Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2010 -00148
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/10/2010
"'TIGARD • 9 Parcel: 1S136DB00201 •
Jurisdiction: Tigard
Site address: 11577 SW PACIFIC HWY
Subdivision: Lot: 0
Project: Good Feet
Project Description:
Owner: FEES
FRED MEYER STORES, INC Description Date Amount
BY NICKEL & COMPANY LLC, STORE #375, PO Restricted Energy Permit 08/10/2010 $75.00
BOX 35547 12% State Surcharge - Electrical 08/10/2010 $9.00
PHONE:
Contractor:
ADT SECURITY SERVICES INC
2815 SW 153RD DR
BEAVERTON, OR 97006
PHONE: 503 - 469 -7212
FAX: 503- 469 -7114
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: N Boiler Controls: N
CCTV: Y Clock Systems: N
Data & Telecommunications: N Fire Alarm: N
HVAC: N Instrumentation: N Total $84.00
Intercom /Paging: N Landscape /Irrigation: N
Required Items and Reports (Conditions)
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N
Other Desc:
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 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. A NTION: Oregon la re. ' es 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 -0' -*100 •u may obtain a cop of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344
'
Issu d By: � Permittee Signature: _ I /_' , g ;a
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.
Electrical Permit Application FOR OFFICE USE ONLY • I
•
City of Tigard Received /0 ) o ( Permit No.: G i'� D -,x l L( g 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Other Permit: 10'00 S ,? 3
IS Phone: 503.639.4171 Fax: 503.598.1960 Date/By:
f I C A R D Inspection Line: 503.639.4175 Date Ready/By: rum: . ® See Page 2 for
Internet: www.tigard- or.gov Notified/Method: Supplemental lnformation
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 IN Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family 0 Master builder ❑ Other: ['Fire pump. ❑ installation of 75 KVA or
��.. JOB SITE INFORMATION AND LOCATION ❑ Emergency system larger separately derived system.
, ❑S Six ❑ Addition of new motor load of ❑ "A" "E" "1 -2" "l -3"
Job no.: 30.s - 8 02 /, Job site address: //S 77 .SW /RG /9i c /tW/ R ecre
ix o or r mom ore re rest dential units. ❑ residential l vehicle parks.
City /State/ZIP: 174 i D 02 97 3 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: 6 00Z 1EE-- ❑ Service or feeder 600 amps or more.
job site: Description FEE SCHEDULE
Cross street/directions to
J 1 Qtr. 1 Fee. 1 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. 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 75.00 2
e e' T`/ DQm E en ? S residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER 1 ❑ 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
tY 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 1 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 I 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: .101/1) /T(Js T.4-41 branch circuit
Each add'I branch circuit 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
.'ll 3) 59 f ' a � /0 ( ) Reconnect only 67.84 , 2
Phone: lJU Fax:
Pump or irrigation circle 67.84 2
E - mail:
Sign or outline lighting 67.84 .2
CONTRACTOR Signal circuit(s) or limited- energy � a
Business name: D r 5 E c we / T panel, alteration, or extension. _ Page 2 2
Y Each additional inspection over allowable in any of the above
Address: a ' /s .S id /53 ad biz Additional inspection (1 hr min) 66.25/ hr
City/State/ZIP: Be A V CA TDN O. 9 700 6 Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18 / hr
Phone: (3 ? j ) f' g - 760 9 9 Fax: (5Z 3) ea q- 7/15/ Inspections for which no fee is 90.00 / hr
specifically listed (Y2 hr min)
CCB Lic.: $ 7 ,1 4/T Electrical Lic.:24' 20906E-- Suprv. Lic.: LE i f 37 C/ ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: e • Subtotal:
i� A7r,�
Plan review (25% of permit fee):
Print name: k fn) Kee. J4 o i Date: �s/7iv State surcharge (I2% of permit fee): 9 00
TOTAL PERMIT FEE: R ti 0 O
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.
N um b er of inspections allowed per permit.
I:\ Building \Permits\ELC- PermitApp.doc 07 440- 4615T(1I /05'COM/WEB