Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
` ' . : COMMUNITY DEVELOPMENT Permit #: ELR2012 -00090
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/10/2012
Parcel: 1S136DB00201
Jurisdiction: Tigard
Site address: 11565 SW PACIFIC HWY
Project: Fred Meyer Subdivision: 2000 -025 PARTITION PLAT Lot: 2
Project Description: Expansion and remodel
Pull temperature sensor cables for refrigeraated cases, u[grade the energy management system for HVAC and
lighting controls
Contractor: WYTEK CONTROLS, INC. Owner: FRED MEYER INC
PO BOX 2510 3800 SE 22ND AVE
TUALATIN, OR 97062 PORTLAND, OR 97202
PHONE: 503 - 691 -9002 PHONE: 503 - 232 -8844
FAX: 503 - 691 -0313
FEES
Description Date Amount
Specifics: Restricted Energy Permit 05/10/2012 $150.00
12% State Surcharge - Electrical 05/10/2012 $18.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1-
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: N Fire Alarm: N
HVAC: Y Instrumentation: Y
Intercom/Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N Total $168.00
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 r1
Issued By: Permittee Signature: 1 1 PP L-160
.t"
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.
Electrical Permit ADDlicad°RECEIVED RJR OH. ICI 0 N I 1
City of Tigard Marg ,-=b Permit No.: A - 11,090
1114 _ .---- • 13125 SW Hall Blvd., Tigard, OR 9722 41/1 AY - 9 2012 Plan Review
• Phone: 503.718.2439 Fax: 503.598.1960 Date : . Other Perottg,040,/—de IS' 7
1-: !I Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: RI See Page 2 for
Internet: www.tigard-or.gov Notified/Method: M, Supplemeotal Information
! 11. I I .... • I.
FEJIMIANW Tiraillaft=1,ttiaMtlailidanniiiaa !:■:..f.'11.1,-flYlitrililtialgErsr[1:L:lii=31411rEnlilriltralag
El New construction 0 Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w/items checked below):
0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition CI Other: where the available fault current 0 Marinas and boatyards.
f ,4;:.;.:;' : ;In exceeds 10,000 amps at 150 volts or 0 Floating headless.
• .4 ?,113:itl I ledUe 1,: ikult il l etuiliii 111 "` 111 '' . .. 'Ali; ' 11"" less to ground, or exceeds 14,000 0 Commercial-use agricultural
0 1 - and 2-family dwelling Ei Commerciallinduarial 0 Accessory building amps fbr all other installations. buildings.
0 Multi 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 75 KVA or
-21Ziaiiiffirfilia0223IILL'2111=1PEZIMIMPMERES 0 Emergency system. larger separately
0 Addition of new motor load of derived system.
0 "A", "E", "I 2
Job no.: Job site address: 11565 SW Pacific Highway 100HP or more. occimancy.
0 Six or more rexideoilal omits, 0 Recreational vehicle perks.
City/State/ZIP: Tigard, OR 97223 0 Health-care facilities. 0 Supply voltage for more than
D Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: I Project name: Fred Meyer store 375 0 Service or feeder 600 amps or more.
RIMIZIEMPRET=.1
Cross street/directions to job site: on HWY 99. Daerlptton QIY- Poo Total
New residential single- or multi-family dwelling unit
Includes attached garage.
Subdivision: I 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
- - .. • • - . ls.pnwly_ 75.00 2
PREggriaMMENBIL(4 ''•-• °N'. l',1:dAMBEVlttrin (with above Sq ' ft
Limited energy, multi
75.00 2
Pull temperature sensor cables for refrigerated cases, upgrade the energy residential with above , • . ft
Services or feeders installation, alteration, stud/or relocation _
managemenr system for FAVAC and lighting controls. 200 amps or less 100.70 2
lralii.71051.=INIENliMEEItliili.ii]Fi.r.7=2111'2'.',;!; 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
•
Temporary services or feeders installation, alteration, and/or
City/State/ZIP: relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59.36 fl
. 201 amps to 400 amps
Owner installation: This installation is being made on property that I own which is not 125.08 2
401 t 599 16 2
intended for sale, lease, rent, or exchange, according to ()RS 447, 449, 670, and 701. amps o amps
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
• •• •,:.•, i ' r,!!!7• 1::1111110,)!L mil l iv i vaitrfin -i.,•,.. • -:01..1, g.;17,1, above service or feeder fee, 7.
' .". •'. " "'.-.,
•1.:. .'..N ,,
A...15 t' ,!..-. - ... • • 'md.PAtiftbd,,LIA:3;;■Loi Iti...:1:1VA 'NAL each branch circuit 42 2
Business name: Wytek Controls, Inc. B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular 67.84 2
City/State/ZIP: dwelling, service and/or feeder
Phone;( ) I Fax: : ( ) Reconnect only 67,84 2
Pump or irrigation circle 67.84 2
E-mail: sign or outline lighting 67.34 2
ligitiaellEfRIMMTLF.1=7,71;)if,, I qraligMlitlailialiTaig Signal circuit(s) or limited-energy 1 150.00
Panel, alteration, or extension. Page 2 2
Business name: Wytek Controls, Inc.
Each additional inspection over allowable in any of the above
Address: P.O. Box 2510 / 19255 SW Teton Ave. Additional inspection (1 hr rain) 6625/ hr
Investigation (1 hr min) 66.25/ hr
City/State/ZIP: Tualatin, OR 97062
Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 691-9002 14 I Fax: (503) 691-0313 Inspections for which no fee is 90.00/ hr
s. ificall . listed A hr rop
1 CCB Lic.: 127381 II I IP I I Electrical Lic.: 34-571C,I Lie.: 48925 cY , : tn1=7,1rtruTH
t Subtotal: 150.00
Suprv. Electrician signature, required: A 1
Plan review (25% of permit fee):
Print name: Asghar Sarparast i Date: 5.09.2012 State surcharge (12% of permit fee): 18.00
TOTAL PERMIT FEE: 168.00
Authorized uignalure:" .., .."....(....-- _,ili ".... This permit application expires if a permit Is not obtained within 180
days after it has been accepted as complete.
Print name: Wael Chatn.seddine Date: 5.09.2012 • Number of inspections allowed per permit.
IAlkilding\PerolintLC-PerinitApp.doe 07/01/10 440.4615TO 1/05/COMPWEB
Electrical Permit Application - City of Tigard 1 , '
Page 2- Supplemental Information W / 41 I k0 alt A0 � h
LIMITED ENERGY PERMIT FEES:
RECEIVED
.w .:w, cc7 .r..,C- 1..iiii,brd::rn.n_�•n
Fee for all residential systems combined........ $75.00
Check Type of Work Involved: MAY 10 2012
❑ Audio and Stereo Systems* CITY. OF TIGARD
❑ Burglar Alarm ❑ Garage Door Opener* • BUILDING DIVISION
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
! < ,'`'t7.. i l;! '�!;! !f;ti,l: FPf @ lillinanHGh1ani
Pee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
HVAC
❑ Instrumentati'on
❑ Intercom and Paging Systems
El Landscape Irrigation Control*
❑ Medical
❑ Nursc Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems: 2
*No licenses ate required. Licenses are required
for all other installations
Meuildinee,mitaLC•PcmitApp.doc 07 /01/10