Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit#: ELR2012 -00210
T I GA.RD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/06/2012
Parcel: 1 S 136DB00201
Jurisdiction: Tigard
Site address: 11565 SW PACIFIC HWY
Project: Chase Bank Subdivision: 2000 -025 PARTITION PLAT Lot: 2
Project Description: (1) low voltage for CCTV
Contractor: MVES CO Owner: FRED MEYER INC
17864 SW GALEWOOD DR STORE #375
SHERWOOD, OR 97140 1014 VINE ST
PROPERTY TAX 7TH FLOOR
CINCINNATI, OH 45202
PHONE: 503 - 928 -2966 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Restricted Energy Permit 09/06/2012 $75.00
12% State Surcharge - Electrical 09/06/2012 $9.00
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
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 0 R 952- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 t or 1.800.332.2344.
DLL Issued By: J At Permittee Signature: /'1A1 A-PPL C.4 l � 7 DLL
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 site at the time of each Inspection.
Electrical Permit Applicatio ) i iii, . ,r r it r 1 , ...i. dm
City of Ti rd SEP 0 6 2012 Received 9 ail} sc Pe>mitNo :& la_ ooaID
13125 SW Hail Blvd., Tigard, OR 97223 p y
- Phone: 503.7182439 Fax 503.598.10 (FTIGAND Review
Other Pemit6V d
I ■ ,` \ � >
Internet Lapcvuuu Line: 503 -639.4173 www_tigard- or.gov BUILDING DIVISION �9`o �aodyb� TI (X �PV le i ffi otmalion
IO 1.5edlAtaod:
• .•7 YPE OF WOI - • PLAN REVIEW
® New construction ❑ Addition/alteration/replacement Plena ehreh on dot apply (submit 2 seas of piano when, checked below):
❑ Demolition ❑Other O ServK� or feeder 400 amps or mere 0 e,�dma over three tom.
where the avmiable fault current 0 Marinas and boatyards.
CATEGORY OF coNLS`i'RUmoN exceeds 10,000 amps a2150 volts or 0 Floating byes
less to ground, or =coeds 14,000 0 Commercial -use agricultural
❑ I- and 2- family dwelling Cl Commerciel/mdust ial ❑ Accessory building arms for all other installations. bmldinas
❑ Multi- family ❑ Master builder ❑ Other. 0 Fite pump. 0 rmlanall°1' of 79 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Eger separately duived system.
A c N . t : o . . ofrevue motor trod of 0 "A ". "E". "1-2 "1 -3 ^.
Job no .t I Job cite cadretw : 1156$ SW Pacific Hwy 100HP or more. occupancy.
0 Six or more rdxdattial units. ['Recreational vehicle parks.
City/State/ZIP: Tigard, OR 97223 ❑ Irt u &M inks. 0 o.nt) roles t ....,.cub..
❑ Hazardous locations. 600 volts nominal.
Sulee/bldg./apt. no.: I Project name: JP Morgan Chase ❑ Soviet or feeder Goo mega or more. ,
FEE SCHEDULE
Cross street/directions to job site:
ntsaitaea I oh. I Fm I Total 1 •
New residential single- or meld-family dwelling unit.
Includes attached garage.
Subdivision: l Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'l 500 sq. ft or portion 33.92 1
Tic map/pnrccl no.: Limited energy, residential
75.00 2
DFSCR/ TION OF WORK (with above sec. g)
CCTV I imitM rm i
rpy, mum annily
residential (with above sq. ft.) •/.00 2
Services or feeders installation, alter adon, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER ( ❑ TENANT 201 amps to 400 amps 13156 2
Name- 401 amps to 600 amps 200.34 2
601 samara w 1,000 ""'W 301.04 2
Adeirra>: over 1,000 amps or volts »110 2
City/State/ZIP:
Temporary aervicea or feeders instattatioo, alteration, and/or
Phone: ( ) j I Fax: ( ) 200 amps or leas 59.36 I
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, tease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 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 10e or feeder fee, 7.42 2
each branch circuit
Business name: B. roe Mt mama GIW1n Mustard
service or feeder fee, fast 56.18 2
Contact name: Eric Long branch circuit
Each add'l breach circuit 7.42 _ 2
Address: Miscenancous (service or feeder not included)
Each manufactured or modular
City /State/LIP: dwelling, service and/or feeder 67.84 2
Phone: (503) 928-2966 Fax: : ( ) Reconnect only 67.84 2
E -mail: erio@mves-co.com Pump or irrigation circle 67.84 2
Sign or outline lighting 67.84 2
CONTRACTOR Signal circil(s) or limited-energy
Business name: MVES CO panel, alteration, or extension. 1 Page 2 75 2
Each additional inspection over allowable in any of the above
Address 17864 SW Galewood Dr Additional inspection (1 hr rain) 6625/ hr
City/State/ZIP: Sherwood, OR 97140 Investigation (1 hr min) 66251 hr
Industrial plant (1 hr min) 78.18/17r
Phone: (503) 92l -2966 � 1 ` I Fax: ( 11` 1'k p (t I l Z' w ( ) is 90.00/ hr hr min
specifically listed CCB Lic.: 191523 i Electrical Lic.: CLE246 f Suprv. Lic.: 24396d ELECTRICAL PERMIT FEES
Suprv. Electrician signature, 1•equaed: ' SubLOtaL 75
Plan review (25% of permit f _
Print name: Eric Long Date: 9/6/12 State surcharge (12% of permit f 9
TOTAL PERMIT FEE: 84
Authorized signature: This permit apprnsitlao expire. it a permit le not obtained within 1811
Print name: I Date: der. after tit °a been ""+fed u —...0....
Mamba of inspections allowed per permit
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