Permit (110) CITY OF TIGARD ELECTRICAL PERMIT
,111 q
ail:',. COMMUNITY DEVELOPMENT Permit#: ELC2017-00763
II GAP D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/12/2017
Parcel: 2S103DD01100
Jurisdiction: Tigard
Site address: 13939 SW PACIFIC HWY
Project: Walgreens Subdivision: None Lot: None
Project Description: (6)branch circuits for RTU replacements.
Contractor: P. DICKINSON ELECTRIC Owner: WALGREEN CO#5780
20719 SW LIDO CT. PO BOX 901
ALOHA, OR 97078 DEERFIELD, IL 60015
PHONE: 503-740-6100 PHONE:
FAX:
FEES
Quantity Description Date Amount
6 crt Branch Circuits wo/Purchase 10/12/2017 $93.28
Specifics: Service or Feeder
1 ea 12%State Surcharge- 10/12/2017 $11.19
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $104.47
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,.- les are set forte in OAR
952-001-0010 through OAR 952-001-0090. You i- obt; - ..' the rules or direct questions to OUNC by calling 503.232.198/7�or 1 80Q, 234 s
d'/
Issued By: ,1r-
Electrical Permit Application rolz Quiet: t si.(Y\I.\
City of Tigard lti�■1! Received
CEI R.I• ..Date/B : i O�iifr�il/� n /
irM
13125 SW Hall Blvd.,Tigard,OR 97223 ' Plan Review
°: C Phone: 503.718.2439 Fax: 503.598.19. Date/B : Related Permit Thin �` f s
Inspection Line: 503.639.4175 l ReadyDate/By: WI See Page 2 for
T I u A R D Internet: www.tigard-or.gov O( ks'1 Notified/Method: �� ! Supplemental Information
TYPE OF WORK 1,„Tic ki PLAN REVIEW
0 New construction Addition/alteration, l�cTgltiit VD Please check all that apply(submit 2 sets of plans w/items checked):
❑Demolition 0 Other: 1\T ,S, 0 Service or feeder 400 amps or more 0 Building over three stories.
(� where the available fault current 0 Marinas and boatyards.
CATEGORY OF CON ION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
0 1-and 2-family dwelling Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
ampMulti-family 0 Master builder 0 Other: Fire forallother installations. bungs.
0 Fire pump. Installation❑ of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
a Q p ❑Addition of new motor load of system.
Job#: Job site address: l
1 3 1 1 S.w ,\c.c:(: l/t.t/J j , 100HP or more. ❑ A» "E» 1.2» l_3„
❑Six or more residential units. occupancy.
City/State/ZIP: "F1 3�,,-. / (f)g / 9 "7 a,a, ? 0 Health-care facilities. 0 Recreational vehicle parks.
/,� ) ! /V) Hazardous locations. 0 Supply voltage for more than
Suite/bldg./apt.#: Project name: 1.,�/, t G r� �" 0 600 volts nominal.
4/ \ ❑Service or feeder 600 amps or more.
Cross street/directions to job site: Cres S S"�`cee'j`' ' . .c v ., c.\ C FEE SCHEDULE
Description I Qty. I Each I Total
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
( / r (with above sq.ft.) 75.00 2
R e 1 l G�C� C C t' G�Vv�\i,S Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
❑ PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 100.70 2
Address: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email:
relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
APPLICANT ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: above service or feeder fee,
each branch circuit 7.42 2
Contact name: B.Fee for branch circuits without
service or feeder fee,first �/
Address: branch circuit 56.18 'S�, / 2
Each add'l branch circuit 7.42 2
City/State/ZIP: �"�. )'("l
Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: P `Ck`V1 Sco V1 E---' c 4 Y. i C Sign or outline lighting 67.84 2
S L 1 Signal circuit(s)or limited-energy
Address:
rTt o)1 Ct O C ® panel,alteration,or extension. 0 See Page 2 2
City/State/ZIP: \ ��4s 0 9 7 Each additional inspection over allowable in any of the above
/ ) Additional inspection(1 hr min) 66.25/hr
Phone:( "o' ) —749 0,—6 /00 Fax:( ) Investigation(1 hr min) 90.00/hr
Email: Q_;A'Q e , C K;t c,o v‘. e k c 4 le C : t`_ o IAA Inspections
plant(1 hr min) 78.18/hr
Inspections for which no fee is
CCB Lic.:t(),q -to it)//
l Electrical Lie.: L j l 14 quprv.Lie.: 6Cv�y S. specifically listed(%hr min) 90.00/hr
4l a ( jI l W ELECTRICAL PERMIT'FEES
Suprv.Electrician sl a re, equired: _.....--,_...4_.....--,_...4 �f Subtotal: • '
Print name: le(' - 'ç "b. C k;\n S 0v\ Date: I V•—k, - (7 ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): j i. i q
Authorized signature: TOTAL PERMIT FEE: i(i''�.i 1 7
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_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK 0
Fee for all residential systems combined: $75.00 Description I Qtr I Each I 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
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
❑ Garage Door Opener* >100 kva(fee in accordance - 552.26 2
with OAR 918-309-0040)
❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* 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 66.25/hr 1
charged at an hourly(1 hr min) _
Inspections for which no fee is 90.00/hr
specifically listed(h hr min)
COMMERCIALWORK ONLYz teal r rr r,",„
Fee for each commercial system: $75.00 Subtotal(Enteron rage 1):
3r * Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
El HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
L\Building\Permits\ELC_PermitApp_ELR_ERE.doe Rev 06/17/2015
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
13939 SW PACIFIC HWY, TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Electrical ELC2017-00763
Inspection Type: Inspector:
199 Electrical final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor