Permit CITY OF TIGARD ELECTRICAL PERMIT
• COMMUNITY DEVELOPMENT Permit #: ELC2012 -00435
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/23/2012
Parcel: 1 S136DB00201
Jurisdiction: Tigard
Site address: 11565 SW PACIFIC HWY
Project: Chase Bank Subdivision: 2000 -025 PARTITION PLAT Lot: 2
Project Description: (1) 200 amp feeder and (34) branch circuits
Contractor: ELITE ELECTRIC GROUP LLC Owner: FRED MEYER INC
PO BOX 823026 STORE #375
VANCOUVER, WA 98682 1014 VINE ST
PROPERTY TAX 7TH FLOOR
CINCINNATI, OH 45202
PHONE: 503 - 277 -3788 PHONE:
FAX: 360 - 891 -2666
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 07/23/2012 $100.70
Specifics: amps or less
34 crt Branch Circuits w /Purchase 07/23/2012 $252.28
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 07/23/2012 $42.36
Electrical
Type of Const:
Occupancy Grp:
Total $395.34
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 ance wi 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. ATT TION: Oregon = • r• q ' s you to follow the rules adopted by the Oregon Utility Notifi : '•n Center. Those rules are set forth in OAR
952 -001 -0 10 through OAR 95,01 -Or "You may obtain copy of the rules or direct questions to OUNC by ca ' ca..•2.1987 or 1.800.33 j 344.
Issued G � / GZ2 t Permittee Signa
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:
CONTRACTO - INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' _ !i / i y �� = i 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.
From: Elite Electric Group Fax: (888) 901 -7914 To: Fax: +1 (503) 598 -1960 Page 2 of 3 7/23/2012 11:15
Electrical Permit Application REcEivE I FOR OFFICE I;SE ONLY
City of d R
a
Ti oO Received M.) / s
Tigard Datefn / Permit No.: G�(..�r� i'•
,, m 13125 SW Hall B Phone' 5 Blvd., tlgard,OR 2, JUL 2 3 2012
(13.718._431 Fax: 503._98.1960 i
'I'IC) Inspection Line: 503.639.4175 Date Rcadv /13y. yam Ei See Paget for
Internet. www.tigard- or.gov CITYOFTIGARD Notified /titerhod: Supplemental Information
. - .. :`..,.: .: ::;:::;::::;;
P lease check all that apply (submit 2 sets of plans wiuctrt5 checked blow
® hew construction 1:1 Addition/alteration/replacement )
['Service or feeder 4(10 amps or more ❑ Building over three staties.
❑ Demolition ❑ Other:
I _ where the available foul[ cwunl ❑ 41>vivas and boatyards.
I: • �: -:`; ::;.'_::.;_;;:':'.._ j':':' -: �al7 - - exceeds 10.000 amps at 150 volts or ❑ Floating buildings.
i - ....... 'h.C(,?NY.Ui•_ CiUNb' TR1f �1'f O, �i :.:::::: ..:..:::::::::..:'.:;:;.;:_.::
�
less to ground, or exectxl.,' I4,000 ❑ Commercial agricultural ❑ 1 - and 2 - family dwelling ►1 Commercial /industrial ❑ Accessory building amps for all other installations buildings.
❑ Multi family ❑ Master builder ❑ Other: ❑ Fire pump ❑ Installation of75 KVA or
.- - :.. ❑ bnergcncy system. larger separately derived system.
: .;119 , o � 1hl ' 1' 97 1 ,. L. jOG� p.QN: : : :..:., ::: :: , :,::-7: :' ❑ Addition ;fnew „,nor hind of ❑.._,.. ' 1 - 3 ^
Job no.: Job site address: 11565 SW Pacific 1
100HP or more. occupancy
❑ Six or more residential into ❑ Recreational vehicle pasts.
City /Stale,'ZIP:•Tigard OR 97223 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal
-ice or feeder 600 amps or mow.
tiuue:bldg.r'a b. no.: Project name: ��� E , ❑ Sea
P J'
.:
I
Cross street/ directions to job site: nesc,vptton I qt l Fee. ( riot
New residential single or multi - family dwelling unit. i
Includes attached garage. I
5ulxlivigiolt: Lot no.: 1.000 sq. 11. or less i 168.54 4
.__.._ ft. , portion 1 33 92 1 p
I fax map/parcel no.: I residential
.
m etxr y 7 50
. :,ptsc f wri6,k ri1 WORiz_:' : :: " . :, -. '
:�. i ' i - U
.. . .: ::.:.:.: (tyilh above sq. ft.)
Limited energy, multi - family
200 AMP Feeder and 34 Circuits residential t with above sq. ft.) i 75.0E f
z i -
i Services or feeders installation. alteration, and /or relocation
200 amps or less I 100. 1 j 2
....
FRQRCRTV vV:\ EH'::'- ::: ::.:::: .. : :;.::�:::•; .:: TEsm'f'.:` " _01 am}rito 4(i0 amps 133.56 2
401 amps to 600 amps 200.34
Name: ___ '
601 amps to 1,000 amps 301.04 '
Address: Over 1,000 amps or volts 552.26 _
Temporary services or feeders installation. alteration, and /or i
City/State/ZIP: relocation
Phone: ( ) Fax: ( ) 201' amps or less j 59.36 I
201 amps to 400 amps i 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 allot, l0 599 amps i 148,54
intended liar sale, lease, rent, or exchange. according to ORS 4.47.449, 670, and 701.
Branch 2
Owner signature: Dale: A. Fee f branch circuits alteration, or el tensor per_ panel
n
❑':•1PPI IC.4tiI <'::' . : ' ::. .:_':::.:`:'Q.:(;nh. PER5 •- - - :: -::':, above sen9c or fe fee, n I i 7.42
I
t •
_ each branch circuit i
Business rtante: B Fee for branch circuits a irhnar
service or feeder fee first
56.18 2
Contact Dante: branch circuit
Each add'I branch circuit 33 7.42 2
Address: Miscellaneous (service or feeder not included) _ . - 2
Each mansifictrned or modular
City/Stale/ZIP: 6 ?.R4
dwelling, service and /or feeder
Phone: ( ) Fax: : ( ) Reconnect only 6784 , I
Pump or irrigation circle 67.84
- E - mail: Sign or outline lighting 67.84
--.7 ' !CQ„,li.3(' °!'„311 si circuit(s) or limited- energy
Business name: Elite Electric Group p arnel, alteration, orextet ioa Pape 2 2
Each additional inspection over allowable in any of the about
Address: PO BOX 823026 Additional inspection 11 hr min) i 66.2.5; hr
Citv,'Stale''LIP: Vancouver WA 98682
investigation ( I brain) 6(i35: hr
Industrial plant (I Iii min) 78.18' hr
Phone: (503) 277 - 3788 Fax: (888) 901 - 7914 Inspections for which no lire is 9(} 00[ hr
spneciticalty listed (Y hr min)
C I_ic.: 191274 I Electrical Lie.: C639 Suprv. Lie.: 57625 _, , . ;` -FEES ` : '
! � ' Subtotal. 352.98
Suprv. Electrician signature. required
Plan revte, (25% of pi:r171rt fee). /��
Print name: Bob Ar Date: 7/23 /12 State surcharge 112 %ofpennit fee) 1.e4► `
TOTAL PERMIT FEE tit " 3i
Authorized signature:
c •
l/�r This permit application expires if a permit is not obtained within INft
Print name: Max Patttito 1 days after it has been accepted as cmnplete.
Date: 7/23/12 • Number of inspections allowed per pantie.
I tn,1110mmlPruwt•, r' - Po , nit App doe 417101/151 1494£1 1T1 I nit;Cr s1M'F.B
From: Elite Electric Group Fax: (888) 901 -7914 To: Fax: +1 (503) 598 -1960 Page 1 of 3 7/23/2012 11:15
•
FAX Date: 7/23/2012
Pages including cover sheet: 13
To: From: Elite Electric Group
PO BOX 823026
Vancouver
WA 98682
Phone Phone +1 (503) 277 -3788
Fax Number +1 (503) 598 -1960 Fax Number (888) 901 -7914
NOTE:
Electrical Permit Application and Credit Card Authorization Form from
Elite Electric Group
•
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