Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit#: ELR2012 -00202
T t G ARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/30/2012
Parcel: 1S136DB00201
Jurisdiction: Tigard
Site address: 11565 SW PACIFIC HWY
Project: Chase Bank Subdivision: 2000 -025 PARTITION PLAT Lot: 2
Project Description: Low voltage for voice /data
Contractor: XTREME COMMUNICATIONS INC Owner: FRED MEYER INC
24023 NE SHEA LN #215 STORE #375
WOOD VILLAGE, OR 97060 1014 VINE ST
PROPERTY TAX 7TH FLOOR
CINCINNATI, OH 45202
PHONE: 503 - 618 -8816 PHONE:
FAX: 503 - 618 -9985
FEES
Description Date Amount
Specifics: Restricted Energy Permit 08/30/2012 $75.00
12% State Surcharge - Electrical 08/30/2012 $9.00
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: Y Fire Alarm: N
HVAC: N Instrumentation: N
Intercom/Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N Total $84.00
Other Desc: Required Items and Reports (Conditions)
This per • it is issued subject t• the regulations contained in the Tigard Municipal Code. State of OR. Specialty Codes and all other applicable law. All work will
be do in accordance with appr• ed 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 I - l quires you to follow the rules adopted by the Oregon "• • • enter. Those rules are set forth in OAR
952 -0r' -0010 th .ugh OA : 2 - 0 0 1 - ' , : , You may obtain a copy of the rules or direct questions to • NC b . r 50 .. 2.1987 or 1.800.332.2344.
Issue. By: t. ' Permittee Sl nat! re: G.,r ✓�
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 503.639.4176 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.
08/30/2012 06:36 5036189985 PAGE 01/03
Electrical Permit ApplicatiRECPIVED FOR OFFICE USE ONLY
City of Tigard 0 Received if
Drrte/By: 0 0 .IX , l Permit No.:
. 13125 SW Hall Blvd., Tigard, OR 97223AU 6 3
1 Plan Review
. M ..: • Phone: 503.6394171 Fax; 503.598.1960 DM/ 4 , Other Permit:
TIGARD .
inspection Line: 503.639.4175 ow oF TIGARD Dale RendY/DY: hint: la Sec Pine 2 for
Internet: www.tigard-or.gov ILDN0 nivi so Not Med/Method:
Supplemental information
• •.' ::.:. : .. ..r : •••!::::: :::: li VOW 0i :!?::;;;:: :'.:•;:.:,:::'.. !'.":::: . ;i'; • ::?:- : r: '': .-. • -• :101,;A14: il!Mt.:YV' : ' - '.' '.. ..: . - : • ' •
. . .. -. -
Please chock all Hutt apply (sohmil 2 scts of plant taltcraN checked below);
0 New construction is Addition/alteration/replacement
0 Service or feeder OM lungs CIT more 0 %Hainr over three stories,
[ Demolition 0 Other: • where the nvnilnble fault current 0 Marinas and borrtynrds.
• • •.-- r. ;C ...: • :.- :.;•i .: exceeds 10,000 amps at 150 volts or 0 Floating buildings.
Icss to ground, or exceeds 14,000 In Cominerclakirse agricultural
0 I - and 2-family dwelling 5i1 Commercial/industrial ['Accessory building imps for all other installations. buildings.
El Multi-family 12 Master builder 0 Other: 0 Fire pump. 0 Inslallatinn nF15 KVA or
.. 0 Emergency system. larger separately derived system. OAddthcin ncw motor load of . . ' • - ::.. ' itit. .-:.:••••;,:.... • ...:,.:,' •:. ,
Job no.; Job site address: //546 01A/ Pici C 149
0 Six or mom residentinl units,
I OOFFP or more. occupancy.
0 Rcermilonal vehicle parks.
City/Statc/ZTP: T m ." t clz-z3 o Hcalth•rare facilities. 0 Supply vollegt for more ihen
, U.e 0 FITT/mens locations. 600 volts nomirml.
Suite/bldg./apt. no.: Project rlfIMC: 0 Service or feeder 600 amps or more.
„,,,. ...: ...: ,.....:...:.1.'H” : 'EtrSeitEDIPA:. ' , ..• ' .: ' .. : .. ..
Cross street/directions to job site: __ neicap'uno 1 uw. 1 net. I Toon, I •
New residential single- or multi-family dwelling unit.
Includts attached garage.
_
Subdivision: I Lot no.: 1,000 sq. ft. or less 1613,54 4
Ea, acid'I SOO sq. R. or portion 33,92 1
Tax map/parcel no.:
Limited energy, residential
::.'..:-:. ::•:•,%:- ij) : ..:::: , ;.: ; t-... '.' (with above sq. ft) 75,00 2
.f .
/ Limited energy, . I m ily
75.00 2
likikil eteatre - vo 1441dth midcntim above sq. ft.)
Services or feeders Installation, alteration, and/or relocation
200 amps or Ims 100,70 I 2
xi tit)PERIA Z .' : • ..4 • ..'.: 201 amps to 400 amps 133.56 2
, . , .. .. , ... . .. . ... ,.., ,.. .. , . ,.. ...
Name: 401 amps to 600 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/ZTP: Temporary services or feeders installation. alteration, and/or
relocation
Phone: ( ) I Fax; ( ) 200 amps or Ices 59.36 I
201
Owner installation: This installation is being made on property that I own which is not 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 168.34 2
Branch circuits new, alteration, or extension, per p anel
Owner signature; Date: A. Fcc for branch circuits with
. . -:.: lai ''..:::. '; : above acrvice nr feeder fee,
7,42 2
each branch circuit
Business name: B. Fcc for branch circuits without
service or feeder fee, first
Contact name; branch circuit 56.18 2
A d dresS: •• .ach eel branch circuit 7.42 2
Miscellaneous (service or feeder not included)
Pach manufachired or modular
City/State/ZIP: 6784 2
dwelling, service and/or feeder
Phone; ( ) I Fax: : ( ) Reconnect only .. 67,84 2
E-mail: Pump or irrigation circle 67.84 2
- -- • - -.. . sign or outline lighting 67.84 2
.,.... :::::,:.1:
,...'.;').,: 1
••!..; C1;q1 ...... .:!; .•• .': ..: ''...i .' .. . :.. Signal circult(s) or limitcci-energ 1
Business name: Xif:___IAloguALcAt. it_ite.. panel, alteration, fir extension, 1 Page 2 75 2
— Each additional inspection over allowable in any of the abov
Address: 2't Z.0 Me. .5)144p Lew ti ws" Additional inspection (1 hr min) 66,25/ hr
City/State/ZIP: Wood I I Co- 470600 Investigation (I hr min) 66.25/ hr
Industrial plant (I lir min) 78.18/ hr
Phone: (03) i li stile I WO LI Li LI 5 ;2 3 ) kif ?its- Inspections for which no fee is
90.00/ hr
specifically Ilstal CA hr mini_
Electrical Lie.: 3.. eis Suprv. Lic.: 37 :7 .. • .:... • . .-- .: .."„: ELECTRICAL' PERMIT PEES- • '.. . - • 1
5—
Suprv. Electrician signature, required: /
Subtotal: ?5
Plan review (25% of permit fee):
Print name: Fki I / eg Date: F . 404 t state surcharge (12% of permit fcc);
Authorized signature: . 5.
.....
TOTAL PERMIT FEE!
this permit oPPlicotien expires if a permit Ic not obtained within IRO
(bp n i after it has bee accented as complete.
Print name: Data: •
•" Number of inapections allowed per numb,
1:l0uirillog1PermktiNELC-rormitApp.dec 0m/t° 49(1-4615T(11/05/COM/WSE1
08/30/2012 06:36 5036189985 PAGE 02/03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
Fee for a),, residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alartn.
❑ Garage Door. Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COIt3M) RGYRT ORIy xx11,,447�
Fee for each commercial • $75.00
system a •
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systerrls
❑ Boiler Controls
❑ Clock Systems
IN Data Tdecomm.unicatiorl Installation
❑ Pire Alarm Installation •
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
❑ Nurse Calls •
❑ Outdoor Landscape Lighting*
❑ Protective Signaling •
❑ Other . „
Total number of commercial systems:
•
*No licenses are required. Licenses are required
for all other installations
I: IRniIAIM1Pertils1ELC .PermIrApp,doc 07/01/10
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit#: ELR2012 -00202
T t G ARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/30/2012
Parcel: 1S136DB00201
Jurisdiction: Tigard
Site address: 11565 SW PACIFIC HWY
Project: Chase Bank Subdivision: 2000 -025 PARTITION PLAT Lot: 2
Project Description: Low voltage for voice /data
Contractor: XTREME COMMUNICATIONS INC Owner: FRED MEYER INC
24023 NE SHEA LN #215 STORE #375
WOOD VILLAGE, OR 97060 1014 VINE ST
PROPERTY TAX 7TH FLOOR
CINCINNATI, OH 45202
PHONE: 503 - 618 -8816 PHONE:
FAX: 503 - 618 -9985
FEES
Description Date Amount
Specifics: Restricted Energy Permit 08/30/2012 $75.00
12% State Surcharge - Electrical 08/30/2012 $9.00
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: Y Fire Alarm: N
HVAC: N Instrumentation: N
Intercom/Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N Total $84.00
Other Desc: Required Items and Reports (Conditions)
This per • it is issued subject t• the regulations contained in the Tigard Municipal Code. State of OR. Specialty Codes and all other applicable law. All work will
be do in accordance with appr• ed 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 I - l quires you to follow the rules adopted by the Oregon "• • • enter. Those rules are set forth in OAR
952 -0r' -0010 th .ugh OA : 2 - 0 0 1 - ' , : , You may obtain a copy of the rules or direct questions to • NC b . r 50 .. 2.1987 or 1.800.332.2344.
Issue. By: t. ' Permittee Sl nat! re: G.,r ✓�
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 503.639.4176 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.