Permit • n CITY OF TIGARD • ELECTRICAL PERMIT
1 COMMUNITY DEVELOPMENT Permit #: ELC2012 -00222
Date Issued: 04/19/2012
• TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 1 S136DB00201
•
Jurisdiction: Tigard
Site address: 11565 SW PACIFIC HWY
Project: Fred Meyer Subdivision: 2000 -025 PARTITION PLAT Lot: 2
Project Description: Temporary service.
Contractor: WHISKEY HILL ELECTRIC INC Owner: FRED MEYER INC
PO BOX 206 . 3800 SE 22ND AVE
HUBBARD, OR 97032 PORTLAND, OR 97202
PHONE: 503 - 981 -4640 PHONE: 503-232-8844
FAX: 503 -981 -4643
FEES
. Quantity Description Date Amount
Specifics: .200 ea Temp Services or Feeders - 04/19/2012 $59.36
200 amps or less
1 ea 12% State Surcharge - 04/19/2012 $7.12
Type of Use: COM • Electrical
Class of Work: ALT •
Type of Const: •
Occupancy Grp:
•
•
• Total $66.48
•
• - Required Itemsand 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 wit 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 OA - 001 -0090. You may or -'s .• .• of the rules or direct questions to OUNC by'calling 503.232.1987 or 1.800.332.2344.
111111%k Issued By - � ermittee 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.
•
04/17/2012 13:02 5039814643 WHISKEY HILL ELECTRI PAGE 02/02
Electrical Permit .A,DDlic • qfiI P 1j FOR OFFICE USE ONI:Y
City of Tigard f o .
Permit Na: j- L Il- a-1—
n Hlvd„ ri r, 97 1 ' 0 12 ��i
Cs d OR �� 2 Plan Review
' 13125 SW I In C . Phone: 503.639.4171 Fax: 503,598N960 Date/13 ; • Other Permit: i
/900- t�aS 7
T T C; ,1 f f? inspection Line; 503.639,4175 -rlr t..,;":1) 'late Reidy /By: hurtle . la See Page 2 for
. interact: www.ti ardor, oV t 1
't ‘,-.1. Notified/Method: i 9a plemenml Information
g C Al ' � - ... r \t \Ii t 1 �i�, Notified/Method: — P
.......'...:': �. :.;... .,. ..: .'. �. :.•'.,�' .11 � r i',�p .J I '. .1:'. ^'It: 1::• .::1•e :'1':i A'I:y ',I.. . :1' :'�.TI'.� _ - .1_� :f: t'1, ..,.
.. .. . i., t .. .. „ 1., , ,..�' „6'. !1 i i :.1. : '':! "'1; : I ';.1. . .. ali, "" 1'i i ., 1 ,1 )1, ; LI,.. : .., ii ti iij : :' :::
, , ... ,.:. � ... :.� .; .. �•'i' 1 . !� . �,, .. ,,; ;l ;�,�.� .1:: 1,:' I, i � • i . 1, �''t�
,..: ,. ,1 '�. , ,,��, , ; . f li,• •t! i :' 1 . I h= { , I' -, � : :i, I' i ,.�YYI . 'Q ,�Y, y, i' , i , �. : : :,d . I.•
��:.. .... : :... �; :�..• : :..�;�... �� :,�... LI,.,,,. �, ��. pl�. .„ e�': ' :{il'!•h.l.'.,tl., . h1 ;: 'Ar S'1 I,��.hr . 11�1'': I, e41,,,;,,. illi9il” �.. p, jlkalf 'il�169.•dt.,..,.u,t..,�t. .,� ,nnS "'91�ariM�7 :i:•Ih '..�i_I;,d�
❑ Ncw construction P.. Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w/itcros checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current CI Marinas and boatyards.
;'.4 ; ; i :;�; :'t'. i:t,i'. y l (li�ytl;I;" t ` ''' 'i;; etllii iF ' : i!ll!!i !'!i;lliilli;;i exceeds 10,000 amps at 150 volts or ❑ Flouting buildings.
... ... .:dij - 4''wi ,. „.,,: 4; t : ?.._„ • � , „ .i'S' , . , , a „'r •.1'� yi - w .'l'14h�i'� �e� :idclSG s ill y .,S' ,
laxs to ground. or exceeds 14,000 ❑ Cn agricultural El I and 2 family dwelling C ommercial /industrial ID Accessory building amps far all other Inslstlntlnne, buildings,
❑ Multi family ❑ Master builder ❑ Other: ❑ Fire pump. 0 Installation of75KVAor
I ", i :' +l!: :rt' I +' - 1 i" k '• , , - „ •;:': p11 +' El Emergency system. larger separately derived system.
... ...........•,,: ...., � . t;.. : illl :'; : y' ..:,......,.. ,.;..... :,'., - , �1, 1 v , j';'; Addition of new ntomr le. of 1 ",
'� d' , , , -. 4a ' �,i'y; I OOHP Of more, occupancy.
Job no.. • Job site a ddress: / ,e... ❑ Six or more residential units. D Recrentiunal vehicle parks.
(;il.y /4tnte/71P; `7�' 12 ❑ Hcelth-earc facilities, 0 Supply voltage for more than
— / Q " / ❑ Haavdnns locations. 600 volts nominal,
Suite/bldg /apt. no,: PFOject name: _e 1 e P � D Service or feeder G00 amps or more.
���/// rl'i'S'd'1 r i tlr;nr:• , ;q ': 1 : ; 1.'.. .,,la.":i'I:I:itr
, '1 phi',. 1` ".
y l l i':'•1'1 a .41; d '.l ; '.,� l i ; V4ii''hyM1ica:S:i, , 9� .'iWL'i111::'n:;h I,.r r N
(;rocs street/directions to job site: pemeipttnn i Qty. I Fro I Tote J
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 3392 I
'Tax map /parcel no.; —
Limited energy. residential 75,00
:. ,� . - 'i .� :I;I : :liR' :'� :" yt �� 1 ..� .�■{��x, � �yyWWyy��(q�W�q{{y��1�1,{{�,((,yy��I�li : :,. � � � iY n � i � '� t �la; i •y,: 'SI• (with above sq.I 7
i! ' . :,�IJ/t1,+ 1' 1 .. ,'W ';
li ;l;:, ' :: �,i .1,.'a i' t' ::ikr C) — wr�.,�
`�.4.:,A�.,:.. :.w....r. J l�, r rr - . 'i:: �I• :� „� r '��� 4
:�
Limited meta, multi - family
,� l C. residential (with above sq. R,) 75.00 2
Services or feeders Installation, alteration, and/or relocation
200 amps or less 100.70 2
. 'Y;! ; ..:! iiiiy,�,y� 01Y
.11$Eit i:j i'i !: '. i
I N!i.t."ii;ti iti Itt' ilr. ' Il' N IS' 'i "tl-iif I” 201 amps to 400 amps 133,56
' ... . ® • ... W..: , ..,,� ..ix, . , 1,.:�Ibr,',y..tw J, • J�1V ^ a r. l 1; 1, :, P• 2
1
� ' � : ; ' !f�' 1� :ins ^ .i,i 1 'a N 1 1 ! ,li t ,l, f. ,l,
Name: riv. 401 amps to 600 amps 200.34 2
601 amps to 1400 amps 301.04 2
Address: Ov 1,000 amps or volts 552.26 I I 2
"'""""" Temporary services or feeders installation, alteration, and /or
City /State /7.11): relocation
Phone: ( ) Fax: ( ) 200 amps or less / 59.36 6 I
Owner installation: This installation is being made on property that i own which is not 201 amps to 400 amps 125.OR 2
intended for sale. !case, 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
, . p'. u ' _ 1 '1i� 1;' i:'.: I. ^ :51 ; Ii:1Y IflIE(��1 lit,y',�s "4� . . t '9'' "Y'n''p . n oboabove service u f fcc 42 2
; N ;.a.• ! f,'
, : ,lip ; ii l l;: 7 t , l a:lit i YYr :A i',∎i ; � Ilg 1'' 7.
: ,. :'S, ''•'!, , ,sy:' . .W, . '� ' 11 :'',1 ,,,'i h i I iI C ' Iwi ; .. - I.,, , '4''; •. cads branch circuit 4 , .1, ..., a�' ut
Business name: R, Fcc for branch circuits without
- service or feeder file, first S6, I a 2
Contact name: branch circuit _ �
- Each add'I branch circuit ~ - — 7.42 I
Address: Miscellaneous (service or feeder not included)
Each manutecturcd or modular
City /State/71P. dweltingscrviccand/orfeeder 67.84 2
Phone: ( ) Fax:: ( ) Reconnect only 67.84 2
Pump or Irrigation circle 67.84 2
E-mail:
Si or outline i
Sign e I pJrting 67.84 2
;i.: ..... , ..... i';h l'M...n t 9'J •`i';' .. '0xV'1' i ` i CJ1>r , .! J : i i `t ; ; :i: i ! i i . 1„ I ..t U, �,, Signal circuit(s) or limited•ene
'L, :, 1' ., . r. ' � 1py
Business name: • ` t panel, alteration, or extension, Page 2 2
i_/..6 t ' � / / C- Each additional inspection over allowable In any of the above
Address: t�.x ago ,. Additional inspection (I hr min) 66.25/ hr
City /State /7-,1P: t1 , • • *DKr • ' ` investi (1 hr min) 66,25/ I,r
,cam J `�/ Industrial plant (I hr min) 7(1,18/ hr
Phone: z. 4/ f f / Fat: 3 98l - 4I G/�.3 Inspections for which no fee is
6 / �/ specifically listed ('A hr min) 90,00 / Itr
(':C,:31..ie.; II.r?'s"Filectrical Lie.: rv. Su i..ic,: Veo, S " ;' ,..;II 'a : 'c,..;'
p L ('lilQli'Ilat ;' �'''` :Crri' "'r';'''I'
Subtotal: ,,517", ,3 //
Sunni. Electrician signature, required: = flan review (25°/u of permit fee): `
Print name a, 61.. J...� Date: ii1i L State surcharge (12a of permit fee): ioR
Authorized signature: f0'fAL PHRMI'1' 11.:E: /
This permit application expires if it permit is nut nhMinr whin tan
days after It has been accepted as complete.
Print name: -- Datc: a Number of inspections allowed per permit.
I:\ QnlldInp \Pnrmilot.c.- PrrsellApp,doe 07/01/10 440.141511IINVCOM/WEB