Permit q CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2011 -00018
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/25/2011
Parcel: 1 S126CA01100
Jurisdiction: Tigard
Site address: 9009 SW HALL BLVD 100
Project: Target Subdivision: Lot: 0
Project Description: HVAC system for refrigeration.
Contractor: SOURCE REFRIGERATION Owner: DAYTON HUDSON CORPORATION
5506 SE INTERNATIONAL WAY BY TARGET CORP T -0345
MILWAUKIE, OR 97222 PROPERTY TAX DEPT/TPN -0950
PO BOX 9456
MINNEAPOLIS, MN 55440
PHONE: 800 - 677 -2688 PHONE: 612- 761 -1588
FAX: 503 - 652 -0449
FEES
Description Date Amount
Specifics: Restricted Energy Permit 01/25/2011 $75.00
12% State Surcharge - Electrical 01/25/2011 $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: N Fire Alarm: N
HVAC: y 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 $84.00
Other Desc: Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification . enter. Those rules are set forth in OAR
952- 001 -0010 through OAR ' r01 -0090. You may obtai estions to OUNC by calling 503.0.1987 or 1.800.332. 344.
Issued By - - ermr' ee '
• NER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE: Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Application FOR OFFICE USE ONLY
� �''� � � p�� Received
City of Tigard � . 4� Date/By: I �22v0 � l 8
n Permit No.:
13125 SW Hall Blvd., Tigard, OR 97223\ p ` I Review � (v 00/ �
1,
Phone: 503.718.2439 Fax: 503.598.1960 �� t � /gy; Other Permit: t p o
T I.G A R D Inspection Line: 503.639.4175 .0��` s \$irate Ready/By: Jude H See Page 2 for
Internet: «. www.tigard - or.gov A `r v Notified/Metho r 6' Supplemental Information
".r:."aa#�' ... .. _„ �.- . Tiri OF W • -- r ?� s z,! - 4$; . - `"" - vii : _ f,_ ma'', °* P - ,- ; RE V ILE'W- , 4!t.!;'7; „ ,.1 2 ``”
a-.�th �i 4' Y cii , n.sk: . .":-•.,, Md i. s .,,.. •q•= :.::' , �aY ,. • 1 ". 4- - .e...w .: A t /� , e°
®Addition /alteration /replacement
❑ New construction 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.
"`'''' `,� " ' ' " ."'' °`" a ' "" '' "'" rrr % ,'• exceeds 10,000 amps at 150 volts or Floating buildings.
T ' i 4 t'it&a' rn' r CATEGO R Y - ; O F , "' COPIS T RU 0 91 , """' ❑
"'' °"' A A "'' ' '` ` """ " " "` f ' less to ground, or exceeds 14,000 ❑Commercial -use agricultural
❑ 1- and 2- family dwelling ® CommerciaUindustrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
r ., � M.m .•.....- y , ❑ Emergency system. larger separately derived system.
iRrt. l' x • fy t JOB SITE,:INFORMATION AI 7LOGATION`. `• " ' . , r, ❑ Addition of new motor load of ❑ A" E I _2 "1-3",
Job no.: Job site address: 9009 SW Hall Blvd IOOHP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: 00 Project name: Tigard ring not Square i� ✓ ❑ Service or feeder 600 amps or more.
,�,� :` F'
': '', °.; � ».... � _. �
Cross street/directions to job site: Description I Qty. I Fee. I Total 1 •
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. R. or portion 33.92 1
Tax map /parcel no.:
�� Limited energy, residential 75.00 2
`_ -, � , k ,' `c IAA DES €RIP,TIpny'4.ORK¢ fIGNIIIPptit, n ; i •: (with above sq. ft.)
Limited energy, multi- family 75.00 2
Terminate low voltage for refrigeration sensor probes residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
IBPROPER OW NER' i ` ° °:'"`- ®s TENANTtl "" . 20 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name:
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
h 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 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, per panel
Owner signature: Date: A. Fee for branch circuits with
• ,
` ®APPL ICANT a:` � ., 10i'CONTAC 51-451 7.42 2
r : : , i ='' , -.. above service or feeder fee,
branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add'/ branch circuit t 1 7.42 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67.84 2
ty dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
- Pump or irrigation circle 67.84 2
Email
E-mail:
, , , &,1,:' . , :.'• " "',?.. ' §CONTRACTOR : s• ` t Sign or outline lighting 67.84 2
_ �- 3 + . +,...., .. -.•,, c,a" �.. s.:;:,,P, •- ....� .. Signal circuits) or limited-energy �°�'
Business name: Source Refrigeration panel, alteration, or extension. Page 2 7j 2
Each additional inspection over allowable in any of the above
Address: 5506 SE International Way Additional inspection (1 hr min) 66.25/ hr
City/State/ZIP: Milwaukie Oregon 97222 Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 932 - 5905 Fax: (503) 652 - 0449 Inspections for which no fee is 90.00 / hr
specifically listed (': hr min)
CCB Lic.: 149200 Electrical Li .. C546 71 t rl 1 uprv. Lic.: 4612S ;I ? 1 CE;CTRICAL ;PERMIT•. "FEES'. ;g`. :' i,:: ,a ° `:'„
Suprv. Electrician signature, required: 11r Subtotal: �
' �� Plan review (25% of permit fee):
):
Print name: Scott W Ramey Date: 0 5/2011 State surcharge (12% of permit fee): II cV
TOTAL PERMIT FEE: sti
Authorized signature:
This permit application expires if a permit is not obtained within 180
Print name: Date: * days after it has been accepted as complete.
Number of inspections allowed per permit.
I\ Building \Permits\ELC- PermitAppdoc 07/01 /10 440 -461ST(11 /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:.
Fee for all residential systems combined $75.00
Check Type of Work Involved:
Audio and Stereo Systems*
O Burglar Alarm
0 Garage Door Opener*
0 Heating, Ventilation and Air Conditioning System*
fl Vacuum Systems*
0 Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
• Audio and Stereo Systems
0 Boiler Controls
O Clock Systems
D ata Telecommunication Installation
0 F ire arm Installation
HVAC
El Instrumentation
0 Intercom and Paging Systems
L andscape Irrigation Control*
El Medical
0 Nurse Calls
Outdoor Landscape Lighting*
El Protective Signaling
I Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1: 113uilding \Permits\ELC- PermitAppdoc 07/01/10