Permit CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: ELR2007 - 00303
; . lh DATE ISSUED: 7/30/2007
TIGARD; 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
g PARCEL: 1S136DB -00201
SITE ADDRESS: 11565 SW PACIFIC HWY ZONING: C - G
SUBDIVISION: FRED MEYER LOT: JURISDICTION: TIG
PROJECT: FRED MEYER
Project Description: Add data cabling for access points inside the Fred Meyer store.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE/IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: X NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
WILMINGTON TRUST CO, TRUSTEE APPLIED TECHNICAL SYSTEMS INC
BY FRED MEYER, INC 6024 SW JEAN RD
3800 SE 22ND AVE STE E -200
PORTLAND, OR 97242 LAKE OSWEGO, OR 97035
Phone: Contact #: PRI 503-684-9611
FAX 503 -598 -0498
FEES Reg #: ELE 2 -7ICLE
LIC 89511
Description Date Amount SUP 2997LEA
[ELPRMT] ELR Permit 7/30/2007 $75.00
[TAX] 8% State Surcha 7/30/2007 $6.00 REQUIRED ITEMS AND REPORTS
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By: Permittee Signature: • 1/C4- , al
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'N: DATE:
LICENSE NO:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
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M
t �, �q City of Tigar Date/B : 6 Permit No.: z 20, ,
13125 SW Hall Blvd, Tigard, OR 97223 j� Plan Review
�I p g � c.' ' 2007 Other Permit:
Phone: 503.639.4171 Fax: 503.598.1 Date/By:
rl Iir1;t i , 4 Date Re B Juris:
Inspection Line: 503 @ ® See P
I I A'R D - 1 k :, Y y ,.. e Notified/Method: Supplemental 2 for
I,lu +� �l 5niuk.r. Internet: www.tigard- or.gov .,-), ��� � 17 � PP tal Information
TY PE I I- 1 WORK I r , ' L n s/ ; 4 g � 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 ® Commercialindustrial ❑ 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 Toad of ❑ °A ", °E ", "1 -2", "1 -3 ",
Job no.: 792375 Job site address: 11565 SW Pacific Hwy IOOHP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City / State/ZIP: 97223 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: 80211 Fred Meyer 375 ❑ Service or feeder 600 amps or more.
F EE SCHEDULE
Cross street/directions to job site: 217 North on Pcific hwy to site -. _ _ _ Description —.- -1 Qty- -1 -- Fee.— 1 Taal —1 -- *
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family
Add data cable for access pints 75.00 2
P residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER ' .. ' - - ❑ 'TENANT - . - 201 amps to 400 amps : 106.85 2
Name: _ 401'antps to 600 amps 160.60 2
• 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City /State/ZIP: Temporary serviees or feedershistallation, alteration, and/or
relocation .
Phone: ( ) Fax: ( . ) 200 'amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 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 6.65 2
Business name: Applied Technical Systems B. Fee for branch circuits
without service or feeder fee,
Contact name: Bob Kumpula first branch circuit 46.85 2
Address: 6024 SW Jean Rd #E -200 Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/ State/ZIP: Lake Oswego, OR 97035 Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: (503) 684 9611 Fax: : (503) 598 0498 Reconnect only 66.85 2
E -mail: m.phillips @atsdata.com Pump or irrigation circle 53.40 2
CONTRACTOR. . • Sign or outline lighting 53.40 2
Business name: Applied Technical Systems ' Signal circuit(s)
energy panel, alterer limited-
or
Address: 6024 SW Jean Rd #E-200 extension. Describe: i Page 2 75 CO 2
City/State /ZIP: Lake Oswego, OR 97035 - _ . Each additional inspection over allowable in any of the above
Per inspection- 62.50
Ph (503) 684 9611 _ _ - Fax: (503) 598 0498 _ Investigation per hour (I hr min) 62.50
C CB Lic.: 89511 . Electrical Lic.: 2 -71 cle _Suprv. Lic.: 29971ea Industrial plant per hour ' 73.75
_ f / ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: ��� 10 1 I Subtotal: 75.. QD
Plan review (25% of permit fee):
Print name: Matt Phillips Date: 7/26/07 State surcharge (8% of permit fee): & . 00
Authorized signature: 7! ��� TOTAL PERMIT FEE: O 1 • 00
Print name: Matt Phillips Date: 7/26/07 This permit application expires if a permit is not obtained within 180
1� days after it has been accepted as complete.