Permit CITY ®F -�I�7I�R® ELECTRICAL PERMIT
VP.'
COMMUNITY DEVELOPMENT
Permit #: ELC2010 -00127
Date Issued: 03/19/2010
71.ARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S104BB07900
Jurisdiction: Tigard
Site address: 14300 SW BARROWS RD
Subdivision: RUSSELL'S SCHOLLS FERRY SUB Lot: 2
Project: Albertsons
Project Description: Install (1) 200 amp service and add /alter (6) branch circuits.
Owner: FEES
NEW ALBERTSON'S INC Quantity Description Date Amount
ATTN: 70428 - CORPORATE TAX, PO BOX 20,
250 PARKCENTER BLVD 1 ea Services or Feeders - 200 03/19/2010 $100.70
amps or less
PHONE: 1 ea 12% State Surcharge - 03/19/2010 $17.43
Electrical
6 crt Branch Circuits w /Purchase 03/19/2010 $44.52
Contractor: Service or Feeder
GMD ELECTRIC INC
PO BOX 72206
EUGENE, OR 97401
PHONE: 541 - 741 -7369
FAX: 541 - 988 -1800
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $162.65
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 952-001-0100. 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: \ �y G\C Yt IR5 � 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' t� LAPP Date:
LICENSE NO. N��
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.
FROM : GMD ELECTRIC FAX NO. :5419881800 Mar. 18 2010 02: 17PM P3
Electrical Permit Application . I. olt 01.11(1.: 1 SI•I ( )NI .1 •
K 7-In C r:lli E D
City of Tigard V, 1..L: - • ' Inalli pulllil MI: Ell 2 CO to 7
; .„-- . 13125 SW Hall filvd„ Tigard, OR • ■7223
l Ail Plan Review
Other Permit:
' 1 Phone: 503.639A171 Fax 503.5'18490D -; 1,) Datc/BL_ ,._ _
Inspection Line; 503,639.4175 WI IAI\ Date lleadyk ty: Julia: fill See Page 2 for
1 1Aiz 1)
Internet: www.tigard , ..,., Notified/Method: I Su oplemental Information
,
-. --•-• k 'r
-- - '
P"' '''' ' .-' ' i • • • : -.: TWO' OF , r i ti" ,,,,'• T V ' -'.0,1‘ : . ' • • :.. . . . • , • • 01,01 UKVitmi :.". : .: • .: ' :: :,,!, ,'.....
, c...y.ri , ;:;i , ..• ;....., :,• ..•... -'. . .,,w,,A „,....„;,; ) .. . • ,.. • . . . . . . , • . ,
0 Now construction 0 Addition/9 1 • tronireplaccment Please check all that apply (submit Z3ets of an . wine= checked below)
0 Service or feeder 400 amps or more 0 13m (dims over three stories.
0 Demolition 1:11 Other: where the available fault cantle El Winos and boatyards.
—........., , ,, ., . , . . ..,.. .
,:.'•,'' i•.. 7. bt. ,. -:= - = : • . , exceeds 10 F
,000 amps at 150 volts or 0 Pleating building .
less to around, or exceeds 14,000 0 commercial agricultural
El 1- and 2-family dwelling E:l Commercial/industrial 0 Accessory building amps for alt other installations. buildings,
D Multi-family 0 Master builder 0 Other: 13 Fire pump. 0 hur allation of 75 KVA or
. . . . . --,,-,: 0 Emergency system. larper rirpontibly tied veal Y.yfoom.
7 I:' I '* .I YII I I I. I . II I', I ! I. .', '.:• • :• . : • • :: 0 Addit of now motor load of 0 A "1-2" "1-3",
10011P or more, clot uroolcy.
Job no.: # 5-7( Job site address: 14309 SW Barrow Ruud
0 six or more residential non, 12 Ret motional vehicle parks.
.__ .
''"" -
City/Slate/ZIP: Tigard OK 97223 D Health-care facilities. D Supply VOitlige for more than
—,..,.. 0 llazoolouS location& WI vas nominal.
Suite/bldg./apt. no.: Pmjcet name: Albertsons*5516- 0 Servico or thcdcr 600 amps or more.
. .. ..]:,•!: ••::f ' , ' ,' [..ttit;.:Ciiti4it)::,
Cross street/directions to job site: SW Scholl!, Perry Road „Tlfx_s.ttiltu? ---- roe. 1 That 1
..
New residential Angie or multi-family dwelling unit.
Includes attached garage.
r .-
Subdivision: I I,ot no,: 1.000 sq. ft. or less
......,....,,,,.....,_ 168.54 .. .............. 4
" Ea. add'I 500 sq, ft Cr portion 3192 1
1 ax map/parcel no --______,.... _
Limited energy, esidil
. . . . , , r enta
„ ':',.', , .. , 1'- : ' '' • :,,''' P . • ', '' ' ' ' ' ': ' • ' bgkaitIVITOIN 1j#' WoWORK . . • ' . ' • • (with above sq. R.) 67,84 2
1,imitai energy, multi
67.84 2
residential (with above sq. R.)
- ,..,. - ,....,....__ ..._ ,.. ,........... Services or feeders installation, altera lis and/or relocatio;:
Tenant Infill 200 amps or less 1 100,70 100.70 2
0*Ntft
_ --. _ _ —
' I I • I - " ' ' ' T i -
;•. :', . .,! : ,.. E . , NAN r . _ . 2n 1 amiNs tn 400 alT 133.56 2
2
401 amps to 600 amps 200.34
Name: Albertson's ... , ' " -
601 amps to 1,000 amps 301,04 2
--- ..„ .,...
Address: 250 Park Center Blvd Ovor I ,000 amps or volts 552.26 2
_ ...,
, Temporary services or feeders installation, alteration, and/or
City/Slate/ZIP: Boise Idaho 83726 relocation
,_._
Phone: (208)39S-6552 ' FitX1 (
I ) ....._ 200 amps or less
.
201 antps to 400 amps
125.08 —
2
Owner installation: This installation is beinc made on property that I own which is not ------- 6 --
intended for sale, lease, rent, or exchange, ac 41 amps to 599 amps 18.54 2
c.ording to ORS 447, 449, 670, and 701. . ..... ...-
Branch circuits - new, alteration, or e i ensIon, per,panet__ _
1 0
Owner signature: Date: A, Fcc tOr branch circuits with
....,-.. , . . • -
. • , . ..., , , ., above service or feeder fee, 6 44.52 2
:" . ,' .: , . : ; . u ,,.:, ..: , r r ' 0 .c.osT/1421":04 : 7.42
each brallCil Cifalit
Business name: H. Fee tor brunch circuits without
. -. service or feeder fee, first
56.18 2
Contact tome: branch circuit ...........
Each add'I branch circuit 7,47 2
Address: Mlsee lloneol is (service or teeder not includedl
_ — i
Each manufactured or modular
City/State/ZIP: dwelling, service and/or feeder 67.84 2
only 67.84 2
Phone:( ) Fax: : ( ) _Reconnect
Puny OT irrigation circle 67.84 2
E-mail:
Sign or outline lightins 67.114 2
,......
,,, , ,•, ,.!., . ,, ; ■,•:, ,.; ' •:•.•'.,., ., ., , C ,; rOR .. . . . • ., - ; , . , • . Signal circuit(s) or limited --
Business name: GM I) Electric Inc panel, alteration, or extension. Pagq......„_____A_
, Each additional inspection over allowable In any of the above
Address: PO Box 72206 Additinnnl inspection (1 hr min) 66.25/ hr
------- --...- . ,—
- --- - ' ' ' - - Investigation (1 lir min) 66.25/ In
City/State/Z g
IP: Euene OR 97401 --------------'----- - ------ - 5 hr ------
Industrial plant (1 hr min) ... ...., . ....„....
Phone: (541) 741-7369 [ Fax: (.541) 988-1800 Inspections for which no fee 15
90,00/ hr _
?ecifically listed Ch ht
CCB Lie.: 162191 lleetrical Lic.: 20-537C Suprv. 1 .ic.: 4874S
'::::. , ,, • :'- ' : .
........_....„.„.. .. _ ,.„,.„ , „.
Subtotal: 145.22
Suprv. Electrician signature, required: #1,' -----------
Plan review (25% of fee):
•
Print name: Michael K Gowins .. ate: 03/18/10 State surcharge (12% of permit key 17.43
TOTAI, PF.RMIT Fki. 162.65
Authorized signature: ..,,.... This permit application minims if a permit 11 not obtained within tall
by after it bus !men accepted as complete.
Print name: Michael K Go ins Date: 03/18/10 * Number of inspections allowed per pennit.
1:11iullding\Pemittn\EIC PermitApp.dor beeline