Permit ,n
CITY OF TIGARD ELECTRICAL PERMIT
1111 COMMUNITY DEVELOPMENT Permit #: ELC2012 -00199
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/06/2012
Parcel: 1 S136DB00201
Jurisdiction: Tigard
Site address: 11565 SW PACIFIC HWY
Project: Fred Meyer Subdivision: 2000 -025 PARTITION PLAT Lot: 2
Project Description: (1) 200 amp service and (1) branch circuit for car charger.
Contractor: CHRISTENSON ELECTRIC INC Owner: TIGARD, CITY OF
111 SW COLUMBIA ST, STE 480 13125 SW HALL BLVD
PORTLAND, OR 97201 TIGARD, OR 97223
PHONE: 503 - 419 -3300 PHONE:
FAX: 503 -419 -3695
FEES
• Quantity Description Date Amount
1 ea Services or Feeders - 200 04/06/2012 $100.70
Specifics: amps or less
1 crt Branch Circuits w /Purchase 04/06/2012 $7.42
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 04/06/2012 $12.97
Electrical
Type of Const:
Occupancy Grp:
•
Total $121.09
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 through OAR 2 -0 89 . Y. u may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. _ /
Issued By: Permittee Signature: eAr /L��O /V
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 603.639.4176 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.
APR -05 -2012 THU 08:27 AM CHRISTENSON ELECTRIC, INC FAX NO. 95034193695 P. 01/02
Electrical Permit Applicati ECEJVED H,I: i 1l I• I( t. l'SF ()NI.\
C1 25 S W Ha Tigard n p R 5 2012 Received Received ,IcA .' S7Co20 A — ,,O
I ll 23125 W ll Blvd., Tigard, OR 97223' »A� ' � � d� I Permit No, - 1"
Plan Review
B Phone: 503.639.4171 fax; 503.598.1960 Date/B : other PetmieuP=2B 1/42 ,0 -
t , Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: NM 0 See Page 2 for
Internet: www.tigard- or.tov BUILDING DIVISION Nolifod/Meibod: Supplemental Information
E OF WORK PLAN;REVIE
•
❑ New construction Addition /alteration/replaccmcnt Please cheek all (hut apply (submit 2 sets of plans w /items checked below);
❑ Service or feeder 400 amps or mom ['Building over three stories.
ID Demolition El thee:
where the available fault currant ❑ Marines and boatyards.
CATEGO Y OF CONSTRUCTION ' . exceeds 10,000 amps at ISO volts or ❑ Floating buildings.
----- less to ground, or exceeds 14400 ❑ Commercial -use agricultural
❑ 1 - and 2- family dwelling ommcrcial/industrial ❑ Accessory building amps for nll other installations. buildings.
❑ Multi - family aster builder ❑ Other: 0 Fire pump. 0 Installation of 75 KVA ar
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separutey derived system.
^ t , � ❑ Addition of new motor load of [] °A" "[S" "1 -2 ", "1 -3 ^,
Job no.:9L CI I ' Job site address: \ I O S 'Al 6'A VV I t0oh1P or mote. occupancy.
1 0 Six or more residential units. ❑ Reereutiennl vehicle padre.
City/State/ZIP: - T1 i s l O a . ❑ tieuhh ous facilities. 0 Supply voltage for more than
❑ Hazardous locstione. 600 velar nominal,
Suite/bldg. /apt. no.: Project name; � • y 0 � / � O J / ❑ Service or feeder 600 amps or more.
P /r a l iQ.i (J / Description FEE SCHE s
Cross street/directions to job site: I Qar. 1 1 FR. I Total I •
•
�c New residential single- or multi- family dwelling unit,._ .
/g)) (Ong — '1 ( 6 2..?;') Includes attached garage.
Subdivision: Lot no.; 1.000 sq. LT_ or teas 168.54 4
Ea. add'I 500 sq. t1. or portion 33,92 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 67.84 2
Limited energy. multi- family 67,84 2
I I ( } ) p� (� �p� ``) 01,4 residential (with above sq. ft.)
4 1— �� yam �/ �� Services or feeders Installation, alteration, and/or relocation
�,6n.c Ck&IX .i1' � amps orless i 100.70 100 2
. ❑ PROPERTY OWNER 1 / U I 0 TENANT • 201 amps to 400 amps 133.56 2
Name: 401 amps town amps 200.34 2
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 leas 59.36 I
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
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, r panel
Owner signature: Date: A. Pee for branch circuits with
above service or feeder fee,
❑ APPLICANT 1:1 CONTACT PERSON each branch circuit I 7.42 1 2
Business name;
CANVS �f ^ r B. Fee for branch circuits wltho u l / service or feeder fee, first 56.18 2
Contact name: branch circuit
Each udd'I branch circuit 7.42 2
Address Miseellancoas ur feeder not included) --
Each manufactured or modular
•
City/State/ZIP:
2
dwelling, service and/or feeder
Phone: ( ) Fax; ; ( ) - Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67.84 2
Sign or outline lighting 67.84 2
• • • 'CONTRACTOR • r . • Signal circuit(s) or limited -energy
Business name: VY ' r \ , k p +�, panel, alteration, or extension. Paget 2
Each additional inspection over allow hie in any of the above
Address; 1\4 L 1 , rY,bIG„..,'L Additional inspection () hr min) 6625/ hr
City/State/
V /� I� !� \�//�� [� � Investigation (1 hr min) 66,25 / hr
'(` ` � P O I Industrial plant (I hr min) 78.18/ hr
• Phone: 3 (419 t : �! t o l ,5 Inspections for which no fee is
` specifically listed OS hr min) 90,00 / hr
� ' CB Lie,: `� ✓ Electrical Lie / .2.A, vr l r7 . Lie.: 6 .• • . • ELECII'RICAL:PERMIT FEES • l � • -
Subtot l. /�b t a
Suprv. Elm: ' signature, required: �� Plan review (25% of permit fee):
Print n Date: State surcharge (12% of permit fee): I a c
TOTAL PERMrf PEI?: l al i Q
Authorized signature: This permit application empires if a permit Is not obtained within 180
Print name: days offer it has been accepted a s complete. .
Date: I • Number of inspections allowed per permit.
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