Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
s COMMUNITY DEVELOPMENT Permit #: ELR2012 -00247
T WGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/31/2012
Parcel: 1 S136DB00201
Jurisdiction: Tigard
Site address: 11565 SW PACIFIC HWY
Project: Fred Meyer Subdivision: 2000 -025 PARTITION PLAT Lot: 2
Project Description: (1) low voltage to install EAS system PCDs
Contractor: COCHRAN INC Owner: FRED MEYER INC
7550 SW TECH CENTER DR #220 STORE #375
TIGARD, OR 97223 1014 VINE ST
PROPERTY TAX 7TH FLOOR
CINCINNATI, OH 45202
PHONE: 503 - 234 -6564 PHONE:
FAX: 503 - 238 -2098
FEES
Description Date Amount
Specifics:, Restricted Energy Permit 10/31/2012 $75.00
12% State Surcharge - Electrical 10/31/2012 $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: N 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: Y Other: N Total $84.00
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 ainn a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: J / _t Permittee Signature: (Al APP1. /C, noAi
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.
01 07:28:59 10 -31 -2012 1 /3
Electrical Permit ApplicatliECEi / FOR OFFICE LSE ONLY
City of Tigard Y ive / �
Dat d �I � f l ( Permit No.: gu Q alga - 6
Il i I " 13125 SW Hall Blvd., Tigard, OR 9722A is 2012 Plan Review
Phone: 503.639.4171 Fax: 503.598.1 T 1 Date/By Other Permit:
'AGAR!) inspection Line: 503.639.4175 Date Ready/By NJ See Page 2 for
Internet: www.tigart! or.gov cIT/ AF T ARD Notified/Method: 11 C CRY 1 lJf 11�7f11.1 Supplemental Information
.' . _. TYPE , ,, 1s -. . PLAN RE.
o New construction - Addition /alteration/replacement Please check all that apply (submit 1 sets of plans w/items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other where the available faultcunent • OF GONST ° > 0 volts or ❑ Marinas buildings.
boatyards.
'G:4TFCORY; R UCTIO
IV;:;;" ' exceeds 10,000 a mps et l5 v ❑Floating b
' less to ground, or exceeds 14.000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling aCommercial /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' _ D Addion of new motor load of ❑ A ", "E", •'1 -2 •'1 -3 ",
Job no.: 111, --1 9 Job site address: igjU,6 5 C r / e i / L o �i IiHP or more. occupancy.
/1 7 ❑ Six ormorc residential units. ❑ Recreational vehicle parks.
City/State/ZIP: 77&44b n l 72 G �7.- ❑ Health -care facilities. ❑ Supply voltage for more than
l ❑ Hazardous locations. 600 volts nominal.
Suite/bldgiapt. no.: Project name: /' ❑ Service or feeder 600 amps or more.
Cross street/directions to job site:,�ot ,. /C Ate? At IS r. ,+!:' I:' :FCE SC.H... I�E.Fee. I'': '; : Total .
Description I a I •
New residential single- or multi - family dwelling unit.
,SL. — 7 2 n h 1* - Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4 •
Tax map /parcel n0.: Ea. add'1500 sq. ft. or portion 33.92 1
Limited energy, residential 75.00
DESCRIPTION OF WORK (with above sq. ft.) 2
�( Limited energy, multi - family 75.00
1I) lL /t1 ---3-72-s9 - �/,ST /�(.0 /4-S S9:s r m PADS residential (with above sq. ft.) 2
Services or feeders installation alteration, and /or relocation
A-i f 'C)• Ciff /C I7` 200 amps or less 100.70
❑ . PROPERTY •OWNER . ❑ TENANT• ' . • 201 amps to 400 amps 13156 2
Name: 401 amps to 600 snips 200.34 2
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
relocation
Phone: ( ) F ax: ( ) 200 amps or Tess 59.36
Owner installation: This installation is being made on property that I own which is not 201 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 168.54 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with -
❑. APPLICANT CONTACT, PERSON above service or feeder fee,
each branch circuit 7.42 2
Business name: e 09GIf Iyr %(_ .. /j e. B. Fee for branch circuits without
? service or feeder fee, first
Contact name: 74 / 0 M r p (rss branch circui[ 56.1 2
Each add'I branch circuit 7,42 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67 84 2
dwelling, service and/or feeder
Phone:.(503 ) 62..2._ 7J (v/ Fax:: (77/ ) 1 /93 «2 lad' Reconnect only 67.84 2
E Pump or irrigation circle 67.84 2
Signor outline lighting 67.84 2
. . • CONTRACTOR Signal circuit(s) or limited - energy � �,_,,
Business name: h c `7• _ _ panel, alteration, or extension. 1 Page 2 ` j /2° 2
—wrc 1 Each additional inspection over allowable in any of the above
Address: ` 15 50 5til ( eck ( fin e / *22D Additional inspection (I hr min) 66.25/ hr
City/State/ZIP: ((„\(, . (CA � 1` 9 r 72 Z 3 Investigation (1 hr min) 66.25/ hr
�� Industrial plant (I hr min) 78.18/ hr
Phone: q. -7' zus 4i (1- F ax: (9 7/ f y,/15 9-.2_698 Inspections for which no fee is
C [� specifically listed (h hr min) 90.00 / hr
CCB Lic.: 7 2 Electrical Lic.: L ( Suprv. Lic.: ,t -`473 ,�;. �"
�' .E
�K9 . .,, •.� ,:!
::GECTI2ICAL::PEIIMIT 'FEES:• ; . •
Suprv. Electrician signature, required: - Subtotal:. 7, UD
Plan review (25% of permit fee):
Pr•intname: P Date: State , 0 '
�n ' ,a . � on
Authorized signaturo: / .1
TOTAL PERMIT FEE: e ,
��� /, Q� This 'permit application expires if a permit is not obtained within 180
• Number of
Print name: Qki 0 e !, 11 y days after It has been acce pted as co m plet e.
Date: / Z— i
��-� < <�' — inspections allowed per permit.
1' Building , Pennits•ELC- PermdApp.doe 07101.10 440- 46157(11'05,COMLWEB
•
� y
01 07:29:28 10 -31 -2012 213
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*
❑ Burglar Alarm
.r,
❑ 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
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
• ❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
•
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting* •
❑ Protective Signaling
Other __S_ee_t.tZCtc
•
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
•
iAn„ildirokPmnnAFlf:.PmnitAnnd c mminn