Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
a COMMUNITY DEVELOPMENT Permit #: ELR2012 -00072
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/19/2012
Parcel: 1 S136DB00201
Jurisdiction: Tigard
Site address: 11565 SW PACIFIC HWY
Project: Fred Meyer Subdivision: 2000 -025 PARTITION PLAT Lot: 2
Project Description: Audio, data telecommunications, fire alarm, intercom, and CCTV systems.
Contractor: APPLIED TECHNICAL SYSTEMS INC Owner: FRED MEYER INC
7015 SW MCEWAN RD 3800 SE 22ND AVE
LAKE OSWEGO, OR 97035 PORTLAND, OR 97202
PHONE: 503 - 684 -9611 PHONE: 503 - 232 -8844
FAX: 503 - 598 -0498
FEES
Description Date Amount
Specifics: Restricted Energy Permit 04 /19/2012 $375.00
12% State Surcharge - Electrical 04 /19/2012 $45.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 5
•
Audio & Stereo: Y Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: y Fire Alarm: Y
HVAC: N Instrumentation: N
Intercom/Paging: Y Landscape /Irrigation: N
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: Y Total $420.00
Other Desc: 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 952- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
1
Issued B / — =ice Permittee Signature:
/OP%
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 603.639.4175 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.
Electrical Permit Applica ,; CE1ED • FOR OFFICE USE ONLY
Cl of Tigard CE WED Received Permit No.: • `J g an Date/B : � i /1 t-L�
a 13125 SW Hall Blvd., Tigard, OR 9z 1 7 2012 Plan Review
Phone: 503.718.2439 Fax: 503.59V.7980 DateB : Other Permit: 54 - ..... _
TIGARD Inspection Line: 503.639.4175 Date Ready/By: Jo n See Page 2 for
Internet:. www.tigard or.gov CITY OF TIGARD Notified/Method: 1 l 17 Supplemental Information
TYPE ILD G DIVISION
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 ® Commercial /industrial ❑ Accessory building amps for all other installations. ' buildings.
• ❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "I -3 ",
Job no.: 328 Job site address: 11565 SW Pacific HWY IOOHP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks. • City/State /ZIP: Tigard, OR 97223 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: Fred Meyer Remodel ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Tote! I •
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 I
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
Data, voice, paging, CCTV, alarm cable install residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
• 200 amps or less 100.70 2
❑ PROPERTY OWNER ❑ 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
t7 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 I 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: r Date: A. Fee for branch circuits with
® APPLICANT ❑ CONTACT PERSON above service or feeder fee, 7.42 2
each branch circuit
Business name: Applied Technical Systems • B. Fee for branch circuits without •
service or feeder fee, first 56.18 2
Contact name: Matt Phillips branch circuit
Each add'I branch circuit 7.42 2 .
Address: 7015 SW McEwan Rd Miscellaneous (service or feeder not included)
• City/State /ZIP: Lake Oswego, OR 97035 Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: (503) 684 9611 Fax: : (503) 598 0498 Reconnect only 67.84 2
E -mail: mphillips @atsdata.com Pump or irrigation circle 67.84 2
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
•
Business name: SAME panel, alteration, or extension. S Page 2 75 2
Each additional inspection over allowable in any of the above
Address: • Additional inspection (I hr min) 66.25/ hr
City/State /ZIP: Investigation (1 hr min) 66.25/ hr
Industrial plant (I hr min) 78.18/ hr
one: ( ) Fax: ( ) Inspections for which no fee is 90.00 / hr
specifically listed (V2 hr min)
CB Lk.: 89511 511vl Electrical Lic.: 2 -71CLE Suprv. Lie.: LEA2997 ELECTRICAL PERMIT FEES
Subtotal: 375
Suprv. Electrician signature, required: o
Plan review (25% of permit fee):
Print name: Matt Phillips Date: 4/12/12 State surcharge (12% of permit fee): 45
• TOTAL PERMIT FEE: 420
Authorized signature: • This permit application expires if a permit is not obtained within 180
Print name: Matt Phillips Date: 4/12/12 days after it has been accepted as complete.
P • Number of inspections allowed per permit. .
I:\Building\'ermits\ELC- PermitApp.doc 07/01/10 44046l5T(11/05/COM/WEB
Electrical Permit Application - City of Tigard
•
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
El Burglar Alarm
El Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
® Audio and Stereo Systems
❑ Boiler Controls
El Clock Systems
® Data Telecommunication Installation
® Fire Alarm Installation
❑ HVAC
❑ Instrumentation
® Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
El Nurse Calls
El Outdoor Landscape Lighting*
❑ Protective Signaling
® Other CCTV
Total number of commercial systems: 5
•
*No licenses are required. Licenses are required
for all other installations
1:1Building\Permits\ELC- PermitApp.doc 07/01/10