Permit ` p ELECTRICAL PERMIT
CITY OF TIGAR® COMMUNITY DEVELOPMENT Permit #: ELC2009 -00559
rR -, Date Issued: 10/22/2009
TIGARD, 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
„�.. Parcel: 1S136DB00201
Jurisdiction: Tigard
Site address: 11565 SW PACIFIC HWY
Subdivision: Lot: 0
Project: Fred Meyer
Project Description: Alter (1) branch circuit.
Owner: FEES
FRED MEYER STORES, INC Quantity Description Date Amount
BY NICKEL & COMPANY LLC, STORE #375, PO
BOX 35547 1 crt Branch Circuits 10/22/2009 $56.18
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 10/22/2009 $6.74
Electrical
Contractor:
MARK ADAMS ELECTRIC INC
PO BOX 2748
CLACKAMAS, OR 97015
PHONE: 503 - 557 -8543
FAX: 503- 557 -8508
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $62.92
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 thr ugh AR 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: 6VOI k ` PermitteeSignature:
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 / 1 TALLATION ONLY
SIGNATURE OF SUPR. ELEC' L Date: w�L 2/Q
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.
Electrical Permit Application r F� ;* v. ..+' ,. I OR.OI I I(.I. VSE ON 1 '4:Y ^rt.� ,,Sy,f •I : �
� _ r r ' C 1 � DateBy: _ • 3SS' '
City of Tigard n L . Received Permit No �I n f)y/�[�
11 114
1 3125 SW Hall Blvd., Tigard, OR 97223, ti, -r� `' l P ~"` r
g Plan R
0 Other Permit:
Phone: 503 Fax: 503.598.1960 9 2009 Date/By: Inspection Line: 503.639.4175 � �+ Date Ready /By: Juris: ® See Page 2 for
I I C A1ZD p O
.. Internet: www.tigard- or.gov y r.I 7 Notified/Method: C Supplemental Information
YPE OF WORKt i ` ' ,",, ONISION 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 _aCommercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: //S ,5 J6J Pmt (Crr 2 / 44 100HP or more. occupancy.
❑ ❑ Six or more residential units. Recreational vehicle parks.
City /State /ZIP: i p� W_, /. d O ❑ Health -care facilities. ❑ Supply voltage for more than
f ❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: 02_ [cfllie te r /t eZ � ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: r hC I-w . _ Description 1 Qty. 1 Fee. 1 Total 1
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map /parcel no.: Ea. add] 500 sq. ft. or portion 33.92 1
Limited energy, residential 67.84 2
DESCRIPTION OF WORK (with above sq. ft.)
/ Limited energy, multi - family 67.84 2
1 , � / J L t e r 4t 1 Lc t ett=L� d e l ( ti i,o e .--
residential (with above sq. ft.)
/ C� �j Services or feeders installation, alteration, and/or relocation
iA,t_ t.J Ake .. ec l s h ' / e6f, 7 Q � ` - 6c 1 200 amps or less 100.70 2
❑ PROPERTY OWNER '❑ TENANT • 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 /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
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, Rer panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT . 0 CONTACT PERSON above service or feeder fee,
•
' each branch circuit 7.42 2
Business name: B. Fee for branch circuits /
Contact name: without service or feeder fee, /
first branch circuit 56.18 � 2
Address: Each add'l branch circuit 7.42 •••ttt 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular
dwelling, service and/or feeder 67.84 2
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
E -mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Signal circuit(s) or limited -
Business name: ‘c ti S 6 L cG 6e i C energy panel, alteration, or
Address: \ , v . 6d x Z 7 el'a extension. Describe: Page 2 2
City/State /ZIP: �aC tM4s 0e___ 9 706— Each additional inspection over allowable in any of the above
e Per inspection 66.25
Phone: ( 63) Zo5 -53-3 ii Fax: (5 3) ,Ss 7 Investigation per hour (I hr min) 66.25
l CCB Lic.: I) 7 f 0 q Electrical Lic.: C Z 4 S Suprv. Lic. • 0/05
.1 \t Industrial plant per hour 78.18
�� ELECTRICAL PERMIT FEES
Suprv. Electrician signs ure, required: � � Subtotal: .5 /�
Print name: 41 , 4 _ a l$ Date: /eV L ' '
State Plan review (25% of permit fee): -a-- surcharge (12% of permit fee): to t 7
Authorized signature: TOTAL PERMIT FEE: t2s q Z
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
Number of inspections allowed per permit.
I:\Building\Permits\ELC- PermitApp.doc 10/01/09 440- 461ST(11/05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined $67.84
Check Type of Work Involved:
n Audio and Stereo Systems*
n Burglar Alarm
❑ Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
n Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY: •
Fee for each commercial $67.84
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
n Audio and Stereo Systems
❑ Boiler Controls
n Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
n Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I: \Building\Permits\ELC- PermitApp.doc 10/01/09