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Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT COMMUNITY DEVELOPMENT Permit #: ELR2010 -00148 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/10/2010 "'TIGARD • 9 Parcel: 1S136DB00201 • Jurisdiction: Tigard Site address: 11577 SW PACIFIC HWY Subdivision: Lot: 0 Project: Good Feet Project Description: Owner: FEES FRED MEYER STORES, INC Description Date Amount BY NICKEL & COMPANY LLC, STORE #375, PO Restricted Energy Permit 08/10/2010 $75.00 BOX 35547 12% State Surcharge - Electrical 08/10/2010 $9.00 PHONE: Contractor: ADT SECURITY SERVICES INC 2815 SW 153RD DR BEAVERTON, OR 97006 PHONE: 503 - 469 -7212 FAX: 503- 469 -7114 Type of Use: COM Class of Work: ALT Total Number of Systems: 1 Audio & Stereo: N Boiler Controls: N CCTV: Y Clock Systems: N Data & Telecommunications: N Fire Alarm: N HVAC: N Instrumentation: N Total $84.00 Intercom /Paging: N Landscape /Irrigation: N Required Items and Reports (Conditions) Landscape Lighting: N Medical: N Nurse Calls: N Protective Signal: N Security Alarm: N Other: N Other Desc: 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 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. A NTION: Oregon la re. ' es you to follow the rules adopted by the Oregon Utility Notification Center, Those rules are set forth in OAR 952 -00 0010 through OAR 952 -0' -*100 •u may obtain a cop of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344 ' Issu d By: � Permittee Signature: _ I /_' , g ;a 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 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 FOR OFFICE USE ONLY • I • City of Tigard Received /0 ) o ( Permit No.: G i'� D -,x l L( g 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Other Permit: 10'00 S ,? 3 IS Phone: 503.639.4171 Fax: 503.598.1960 Date/By: f I C A R D Inspection Line: 503.639.4175 Date Ready/By: rum: . ® See Page 2 for Internet: www.tigard- or.gov Notified/Method: Supplemental lnformation TYPE OF WORK 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 IN Commercial /industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi- family 0 Master builder ❑ Other: ['Fire pump. ❑ installation of 75 KVA or ��.. JOB SITE INFORMATION AND LOCATION ❑ Emergency system larger separately derived system. , ❑S Six ❑ Addition of new motor load of ❑ "A" "E" "1 -2" "l -3" Job no.: 30.s - 8 02 /, Job site address: //S 77 .SW /RG /9i c /tW/ R ecre ix o or r mom ore re rest dential units. ❑ residential l vehicle parks. City /State/ZIP: 174 i D 02 97 3 ❑ Health -care facilities. ❑ Supply voltage for more than ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: 6 00Z 1EE-- ❑ Service or feeder 600 amps or more. job site: Description FEE SCHEDULE Cross street/directions to J 1 Qtr. 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 Ea. add'I 500 sq. ft. or portion 33.92 1 Tax map /parcel no.: Limited energy, residential 75.00 2 DESCRIPTION OF WORK (with above sq. ft.) Limited energy, multi- family 75.00 2 e e' T`/ DQm E en ? S residential (with above sq. ft.) Services or feeders installation, alteration, and/or relocation 200 amps or less 100.70 2 ❑ PROPERTY OWNER 1 ❑ TENANT 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 Name: 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 tY relocation Phone: ( ) Fax: ( ) 200 amps or less 59.36 1 201 amps to 400 amps 125.08 2 Owner installation: This installation is being made on property that 1 own which is not 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 I CONTACT PERSON above service or feeder fee, 7 42 2 each branch circuit Business name: B. Fee for branch circuits without " service or feeder fee, first 56.18 2 Contact name: .101/1) /T(Js T.4-41 branch circuit 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 ty dwelling, service and/or feeder .'ll 3) 59 f ' a � /0 ( ) Reconnect only 67.84 , 2 Phone: lJU Fax: Pump or irrigation circle 67.84 2 E - mail: Sign or outline lighting 67.84 .2 CONTRACTOR Signal circuit(s) or limited- energy � a Business name: D r 5 E c we / T panel, alteration, or extension. _ Page 2 2 Y Each additional inspection over allowable in any of the above Address: a ' /s .S id /53 ad biz Additional inspection (1 hr min) 66.25/ hr City/State/ZIP: Be A V CA TDN O. 9 700 6 Investigation (1 hr min) 66.25/ hr Industrial plant (1 hr min) 78.18 / hr Phone: (3 ? j ) f' g - 760 9 9 Fax: (5Z 3) ea q- 7/15/ Inspections for which no fee is 90.00 / hr specifically listed (Y2 hr min) CCB Lic.: $ 7 ,1 4/T Electrical Lic.:24' 20906E-- Suprv. Lic.: LE i f 37 C/ ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: e • Subtotal: i� A7r,� Plan review (25% of permit fee): Print name: k fn) Kee. J4 o i Date: �s/7iv State surcharge (I2% of permit fee): 9 00 TOTAL PERMIT FEE: R ti 0 O Authorized signature: This permit application expires if a permit is not obtained within 180 Print name: Date: days after it has been accepted as complete. N um b er of inspections allowed per permit. I:\ Building \Permits\ELC- PermitApp.doc 07 440- 4615T(1I /05'COM/WEB