Permit r „ , ' � CITY OF TIGARD ELECTRICAL PERMIT
!I COMMUNITY DEVELOPMENT Permit #: ELC2010 -00232
TIGARD' 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/12/2010
i . i ,,,, , Parcel: 1 S 136DC04500
Jurisdiction: Tigard
Site address: 7501 SW DARTMOUTH ST 100
Subdivision: Lot: 0
Project: Winco
Project Description: (25) branch circuits for deli /seafood remodel.
Owner: FEES
WINCO FOOD, LLC Quantity Description Date Amount
ATTN: SUSAN BUSCHE, PO BOX 5756
BOISE, ID 83705 25 crt Branch Circuits 05/12/2010 $234.26
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 05/12/2010 $28.11
Electrical
Contractor:
NORTHSIDE ELECTRIC
PO BOX 12323
SALEM, OR 97309
PHONE: 503 - 585 -4879
FAX: 503 - 364 -0248
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $262.37
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 - 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. /
Issued By: Permittee Signature: '� 1 7L7 (1:4--7-7(1"/
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 an inspection that business day.
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.
MAY /11 /2009 /MON 02: 11 PM NOATHSIDE ELAW & ir FAX INIo,503 - 364 - 0248 P. 001
.A
Electrical Permit a lication E it. : : • . roi of iICL USE ONLY . •
IN ' City of Tigard 1 1 2010. 6 te/El ; Permit No. :�u` 7 (0�' ,
't 13I25 SW Hall Blvd., Tigard, OR 97223 MA Plan Review •
. g ,, ' Phone: 503.639.4171 Fax: 503.5981 960 /� ❑ t� D ; Other Permi ' y/� + � /1". ,,i / 94
•T. ' .. . D, Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: Mill 2 $ee Page2 or
('_ Intemer vv
ww.tigard- or.gOV V RI HI N ,` IISIo t Notifted/Metbod: Supplemenial Information
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Y x � A � F� ��t� 'l^F. A'9":.. �• R..: W t .t s �k'� � � rt, °.... �, a.4 �I.t� .1,. ns
0 New construction , dition /alteration/replacement • Please ekeok all that apply (submit 1 sets of plans wfitems checked below):
❑ 5ervi a or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition • ❑ Other: where the available fault current Q Marinas and boatyards.
T=Tt rr _'S k'. , p= 7 : . 0e r1 ;� ,t Ord et f^:cgzr,;; ; S W+ i Ni:, , i Ou .:a ,eceeds 10 000 ps:a 1 r.voha u oat .,-0ui, '
'` to ¢tbudd or exceeds X14 ;000 ' , 't] �omtner6ial =5ase cillhr a 5 ' '
�u ..eo .,:..,rn�.'� � � t~'� � ' t: , • ..a::. '•;'. ti i #� � a ..tt �
❑ 1 - and 2- family dwelling ommercial/industrial ❑ Accessory building amps for all other installations. bulldiniis,
❑ Multi family ❑ Master builder ❑ Other ❑Fire pump. • ❑ Installation of 75 KVA or
u > c x y: ; a a v ❑Emergency system.
larger separately derived a stem.
i9 a �h ,, s ! P Y Y
a rXk.'i � �Q i.S &e . r ,, f ,z°.r, D Adds❑ Addition of new motor load of . ❑ ., „ ., -Z „ .,1 -a,., .
Job no.: I Job site address: '50 y k V j� .1 1 L 100FII' ormore. occupancy.
T
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: I , cord a a o, ❑ I-lealth.•care facilities. Cl Supply voltage for more than
0 Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: ❑ service or feeder 600 a or more.
. rt ' �5'..". r}'e?Yw'" "r,r15;:: l JE / Sr:,0014.L'E'h tWVl"rY i
Cross street/directions TO Job site :. Description Qty. Fee. Taint _
New residential single- or multi- family dwelling unit.
Includes attached garage.
•
Subdivision: • Lot no.: 1,000 sq. ft. or less 168.54 : 4 _
Ea. adel 500 sq. ft, or portion 33.92 1
Tax map/parcel no.: Limited energy, residential
�
.+L r( si + ii L e r S / x a y a t'Sr�7� 777p t'�j �( A �� ,�^� �t A y St 'with e 4. 2
`�'. ii h,a'T�'�1F rEF. �^.' i1r, S wJ_ c�' fiY�f�4:-0'.'` �'""': c? it��" 1�r. 1; ����:b,��',2�'x':�'t,,�".)j -Abw .1 '�'• � ft.
Lim energy, multi - Family
V 67.84 2
I . i1 tT residential (with above sq. ft.) .
Services or feeders installation, alteration, and /or relocation
I'�,y` -_ ` 200 amps or less 100.70 2
11.5tk i57, ,x .+.. K tt+ Y t:.4& rk.LN i! w {., .' ,R aO: tiHt r 1
a rt!_ - ^ - !�
, s . , .: .,,.� ,,7as6�!t <ke ���. r...�{e .. 'i;;F� t ,ld - � „ a 20 amps to 400 amps 133.56 2
Name; 401 amps to 600 amps 20034 2
601 amps to 1,000 amps 301.04 2
".)ddress: Over 1,000 amps or volts 552.26 2
`ity /StatcJZIP: Temporary services or feeders installation, alteration, and /or
- reloca
Phone: ( ) Fax: ( ) 200 amps or less 59.36 I
Owner. installation: This installation is being made on property that 1 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
Owner signature: • Date;
Branch circuits - new, alteration, or extension, per panel
" �.�� d � } �, � o' � ii � � t ., � � � � 5� A Fee for branch circuits with
Q ^t J ❑ .diNi _ LO h ; above service or feeder fee
mss. 7,42 .2
Business name: each branch circuit
B. Fee for branch circuits •
•
Contact name: • wlthoul service or feeder fee,
56.I8 5 2
first branch circuit
Address: • • • • • • Each add'I branch circuit ,+.' • . 7,42 1.73 i') 2
• Miscellaneous (service or feeder no_fincludcd)
City/State/ZIP: Each manufactured or modular 67.84 .2
• Phone ( ) dwelline, service and /or feeder
( )_ F Reconnect only . 67.84 2
E -mail: . r* {;,v .'�m�, , {c Pump or irrigation circle 67.84 • • 2
( i�. ? 0.
r� . �, . 7C01,40�A . , ;R:�,� + + g :.n.;. „1 " N i n Dr. outline lighting 67.84 2
Business name: A '� ,\ r.,�; __ F r �,� Signal circuit(s) or limited -
t��y.? - G energy panel, alteration, or •
Address:' jV L-'. (, �1 ?�� • extension. Describe: Page 2 2
City /State/ZIP: it Ali C� O,/ ' I •l Each additional inspection over attowable in any of the above
E Ley F t F ax: (5) )' L ) r 4 Per inspection 66.25
Phone: eS) �f \ 11
� H1 Investigation per hour (1 hr min) 66,25 �
CB Lic.:q 2 Electrical Lic.: Qi--j �j 4 , - /C Suprv. Lie.: 2T- ff Industrial plant per hour 78.18
Suprv. Electrician signature, required: tal: 31f.
Subto
:pint name: ( Date:
Plan review (25% of permit fee):
O . �t r� Stat s urcharge (12% of permit fee): I I'
Authorized signatur `4 + 4 TOTAL PERMIT FEE; �a
This permit application expires if a permir is not obtained ;vitbin ISO
Print name: Date: days after it has been accepted as complete.
a Number of inspections allowed per permit.
rt? uildinuu 'ermltA.ELC- NirmitApp.doo 10101/04 ,140.4615T(11 /03 /C0M/w0E 26 a
•