67.84 2
Pump or inigation circle • 67.84 2
E-inail:
. Sign or outline lighting 67,84 2
0001! ::•1:;':: Signal circuil(s) or limited.cncrgy
Business namc: ATLAS ELECTRICAL CONTRACTORS, INC. panel, alteration, or extension, Page 2 _ 2
— Each additional Inspection over allowable In any Of the above
Address: 4403 SE ROETHE ROAD Additional inspection (1 hr min) 66.25/ hr
Investigation (I hr min) 66.25/ hr
City/State/ZIP: MILWAUKIE, OREGON 97267
Industrial plant (1 hr min) 78.18/ hr
•
. ..
Phone: (503) 659-2212 Fax: (503) 659-4944 Inspections for which no fee is
90.00/ hr
specifically listed (Y. hr min)
CCB Lic.: 1532 Electrical Lic.: 3-2C Suprv. Lic.: 1532 :.•':,1, ;.'Elcf.:(TRICAL: pt1Uw'urItEs:::H
Subtotal; 85.86
Suprv. Electrician signature, requir_ ) j 5 .0 a S
Plan review (25% of perrnit fee);
— C
Print name: TY SHEPERSKY ' - A ate: 4/16/10 — State surcharge (12% of permit fee): 10.30 _
TOTAL PERMIT FEE: 96.16
Authorized ‘ orized signature: ,,) T
)0, .
- .
This permit a pplicarion expires if a permit is not obtained within 180
days oiler it has been accepted as complete.
Print name: TY SHEPERSKY Date: 4/16/10
• Number of inspections allowed per permit.
1:113uildl/PermtraLC-PermilApp,dao 10101109 440