Permit CITY OF TIGARD ELECTRICAL PERMIT
• " COMMUNITY DEVELOPMENT Permit #: ELC2009 -00317
T [ G AR O 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/24/2009
Parcel: 1S136DB00201
Jurisdiction: Tigard
Site address: 11565 SW PACIFIC HWY
Subdivision: Lot: 0
Project: Fred Meyer
Project Description: Install /alter (2) branch circuits.
Owner: FEES
FRED MEYER STORES, INC Quantity Description Date Amount
BY NICKEL & COMPANY LLC, STORE #375, PO
BOX 35547 2 crt Branch Circuits 06/24/2009 $53.50
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 06/24/2009 $6.42
Electrical
Contractor:
STONER ELECTRIC
1904 SE OCHOCO
MILWAUKIE, OR 97222
PHONE: 503 - 462 -6500
FAX: 503 - 659 -4968
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $59.92
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 t roug AR 952 -001 -0100. You may obtain a copy n of � the / rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: 00k u Q C Q /V� tC J l 1 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 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.
11. 06y22/2009 13:57 FAX 1 001
Electrical Permit Application RECEIVE FOR OFFICE USE ONLY
City of Tigard Received
JUN 2 2 2009 Dare/13 : Permit No.: ILO* .003
13125 SW W Hall Blvd., Tigard, OR 97223 Plan Review
14 2 Phone: 503.639.4171 Fax: 503.598.1960 DateB . Other Permit: P • /1 , i, ` t
•
T [ GAR R D inspection Line: 503.639.4175 CITY OF TIG • ' ) I Date Ready/By: MI ® See Page 2 for
Internet: www.tigard- or.gov BUILDING DIVISI (1 :1 'tified/Method: Supplemental Information
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❑ 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.
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.., t' 1t . � .,,:.. - .•::, d., (< ;.w „i,. ;; H!rd!rl :a!r less o ground, or exceeds ❑ Commercial agricu 1 a
❑ 1 - and 2- family dwelling fK1 Commercial/industrial ❑ Accessory building amps for all other installations buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
;yat:a' I:I',ie5!i.Z1fil5ri ,aa !ardl• •' :,, ;J:cxr.:rm:'Id1:n�:::I!muusn �iqc ">,3ioP' ; P' c 'i••+!:C.s +ei ❑ Emergency system. larger separately derived system.
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Job no.: (, g Z-�d) Q I Job site address: !Islas s'w pc.. I4W ❑ y or more. occupancy.
Si ix or more residential units. ❑Recreational vehicle parks.
City /State /ZIP: � a „ D� 9 7 Z 1, ❑ Health - care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ,E--D . 1�,p ��, ❑ Service or feeder 600 amps or more.
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Cross street/directions to b it
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job site: ^ Description .vcc ° "" G`'� '` .t� ." 3 Fe li ...; ` , r..J • !
J Dpeription � Qty. I Fee. j Total I
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: _ _ Limited energy, residential
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_n - , X4lati rs L a r + r.• r .r g ,. ..i!:.:• ` : +t'• hii yrt , if 75.00 2
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Limited energy, multi - family 75.00 2
1.--)1,126 fe,2 /egS7leeQ,'►•i Oaec, residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
ti
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3t;i4..411'itr,...., ri'" = y,thy itm, c, ,:: i ,ir 1:F i CI ju ..+ ,. �..: ,::_ 1.., iY :; li."- 201 amps to 400 amps 106.8$ 2
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Name: L 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City/State/ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that [ own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Owner signature: Date: Branch circuits- new, alteration, or extension, per panel
_ A. Fee for branch circuits with
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iie:6%�rFiF.vz4'Ih:13r -!rn,u +.':llf::i I L .a,LletitN�S..: �ni: 1.: lix�it�lllil ,!Ri.`1'5d ;c!'! ^1= 1:;" = ^.,. •I- ..• !S!. ....s::;1..'!! ;:�S?` above service or feeder fee, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee
first branch circuit ( 46.85 2
Address: Each add'1 branch circuit / 6.65 6,6S 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) I Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
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Business name: STONER ELECTRIC Signal circuit(s) or limited -
energy panel, alteration, or
Address: 1904 SE OCHOCO extension. Describe: Page 2 2
City/State /ZIP: MILWAUKIE, OR 97222 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (503) 462 -6500 Fax: (503) 659 - 4968
Investigation per hour (1 hr min) 62.50
CCB Lie.: 44823 Electrical Lie.: 26 - 122C Suprv. Lie.: 3496S Industrial plant per hour 73.75
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ii)}itI ilni i lilah_ _ratary iGiJ'ls: _ t '3, RM
i Subtotal: . 5-.0 'A:.,.:JL
Suprv. Electrician signature, required: I t
Print name: MICHAEL FALCONER
Date:.
/ /22, / O 9 Plan review (25% of permit fee): --- State surcharge (12% of permit fee): 4. iiZ
Authorized signature: TOTAL PERMIT FEE: ”, 9z..
Print name Date: This permit application expires if a permit is not obtained within 180
Jays after It has been accepted as complete.
• Number of inspections allowed per peril.
t:\ Building \Permits1ELC- PermitApp.doc 05/23/06 440- 4615T(11 /05 /COM/WEB