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Permit • • ,1 CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit#: ELC2022-00687 TIG".RD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/8/2022 Parcel: 2S10413607900 Jurisdiction: Tigard Site address: 14300 SW BARROWS RD Project: Safeway Subdivision: RUSSELL'S SCHOLLS FERRY Lot: A Project Description: Electrical for grocery store conversion from Albertsons to Safeway. Contractor: INDUSTRIAL COMMERCIAL ELECTRIC COMPANY Owner: SPIRIT SPE HG 2015-1 LLC PO BOX 21282 BY SPIRIT REALTY CAPITAL KEIZER, OR 97307 ATTN PETER CAVAZOS 2727 HARWOOD ST STE 300 DALLAS,TX 75201 PHONE: 503-981-2383 PHONE: FAX: 503-981-0053 FEES Quantity Description Date Amount 1 ea Services or Feeders-201 to 12/01/2022 $133.56 Specifics: 400 amps 64 crt Branch Circuits w/Purchase 12/01/2022 $474.88 Type of Use: COM Service or Feeder Class of Work: ALT 1 ea Plan Review Electricial 12/01/2022 $152.11 Type of Const: 1 ea 12%State Surcharge- 12/01/2022 $73.01 Occupancy Grp: Electrical Total $833.56 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 throuah OAR 952-001-0090. You may obtain a coo%moles or direct auestions to OUNC by callina 503.232.1987 or 1.800.332.2344. Issued By: — Permittee Signature: 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'N 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 Application FOR OFFICE I51•:ONLY I �7 11 �7 �^ City of Tigard RECE �aY ' j3/Pe nit#: � // /��/Y 1//l�7 • 13125 SW Hall Blvd.,Tigard,OR 97223 �jIan Revie°O°yyy 7 q ��K!^� LLllllll/JJ((/���/JJ ' ti Phone: 503.718.2439 Fax: 503.598.1960 SEP 2 9 2u f bate/By:/(f l Related P n20�D0�38 T 1 GA R D Inspection Line: 503.639.4175 T /+ Ready Da /By: !// luris: H See Page 2 for Internet: www.tigard-oegov VITY OF 1I1.3 fted/Method: ' ' Supplemental Information - �1YPE OF glIII1nINCG DIVISI� r e. PLAN REVIEW, cW,( .• ❑New construction AdditioAlalteratimaxeplacement Please check all that apply(submit 2 sets of plans w/items checked): f ❑Service or feeder 400 amps or snore 0 Building over three stories. 0 Demolition ElOther: where the available fault current 0 Marinas and boatyards. CATEG Y OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings. El1-and 2-family dwelling Commercial/industrial ElAccessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural amps for all other installations. buildings. ❑Multi-family ❑Master builder ❑Other: 0 Fire pump. 0 Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION ,.� 0 Emergency system. larger separately derived Job#: I Job site address:) �'cc iJ yYytt,,g,z) �� ❑Addition of new motor load of system. 4 �e+_a �-� IOOHP or more. ❑••A,,,•E" "l_2" ,•1_3„ 7��I/J� 0 Six or more residential units. occupancy. City/State/ZIP: �• / © ' y^/�{'/� `�` 22� ❑Health-care facilities. 0 Recreational vehicle parks. Suite/bldg./apt.#: Project nameA.+'M1 1�A111 i /r��1 +1 ❑Hazardous locations. 0 Supply voltage for more than iPt -• •Z ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: W �qrt c- 1- FEE SCHEDULE Pt IC 4 /� 4 Description I Qty. I Each i I Total I ' r^fY 7W ��,( New residential single-or multi-family dwelling unit. Subdivision: I Lot#: Includes attached garage. 1,000 sq.ft.or less 168.54 4 Tax map/parcel#: S 1 D 4►�- 1 tt't7 Ea.add'1500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential 1 �.}y� .ems, ay- tart �p /� (with above sq.ft.) 75.00 2 3 l Vetti r_ TeNiAir l i 1,Tpp 0e-wl _ �14 rr1 V Limited energy,multi-family 75.00 2 Y 1 A,,_ 12.0 i�1`rC---y,a�- residential(with above sq.ft.) (n'�,1 l f a W (f! G��IL ' ` IIhG� Renewable Energy 0 See Page 2 ❑ PROPERTY OWNER I ^ !TENANT �s Services or feeders installation,alteration,and/or relocation . Name: �G = f4,41r � 451 4, C'`T t{I / 200 amps to 400 amps 133.56 2 t Address: I W ye- F7t/Gl� ' 17a 111 � �!3• , City/State/ZIP: "{"' L 401 amps to 600 amps 200.34 �0 2 \ 601 amps to 1,000 amps 301.04 2 (9 1e� Fax:( ' T Over 1,000 amps or volts 552.26 2 €� Phone: bV ' ✓� Pp t ��IDTemporary services or feeders installation,alteration,and/or Email: l,L •1 tx' �t, C �1k 5tl�4 . 4.�4'�, relocation Owner ins[ llation:This installation is being made on property that I own which is not 200 amps or less 59.36 1 intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2 .`h Owner signature: Date: 401 amps to 599 amps 168.54 2 `! PLICANT I CONTACT PERSON Branch circuits-new,alteration,or extension,per panel I ,, s,y� 1 /� �+ �j �.�•y,�gcx A.Fee for branch circuits with 1 Business name:, (�L/4 ^i�faL 1'U-� abover or feeder fee,65 1 pQ' 1 l each brancheicircuite 7.42 G7q 2 Contact name: G W B.Fee for branch circuits without Address: V7tV e eakvejsrr G serviceorfeeder fee,first 56.18 2 N! branch circuit City/State/ZIP: 0i 0 /L,`1— Each add'1 branch circuit 7.42 2 ce012-TEAMQ _ I Miscellaneous(service or feeder not included)j Phone:��i crp. Fax::( Each manufactured or modular 67.84 2 tom, r e,/ iii��� dwelling,service and/or feeder Email: t1 V nitll\Gp1 e Ge 1h Reconnect only 67.84 2 l CONTRACTOR Pump or irrigation circle 67.84 2 Business name: J/ -a� �yt 4� 2, C.:: Sign or outline lighting 67.84 2 � Signal circuits)or limited-energy Address: 4/, n /+ � panel,alteration,or extension. ❑ See Page 2 2 City/State/ZIP: '/- -'tom ,D G Each additional inspection over allowable in any of the above f�(�r� (/1� ! J: Additional inspection(I hr min) 66.25/lu Phone:(S ) �� �O �� Fax:( ) Investigation(I hr min) 90.00/hr Email: Industrial plant(l hr min) 78.18/hr Inspections for which no fee is 90.00/hr CCB Lic.: / iiddlr I Electrical Lic.: GS--,), I Suprv.Lie.: 5-)i Pr specifically listed(i hr min)l� ELECTRICAL PERMIT FEES ,required: Subtotal: G Of it Print name: Date: 0 Plan Review Required(25a/e of permit fee): ! , State surcharge(12%of permit fee): 73, Authorized suture: C- . _� TOTAL PERMIT FEE: d . 1 This permit application expires if a permit is not obted within 180 Print name: 0 14N („� Date: ���rrr "]e>, days after it has been accepted as complete. Zz • Number of inspections allowed per permit. L03uitdinglPermits\ELC_PermitApp_ELR_ERE-doe Rev D6,17/2015 615T( /051COM/WEB Electrical Permit Application FOR OFFICE I SE ONLI City Of TigardIMII Received Date/ : Pemait#: n 13125 SW Hall Blvd.,Tigard,OR 97223 plea Review Phone: 503.718.2439 Fax: 503.598.1960 Related Permit#: DatdB f]GAR D Inspection Line: 503.639.4175 Ready Date/By. Jude' Id See Page 2 for a Internet: www.tigard-or.gov Noti 6ed:Method Supplemental Information RK 1,. aa a_s " y TYPE OF `� < ,gin.":,�{ , ` � tYa&^�f �§�5, m` -6,g �` �:� x �-i9`""?&.,�e�..7 ❑New construction .Addition/alteration'replacement Please check all that apply(submit a sets of plans w/items checked), ❑Demolition ///❑Other: 0 Service or feeder 400 amps or more 0 Building over three stories. where the available fault current ❑Marinas and boatyards. l#" `",'. - CATEGgligti=UF CONS CTION _ " . exceeds 10,000 amps at 150 volts or 0 Floating buildings. ❑ 1-and 2-family dwelling !4 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural ❑Multi-famil amps for all other installations. buildings. y y IIIII Master builder Other 0 Fire pump_ 0 Installation of 150 KVA or R. .wd', rs. , {"Is, JOB SITE INPORM4,TISNi. '2'. " ,,,?''�"=` v'1, "rFa3s-_'e ❑Emergency system. larger separately derived Job#: Job site address: E L-V � V "v I I %on ❑Additioo of new motor load of system. t t 1J lUGHP or more. ❑A',"E,,,"1.2,,,•,1.3,', City/State/ZIP: in ❑Six or more rosidentiai units. occupancy. -13 �./I ❑Healthcare facilities. 0 Recreational vehicle parks. Suite/bldg./apt.#: Project name: ElHazardous locations. 0 Supply voltage for more than ❑Service or feeder 600 amps of more 600 volts nominal e. Cross street/directions to job site: Description l Qtr. I Each I Total I • New residential single-or multi-family dwelling unit. Subdivision: Lot#: Includes attached garage. Tax ins 1,000 sq.ft.or less 168.54 4 p/parcel#: „ , , ate. g t ,t,i Ea.add'150o sq.ft.or portion 33.92 1 > :. DES '1 er .e':� :.;;Ai, . - -7 Limited energy,residential 75.00 2 ' ' f 1111-E-a C a 02,,a--fX7b w . (with above sq.ft.) Limited energy,multi-family residential(with above eq.ft.) 75.00 2 Renewable Energy ❑ See Page 2 ;'; CI OWNER L :a Services or feeders installationzalteration,and/or relocation Name: 200 amps or less 100.70 2 Address: See_ p,t," i. 3No -bIt ! a�), C� 401 amps 201 amps to 400 amps 133.56 2 City/State/ZIP: "'1 L• to 600 amps 2(0 34 2 601 amps to 1,000 amps 301,04 2 Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 2 Email: Temporary services or feeders installation,alteration,and/or relocation Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 I intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2 Owner signature: Date: 401 amps to 599 amps 168.54 2 _ ❑ CONTACT Pi'itso. Branch circuits-new,niteratlon,or extension,per panel,, , � � ❑`:A1'PLICAI\'F x �' ,.. A Fee for branch circuits with Business name: above service or feeder fee, 7.42 2 each branch circuit Contact name: p-I B.Fee for branch circuits without Address: see �1(4- C4"9_f) el.C.ae�-a—a7b s T- branch circuit service or feeder fee,first 56.18 2 � City/State/ZIP: Each add'l branch circuit 7.42 2 Miscellaneous(service or feeder not included) Phone:( ) Fax::( ) Each manufactured or modular dwelling, 67.84 2 Email: service and/or feeder .. Reconnect only 67.84 2 " as. ., �. ;�. -. � Ptunp or irtigation cards 67.84 2 Business name: �. . Itl � / _ 111a Mom/ Sigh or outline lighting 67.84 2 Signal cireuit(s)or limited-energySee Pa Address:AU3o 3-fF.,,✓t Co�a e, - C f I(9n)#I S9 panel,alteration,or extension 0 Page 2 2 City/State/ZIP:\n 1\1 C.(\t AWI( I Ci2 - i( � l� JKCi Each anal inspection inspection over allowable in any of the above �i ) ( Additional inspection(1 hr min) 66.25/hr Phone:(3()C1Qa �r-y, Fax:( ) Investigation(1 hr min) 90.00/hr Email•\AC Q I rf n !o'(nCfyt! ` c ) Industrial s plant w is min) 78.18!hr [�CiC. s.Y Lil t)li V Inspections for which no fee is 90 MI:: CCB Lic.:1 Electrical Lic.: cr.. a Suprv.Lie.:pa&% sKee.ificall listed h mmi vv 1 y ..' .i " ea ,'? ,i r FEES "' <-.- ., Suprv.Electrician signature,required: --- sn6rota Print name: - b ri['f2_ (,-` Date: 'al ' 199 ❑Plan Review Required(25%of permit fee) `'[, State surcharge(12%of permit fee): Authorized signature: -j c•v� "�` TOTAL PERMIT FEE: This permit application expires if a permit is not obtained within 180 Print name:-IOm (0 Mt,+h i Date: 1 I 1 a� days after it has been accepted as complete. ` 1 a Number of inspections allowed per permit. I:1BuildinglPennital6LC PermitApp_EI,R ERB.doc Ray 06/172015 4404615T(I1/05ICOM/WEB