Permit CITY OF TIGARD ELECTRICAL PERMIT
• COMMUNITY DEVELOPMENT Permit #: ELC2013 -00267
T [ CARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/09/2013
Parcel: 1S136DB00201
Jurisdiction: Tigard
Site address: 11565 SW PACIFIC HWY
Project: Fred Meyer Subdivision: 2000 -025 PARTITION PLAT Lot: 2
Project Description: (2) branch circuits and (1) 200 amps or less to replace emergency generator and ATS switch
Contractor: COCHRAN INC Owner: FRED MEYER INC
7550 SW TECH CENTER DR #220 STORE #375
TIGARD, OR 97223 1014 VINE ST
PROPERTY TAX 7TH FLOOR
CINCINNATI, OH 45202
PHONE: 503 - 234 -6564 PHONE
FAX. 503 - 238 -2098
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 05/09/2013 $100 70
Specifics: amps or less
2 crt Branch Circuits w /Purchase 05/09/2013 $14 84
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 05/09/2013 $13.86
Electrical
Type of Const:
Occupancy Grp:
Total $129.40
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�O You ma obtain the rules or direct questions to OUNC by calling 503 OyK
�`I 232 1987 or 1 800 332 .
Issued By: I Permittee Signature: A PPL, / � / o k.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:
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.
01 Electrical Permit A ' RECEIVED 09:02:19 05 -09 -2013 1/3
•
Apll FOR OFFICE USE ONLY :-
City of Tigard MAY 0 9 2013 Received .
penni N o.: oZf»
Date/B : 5-/q/c. 3 - oo au?
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
211111 5 Phone: 503.718.2439 Fax: 503.50W OF TIGARD Date/B : Other Permit:
TIGARD Inspection Line: 503.639.4175 t Dale Ready/By: 1 I la See Page 2 for
Internet: www.tigard- or.gov BUILDING DIVISIOP Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
:
P lease 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.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION
El Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.:'/ s/Z, &. Job site address: /45(.'5 SI,) Ad / F / t i LJ� I00HPor occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/Z1P: / / th/t �. ®a_ ❑ Health -care facilities. ❑ Supply voltage for mom than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: )p,> f ?, 0- �^ ❑ Service or feeder 600 amps or mom.
FEE SCHEDULE
Cross street/directions to job site: � � � f / F/e 17�1U V * SL.) 7Z Description I Qry. I Fee. I Total i •
/- New residential single- or multi- family dwelling unit.
R/,/ /LD//) 6 Psie/Y1 �I $upZO13- 00 0 7J Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'1500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
• /_?G 7 ` n Limited energy, multi - family 75.00 2
4 !L ZZ� /V6/0 - i- Q 7)2e i/G residential (with above sq. ft.)
Services or feeders installation„ alteration, and/or relocation
HePL/ Gene 'CW Gr T ,, S , I �'C 200 amps or less 100.70 h..)9, 7j, 2
U. PROPERTY PROPERTY OWNER ER ❑ 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 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, 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 CONTACT PERSON above service or feeder Cee, Z. 7.42 ?lief 2
p each branch circuit I
Business name: / " B. Fee for branch circuits without
CD t?/fn . G1✓G service or feeder fee, first
56.18 2
Contact name: Mi C4 ji f /y. LL branch circuit
r, '\ ,_ /� Each add'I branch circuit 7.42 2
bi d 7
Address: 7c5() S /t &it_ U 4 * Z?1) Miscellaneous (service or feeder not included)
City/State/ZIP: �; /� ,172-2,3
Each manufactured or modular
/10�tb t�hC� dwelling, service and/or feeder 67.84 2
-
Phone: (97/) ./ 9 z / i./ Fax: : #7/ 1.)5 - yi6 g Reconnect only 67.84 2
raj ON �D rizn Iii tit i O ih Pump or imgation circle 67.84 2
E -mail: Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited - energy
Business name: COCHRAN INC panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 7550 SW TECH CENTER DR. SUITE #220 Additional inspection (1 hr min) 6625/ hr
Investigation (I hr min) 66.25/ hr
City/State/ZIP: TIGARD OR 97223 Industrial plant (I hr min) 78.18 / hr
Phone: (971) 205 -4242 Fax: (971) 205 -4268 Inspections for which no fee is 90.00 /hr
specifically listed ('/: hr min)
CCB Lic.: 72942 Electrical Lic.: 37 h uprv. Lic.: 3447S ELECTRICAL PERMIT FEES
Subtotal:
Suprv. Electrician signature, required: \ Plan review (25% of permit fee): /a '„sy
Print name: KENNETH K/tTO , / 1 Date: �-9' -J3 State surcharge (12% of permit fee): 43, 6.0
TOTAL PERMIT FEE: / ZZ7, !/D
Authorized signature: i /;
�� !. This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: �, 1 G Date: c5'-g-/3 • Number of inspections allowed per penult
\ Bui lding\Permits\ELC- PermaApp.doc 07/01/10 440- 4615T(I I /05 /COMJWEB
01 09:02:45 05 -09 -2013 2/3
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
..RESIDENTIAL WORK ONLY
Fee for a residential systems combined ... $75.00
Check Type of Work Involved:
El Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
El Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918 309 - 0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other _
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
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