Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
• COMMUNITY DEVELOPMENT Permit #: ELR2012 -00161
T (G A RID 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/30/2012
Parcel: 1 S136DB00201
Jurisdiction: Tigard
Site address: 11565 SW PACIFIC HWY
Project: Fred Meyer Subdivision: 2000 -025 PARTITION PLAT Lot: 2
Project Description: Low Voltage for thermostat wire for (1) ductless split system
"REPRINT 7/30/12 to reflect ELR case -not MEC**
Contractor: JACOBS HEATING & AIR CONDITIONING Owner: FRED MEYER INC
4474 SE MILWAUKIE 3800 SE 22ND AVE
PORTLAND, OR 97202 PORTLAND, OR 97202
PHONE: 503 - 234 -7331 PHONE: 503 - 232 -8844
FAX: 503 - 808 -9108
FEES
Description Date Amount
Specifics:, Restricted Energy Permit 07/30/2012 $75.00
12% State Surcharge - Electrical 07/30/2012 $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: Y Instrumentation: N
Intercom/Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N 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 / 0.
952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503,232.1987 or 1.800.332.2344. f
Issued By: /[�,{' b Permittee Signature: U� j , 4PL_I CA / oI \L
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 she at the time of each Inspection.
RECEIVED
Electrical Permit A.ulication JUL 26 FOR OFFIC:E iiSti ONI.N
0 ,..1
.. City of Tigard 2012 ! Dveb,.. "I LIM --- l ''' ' W
'''.. ' ' a . -001
• IN.--: 1.5 12 SW Hun Blvd.. Tigard. °K 97233 OFT1GARD p,..,....i.„ , Oracr Porunt,
• ` Phtle.c: 50:.1.71S2419 Fax: 503.598,19 Sv. I
. ci A t di I n5peCrian Litre: 50.639.417S B IIDINGDIVISIOW:R.24,-By: -----...._.4.1 t B ster-,3: for
1 • Not4'c6Nleato:i• A , I Supplemental Information
littcmct: wtrw.ligard-oz:gov
' • -
L --,------------t/--------" pb :33 . duet; all 001 14ply introit 1 bets oi pleas u.viteins check: a behavo:
• 0:New construction Additiontherationireplateme Os f amp or more 0 Building oi Ps= stories
0 DdlnOtitiOn Q Other what die wails &A current 0 Marivas and horyardi,
• CATEGORY CIS145.FRLIPTIO.S,. . :,•: -...••••• • .. ;„ : ;:,: .. . ;• •,:,1 ' .-....; ex.nseds 19,000 =pis; 10 Nvits, or 0 Ploansis buildings.
tcss to good. cc exiszds i4,000 InCommercial-us: =vitae:al
0 1- n111.2-inIntily dwelling L ominereiatiirithistrial 0 Acccsrwry building :Juno thr all other rosdkeumis, buildings.
l i p lvtuiti -earn ily 0 Master builder • D Other: OFirc.purap. El wonliation of 7 3 KV A Or
., .. . . ' 0 Emergency system. tarper sgraratcly &rived symen,
i . • ..
I • . - • . JOB Sflt•INFolimAsitus AN.P . :1,tor-A TIPN . :.., .... ...... ,::.!..:.: • : .: 0 Addition of new motor WO or CI "A", "r1-2
• • " .
1 . . toottP or nape- occupancy,
..l oh. no.: lob 5ile address: VI . •
' 3 ‘ 1 .1 , 9 . L _: ..1 A A .. i I • ra 5ix..or mute reidallial hart. 0 Itcrjrational vr.hi4la p.v14. .
0 Hcalt13-eirc facilidas r:l Supply voltqc formore then
. 1 .City1StatcalP: . • i • • a, • 1 0 . • ... L . La Itatudous location". 600 volts nominal
I, Suittilbleig./.apt. no.: .Project name: Dna - ,P-A•CV4- Cl Ser.= or feeder GOO arm glf 21101::
. 'Cros3.S.I to job SiL0'. uneri, ihip IIMINIMMIN Tt.ho •
' - 'Ncw residential single- or multi-family dwelling wait.
includes attached garage.
• •
_
• • .
• • . 1400 sq..ft. or leis • 1 168.54 .i 4
SOdiViSiC01: 1 L.01 no.:.
- E. WV SOO sq. ft. or portion 53,in I I.
.r1tX•Inap:parcel 110.: Lintited•encrey, residential 75
DESP
-,---....., .90 :12:
... . WI,IPS.0F:*00.-. •:•::• :. ; : . ... ............::....".., ..:: !: :...!,...., .: h m„ (with above•so. fr.)
• • .. • u.1 .......„1,,...ii). I 7S.00 1
•:1 .. - .1 \)C2‘ --,11, (IL' 'AA ''' .6 a i__. f ' - "C 1 reiidential (With above sq. &I
. r- • Services or readers, iniudlati0 o. alteration, anWor relowtion
• I lik •• ---1.. •c.' . • . _. ..i . 4'1.2. • " \ 200 trim or bets I 10(00 ; 2
• • ' .l..." CI:elt01 0*-AR .:. ' . ,, • ••• - : 41 .. .1 . : : . :TrzsA.NT. :. .. - :: iv- - .: 201 amP W 400 amps I 113.56 I . i 2
401 amps to 600 =vs I 200:34 1 J
,anie:
601 amp w 1.000 amps 501.04 1 2
..... l5B. . OVCr.r, MIPS Or VOta S52.2 1 2
- 'temporary $0E-vices or feeders tostallarion. alteration,.and/or
Cite/ 9,ttneall:
■ ^
' I Fos: ( • 1 r 7:00 ---.jIr
1,
°-L.....-'-'-'--- or less ; 1
.' Plume'
L- - ' l 201 on to 400 ta.mf
.! Ovvrwr installation: This insiallaiion is being milk: on property that I own. which is not I 123
=asap 594 amps I l65,54 1 • ,--11
i intunded for stale. lease. ren t. or exchange, ae.cordin to ORS 447 401 I ' .449. 670, and 701.
BrArteh.eiratits new. alteration. °vesication, per panel
. . .
Owner signature: • Dttle. • A. Fee for branch cut was 1 1
- above service or foeder Ice.
• -1 .. ,.... : • ' .. • . • El ,LICAST . , :; . - ••1 ...:.:, :....:..:: ID' .0*tiier,.:1 ;•i!
- -.ch branch circuit . 1 7,42 1 - 1 :1
• Rusittess mune: • . . • . I la, Fcre for branch circuits. without i
or feeder fix, tina 1 , •
• . . branch circuit 1
56.1s
• : Conmet•r
.. • - • • Each at branch r.treen 1 1 7.42 r 1 1
I Address: •
. . NliscolInneorts (service or feeder nor included! . • 1
t• ,. - ' - Each raunufer.twatiar modular
• 1 L:11)1StaterIZIP: • • dwellity.sereice andlor feeder 67.54
• i„......--.--:..- • .-
• I Phone: ( ) I Fax: ;•( 1 Rceannor-t only n7.K4
• ........,______________.,---•-______. - Pump or irrigation circic I 67,84 1 2
. li •Si%ttt or outlim 1 iduing 1 I 67.84 .1
• • • .cott7 . • • - .• .. • - - ••• •
•••••,..• •- •
. . .... . .. ...„ ... s elietonspar limited-1mM' I 1 •
i • nancl.aheration. or extension. Pace 2 Ll ,5 ,C:13 1721
--77----------.. n namez . . e a - I 4 .4. ' . Eleh addintwatinspection over allowable in stuv of .the above
. .. , ,,t9 , ( Adigion2linspecuon 0 hr min} I I 66:15/hr I
Addr..-$3, Li. . .6. k •. I.t . _ 1 - • -----1 66251 hr 1
City:State.q.11 pyfrn riiryl nR C1 0 a -
_., 1 Industrial plata 0 hrtnaat 1 I 76.1S( hi I -
Phone'. k 4_.1 .1 , .
I Fax:.' W . ' F■:- I I inspections for winch cra ice is 1 1 90.00/ hr I
1 sponlicallv liSled er: iv min)
Ltc „, f.44,44 I
... C:etrical 1.1e4 -51 St:pry:Lie.: vicralcAL.PE1ti11r..F.Ers7..-....,:,.::,..:.--•.:•.[::
• . ,_., , a p . • t i Subtotal: -- W, .60
1 Su rs 1 ' i i. . n ' • ' i d Z.,...0•
,
sup r. L.et„Ar c an sr_n.turt., r‘qu r‘ . / -"---.. \ 4: .,e______
lt.----,"------- I i Nan review (2 '60f of per 111 fcc): 1
c
' .P rill 1. riarno:4 h '4 4., 2-c,.. f L-
Date; State burcharge 02% of permit fiat): , CI • 00 1 • . TOTAL PERMIT FEE: i q • ('('\
i
•tianori.ied si , _ J ,9- ,4x AI ) .1 1114 peralit ;pplitation cipieca Ku nem', 4 nor ebtoined nitlain t80
' i cl=sy aftrt it JUL% berg Welgcti u cmulgotr--
! Print name: . • _a a . a? Da .430- ,I., I • Nctunix of iospuctior.s allowed per pcmir.
1,1;a41:q dm STDHIG 4.:6.-tatSTI:LI“:: com..wea
)
170/E0 39Vd ONIIV3H sgoovr LSZ661860S _
80 :DT ZIOZ/9Z/L0
Electrical Permit Application - . City of Tigard
Page 1- Supplemental I:ufor rnation
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK: OI�F.Y:Y:
F for .Eli residendel,s1stems. combined... —.. 575.04
Check Type oCVurk involved:
L Audio and Stereo Systems*
O tiarr2gc Dour Opente •
0. Heating. Ventilation and Air Conditioning System"
O Vacuum •iy tetrai`
G .O.ther
C;Q? INIER.C111..11frORK ONLY:. s • .•
Fee for zja1 commercial
svttein
(tiE E OAR 918.309 -UUOO)
Check Type of Work
O Audio and 3tcreo.S} stems •
O Boiler Control
0 C' :lock Stisierni
Q L) to Tel comtnuniauiun Installation
• 0 :Fire .Alann .Alan InsuLitic
.• � frzururnent3norl
El i.ntercum as:d Pse:ie, Si st.erras
:0 ;Landscape irrigation Contra*
• I e di all
?purse Calls
• Outdo3i Landscape Lighti ne
Q Protrctirc Signaling
• O..th r
ToLd niuti:bcr rkt torrunrrcial stistemi.:
*No licenses are required. Licenses are required
for :sil other installarions
00/00 39Vd 9NI1V3H S3000T LSZ6Et8EOS 8b :01 ZTOZ /9Z /L0