Permit a CITY OF TIGARD ELECTRICAL PERMIT
11. COMMUNITY DEVELOPMENT Permit #: ELC2011 -00685
TIGARD- 13125 SW Hat Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/01/2012
Parcel: 1 S136DB00201
Jurisdiction: Tigard
Site address: 11565 SW PACIFIC HWY
Project: Fred Meyer Subdivision: 2000 -025 PARTITION PLAT Lot: 2
Project Description: Expansion and remodel
Contractor: WHISKEY HILL ELECTRIC INC Owner: FRED MEYER INC
PO BOX 206 3800 SE 22ND AVE
HUBBARD, OR 97032 PORTLAND, OR 97202
PHONE: 503 -981 -4640 PHONE: 503 - 232 -8844
FAX: 503 -981 -4643
FEES
Quantity Description Date Amount
15 ea Services or Feeders - 200 05/01/2012 $1,510.50
Specifics: amps or less
1 ea Services or Feeders - 201 to 05/01/2012 $133.56
Type of Use: COM 400 amps
Class of Work: ADD 3 ea Temp Services or Feeders - 05/01/2012 $178.08
200 amps or less
Type of Const: 495 crt Branch Circuits w /Purchase 05/01/2012 $3,672.90
Occupancy Grp: Service or Feeder
1 ea 12% State Surcharge - 05/01/2012 $659.40
Electrical
1 ea Plan Review Electricial 05/01/2012 $1,373.76
Total $7,528.20
Required Items and Reports (Conditions)
This permit i - - - ubject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done accordance ' 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. • TTENTION: Or- a •w "equires you to follow the rules adopted by the Oregon Utility N • -lion Center. Those rulek are set forth in OAR
952- th •ugh 0 - 4 •0'F0090. You may ob in a copy of the rules or direct questions to OUN • • c<11IGt •232.1987 or A; • • .r • -
, ,gin , ,62—e
Iss - d By: rV l Permittee Signa . I/
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:
CONTRACTO - INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' / % d r 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.
.. _ 1 ao / /-ODO
Electrical Permit Applicati FOR OFFICE USE ONLY
City of Tigard Received Permit No: / / / - Date/By: ^�Q A : 13125 SW Hall Blvd., Tigard, OR J2 F CEIVED Plan Review I ' , L n t A(
C Phone: 503.718.2439 Fax: 503.598.1 U t c q L O„ Date/By: , a U"I Sher Permit:
f 1 G A I: D Inspection Line: 503.639.4175 l• Date Ready/By: ' / hues ® See Page 2 for
Internet: www.tigard - or.gov Non, ed/tvfathod: , di Supplemental Information I _
TYPE OF i /`� I T, l PLAN REVIEW
ftL'ING DIVISION Please check all that apply (submit 2 sets of plans w /items checked below):
❑ New construction ® Addition/alteration/replacement
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.
1 -and 2 dwelling C /industrial less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
El y g ® ❑ A ccessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
X mergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "l - ",
Job no.: I Job site address: 11565 SW Pacific Highway 1001iP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: Tigard, OR, 97223 ❑ Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: I Project name: FM #375 Tigard ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: SW 71st Ave Description I (jw I Fee. I Total I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Li Limited 500 y, es ft. or portion 33.92 I
Tax map /parcel no.: IS136DB, Tax Lot 201
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
Remodel with in the walls replacing inside lighting and new equipment, removing residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
old panel sections and replacing with new. 200 amps or less i Z .. 100.70 1510.5 2
❑ PROPERTY OWNER I 0 TENANT 201 amps to 400 amps 3 N .1 . 133.56 133.56 2
Name: Fred Meyer Stores 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: 3800 SE 22 Ave Over 1,000 amps or volts 552.26 2
City/State /ZIP: Portland, OR, 97202 Temporary services or feeders installation, alteration, and/or
relocation
Phone: (503)232 -8844 Fax: (503)797 -3509 200 amps or less 3 59.36 178.08 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I 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, alterati t nsion, per panel
Owner signature: Date: A. Fee for branch circuits with . AO .? ]�,�I
❑ APPLICANT I 0 CONTACT PERSON above service or feeder fee, • 1+r, 7.42
"/ T� 1 "� 2
each branch circuit
Business name: Mulvanny G2 Architecture B. Fee for branch circuits without
service or feeder fee, first 1 56.18 1 46.98 2
Contact name: Amy Scheckla - Cox branch circuit
Each add'I branch circuit 7.42 49+9' 2
Address: 601 SW Second Ave Miscellaneous (service or feeder not included)
City/State /ZIP: Portland Or, 97202 Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: (971) 998 - 1443 I Fax: : (503) 223 - 8381 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail: amy.scheckla cox @mulvannyg2.com
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
• Business name: TBD W IA, / e 1,4,11_, EG, /L ..,. L.. panel, alteration, or extension. Paget 2
5 `/ ^ Each additional inspection over allowable in any of the above
Address: Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City/State /ZIP: Industrial plant (1 hr min) 78.18/ hr
Phone: ( ) Fax: ( ) Inspections for which no fee is
? f specifically listed (% hr min) 90.00 / hr
CCB Lie.: /62 Electrical Lie.: e, ? co Suprv. Lie.: /C Z 5 ELECTRICAL PERMIT FEES
/ ` Subtotal: 5 t (/9 5 O
Suprv. Electrician signature, required: ` N • �d ‘ CrR La1.I4/. Plan review (25% of permit fee): �� 3 7 3 .7 _
Print name: L( , Ll.4A N G 2C� �- Date: (_ _ l I State surcharge (12% of permit fee): �SQ
Authorized signature: U TOTAL PERMIT FEE: '7 ,
—�� This permit application expires if a permit is not obtained within 180
Print name: i C D t b t Dater /...- / Z days after it has been accepted as complete.
Number of inspections allowed per permit.
I:\ Building \Permits\ELC- PermitApp.doc 07/01/10 440-4615T(II /05 /COM/WEB
This form is recognized by most Building Departments in the Tri -County area for transmitting information.
Please complete this form when submitting information for plan review responses and revisions.
This form and the information it provides helps the review process and response to your project.
ill City of Tigard
Buildin g Division
TIGARD
TRANSMITTAL LETTER
TO: l,L.t. DATE RECEIVED:
DEPT: BUILDING DIVISIO RECEIVED
JAN 27 20
FROM: OF TIGARD
DIVI N
n riAlinr . BUILDING
COMPANY: u..1111� ' / g.. PHONE: q - 1 i - ' 9 9 8 1 Y `t 3 By l J
RE: 0 5(P E 7 A9-e. 01) E .C. /- 606g.
(Site Address) (Permit Number)
- 1
(Project name or subdivision n e and number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: Copies: I Description:
Additional set(s) of plans. Revisions:
Cross section(s) and details. Wall bracing and /or lateral analysis.
Floor /roof framing. Basement and retaining walls.
Beam calculations. Engineer's calculations.
Other (explain):
REMARKS:
FOR OFFICE USE ONLY
Routed to Permit Technician: Date: Initials:
Fees Due: ❑ Yes ❑ No Fee Description: Amount Due:
$
$
$
$
Special
Instructions:
Reprint Permit (per PE): ❑ Yes I ❑ No ❑ Done
Applicant Notified: Date: Initials:
(:\Building\ Forms \TransmittalLetter - Revisions.doc 02/08/2011
r
-� RECEIVED
JAN 2 7 2012
u
u.
M U LVA N N Y G 2 an oFTIGARD
•
TRANSMITTAL
DESIGN AT WORK
TO Community Development DATE 1.27.12
13125 SW Hall Blvd. PROJECT Tigard FM #375
Tigard, OR 97223 PROJECT NUMBER 11 0029 02A 08
ATTN Gary Noble NUMBER OF PAGES (Set) Including Cover Page
PHONE 503.718.2439
FAX
FROM Amy Scheckla -Cox
CC
SEND VIA Courier 1 2 3 4 hours (circle one)
RE Tigard Permit Set
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2 2 Half size drawing sets o 2 LL ,,� . X CC
NOTES
Gary,
Here are the two half size permit sets that you requested. If there are any questions,
please let me know.
Thank you,
Amy Scheckla -Cox, LEEDTM AP I Associate
D: 971.998.1443
F: 971.217.0114
E: amy.scheckla- cox@mulvannyg2.com
p: Fred meyer111111- 0029 -01 - fm tigard102corresp2204jurisdictlonlbuilding \transmittal -gary noble_1.27.12.doc
Privileged and confidential Information: the information in this document Is intended only for the use of the above named redplent. Any
wrongful review, dissemination, distribution or copying of this communication Is strictly prohibited. If errors occur in transmission, or enclosures
are not as noted, please notify us at once.
503.223.8030 691 Sty SECOND AVENUE I SUITE1200 I PORTLAND, OR 1 97204
503,223.8381 M4lvenny!G2.com