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Permit III CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT 2 COMMUNITY DEVELOPMENT Permit #: ELR2011 -00032 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/09/2011 Parcel: 1 S 126CA01100 Jurisdiction: Tigard Site address: 9009 SW HALL BLVD 100 Project: Target Subdivision: Lot: 0 Project Description: Low voltage for data cabling. Contractor: NORTHWEST COMTECH INC Owner: DAYTON HUDSON CORPORATION 12807 NE 22ND ST BY TARGET CORP T -0345 VANCOUVER, WA 98684 PROPERTY TAX DEPT/TPN -0950 PO BOX 9456 MINNEAPOLIS, MN 55440 PHONE: 503 - 252 -1462 PHONE: 612 - 761 -1588 FAX: 503 - 252 -2343 FEES Description Date Amount Specifics: Restricted Energy Permit 02/09/2011 $75.00 12% State Surcharge - Electrical 02/09/2011 $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: 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 •r•ance - •proved 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. A • ENTION: Oregon law equi - you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -00 0010 through OAR 952 - 001 -0' •0. Yo ay .btain a copy of the rules or direct questions to OUNC by calling 503.232.1 87 or 1.800.332.2344. Issu =. By: ' //, Permittee 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. Electrical Permit Application FOR OFFICE USE ONLI , _ n City of Tigard Date/B : J �',�f, • 13125 SW Hall Blvd., Tigard, OR 97223 Received Plan Review ��� Permit No.: �' n Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Other Permit: T IC , I: D Inspection Line: 503.639.4175 Date Ready/By: luris_ ® See Page 2 for Internet: www.tigard - or.gov Notified/Method: Supplemental Information TYPE OF WORK PLAN REVIEW ❑ 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. CATEGORY 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 ommercial /industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi - family Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ", Job no.: Job site address: O O ( � .4 7 1 qJ c, ,� nn f 100HP or more. occupancy. ❑ \ ❑Six or more residential units. Recreational vehicle parks. City/State/ZIP: G ❑ Health -care facilities. ❑ Supply voltage for more than ty I ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Pi(ject name: 779/C..6.. � 0 Service or feeder 600 amps or more. 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 1 Tax map /parcel no.: Limited energy, residential 75.00 2 DESCRIPTION OF WORK (with above sq. ft.) / Limited energy, multi - family 7 ((2t r / " U© ('�y Y e"- 1�J 1 1 I ,/_t $ f residential (with above sq. ft.) 75.00 2 /`�� / /7 S ervices or feeders installation, alteration, and/or relocation 200 amps or less 100.70 2 ❑ PROPERTY OWNER ( ❑ TENANT 201 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 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 ❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee 7.42 2 each branch circuit Business name: B. Fee for branch circuits without service or feeder fee, first 56.18 2 Contact name: branch circuit Each add'l branch circuit 7.42 2 Address: Miscellaneous (service or feeder not included) City /State /ZIP: Each manufactured or modular 67.84 2 dwelling, service and/or feeder Phone: ( ) Fax: : ( ) Reconnect only 67.84 2 Pump or irrigation circle 67.84 2 E - mat Sign or outline lighting 67.84 2 //�� __ CONTRACTOR /C� � ee Signal circuit(s) or limited-energy OU Business name: A � � G� panel, alteration, or extension. Page 2 �� 2 1L- - C-= Each additional inspection over allowable in any of the above Address: ( J 0 ' ._ /� ' , �. Additional inspection (1 hr min) 66.25/ hr Investigation (1 hr min) 66.25/ hr City/State /ZIP' / t, C,C) 1 /h4 w cg 6 ' ( Industrial plant (1 hr min) 78.18 / hr Phone: (53) 25,„7.../c .../ 6 Z Fax: ( ) Inspections for which no fee is 90.00/ hr specifically listed (/2 hr min) CCB Lic.: (79 0t {0 Electrical Lic.:C`e Suprv. Lic.: ELECTRICAL PERMIT FEES Subtotal: -7 - co— Suprv. Electrician signature, required: o Plan review (25% of permit fee): . Print name: JA - / , 5 4 H u Date: State surcharge (12% of permit fee): 9 .O a TOTAL PERMIT FEE: $ Authorized signature: O!2 This permit application expires if a permit is not obtained ithin 180 Print name: Date: days after it has been accepted as complete. Num of inspections allowed per permit. 1:\ Building Tennits\ELC- PennitApp.doc 07/01/10 440-4615T(11/05 /COM/WEB