Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2006 -10024
DEVELOPMENT SERVICES DATE ISSUED: 3/7/2006
° !�I + 13125 SW Hall Blvd., Tigard, OR 97223 503- 639 -4171
PARCEL: 2S 104 BB -07900
SITE ADDRESS: 14300 SW BARROWS RD ZONING: C -C
SUBDIVISION: RUSSELL'S SCHOLLS FERRY SUB LOT : 002 JURISDICTION: TIG
Project Description: New EMS system for cooler /freezer.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL /PANEL:
MANF HM/ SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: 1 W /SERVICE OR FEEDER: 8 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
ALBERTSON'S INC #576 ELECTRICAL DIMENSIONS INC
PO BOX 20 PO BOX 12146
BOISE, ID 83726 3961 N WILLAMS AVE
PORTLAND, OR 97212
Phone: Contact #: PRI 503 - 282 - 7255
FAX 503 - 280 -1619
FEES
Description Date Amount Reg #: ELE 26 -432C
[ELPRMT] ELC Permit 4/1/2006 $133.50 LIC 44008
[TAX] 8% State Surcharge 4/1/2006 $10.68 SUP 29645
Total $144.18 REQUIRED ITEMS AND REPORTS
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow 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 copies of these rules or direct questions to OUNC at 503 - 246 -6699 or
1- 800 - 332 -2344.
Issued By: „ 1� Permittee Signature: 51 � (01),c)
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 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.
Electrical Permit Application FOR OFFICE USE ONJLI
City of Tigard °° C E 6 V E D Da s Permit No.• e '� /d 4 �/ d2
13125 SW'HaI1' , vd., Tigard, OR 7 28 f " ' Plan Review
Phone: 501639.4171 Fax: 503.598.1960 �r"'"i%//t4�� s•)' , Date/By: Other Permit:
Inspection Line: 503.639.4175 I•l A D O 6 2006 - 'f .L Date ReadyBy: Jam: El See Page 2 for
Internet: www.ci.tigard.or.us M P. Notified/Method: 1 ) 6 Supplemental Information
®F Wdttiii PLAN REVIEW . .
1:1 New construction P�/liVilo alieraii6t 1Fcement Please check all that apply:
❑ Demolition ❑Other. ❑Service over 225 amps, comm'l DHazardous location
❑Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
'' ' CATEGORY 'OF CONSTRUCTION - . • . ' of 1- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling ,Commercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
El Multi family ❑Master builder ❑Other: ['Building over three stories ['Feeders, 400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or
' JOB SITE INFORMATION AND :LOCATION :. DEgress/lighting plan RV park
.t ��� ❑Health -care facility ['Other:
Job •
no.: �� t`�7 J ob site address: ( 3 � Q r l�s I -�p •
Submit . sets of plans with any of the above.
City/State /ZIP: " r gj, c:sstz_. C) 17,23 The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: -
-`' ' ` ; °i.FEE *::SCHEDULE , - `
' L Description I Qty. I Fee.' I Total ` ••
Cross street/directions to job site: WiltAuvr New residential single- or multi - family dwelling unit.
Includes attached garage. •
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 . 2
DESCRIPTION OF WORK Each manufactured or modular
dwelling, service'and/or feeder 90.90 2
i mC (y Services or feeders installation, alteration, and/or relocation
�� ��� 56 2
�� S f C� ; Y" { il/ ' 201 amps to 200 amps or less 400 amps 106. 80.30 85 2
„„,-;:, gj�.PR E,ERTY`0 ,, Ii'. `11 • TENANT ;�
401 amps to 600 amps 160.60 2
Name: 4 l-S K5 4-47(0 601 amps to 1,000 amps 240.60 2
Address: 143 $ ` git 5 . Over 1,000 amps or volts 454.65 2
l+ Reconnect only 66.85 2
City/State/ZIP: (tb /s� ctz 17 ,„ Temporary services or feeders installation, alteration, and/or
) y�6�g F ax: ( ) relocation
Phone: (
S "v J S 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
3 . `„ - A. Fee for branch circuits with
r,r ��:[] ^' °D "CONTACT „PERSON'�'� ' -'.:
service or feeder fee, each /� 6.65 .2.0 2
Business name: . Aik AC 6�C.1xt� branch circuit /
B. Fee for branch circuits
Contact name: without service or feeder fee,
each branch circuit 46.85 2
Address:
Each add'1 branch circuit 6.65 I 2
City/State /ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) Fax: : ( ) -
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited-
f '.7-‘',',-,;,:;-,,,,.:. .,. ; 4 , . ,... energy panel, alteration, o
-,. a .. �GONTRAC - .., _ .. en el, alterat or
extension. Describe: Page 2 2
Business name: � lctdt9, -1MELS f15 •
Address: Each additional inspection over allowable in any of the above
�j 6n 1 `K1 to f tl 444.1 A-tte Per inspection 62.50
City/State /ZIP: 0 e> • gi--17T'7 Investigation per hour (I hr min) 62.50
Fax: Industrial plant per hour 73.75
Phone:
( ) 282.....,—/.2.C. i `��) -/ - > ",`.' `_ . `'' '= " ELEl31TLICAL, : PER ;_F
M1TEES* _
CCB Lie.: 4 x.13 Electrical Lie.: -4( 32e Suprv. Lie.: 21'1 ' Subtotal «j F,6
Suprv. Electrician signature, required: Plan review (25% of permit fee)
' � �- 4 gr Date: 3i�6� State surcharge (8% of permit fee) �j,
Print name:
,� / TOTAL PERMIT FEE 1414. ti
Authorized signature:/.14-(11/h2/).--7-1------ This permit application expires if a permit is not obtained within 180
�
j days after it has been accepted as complete
Print name:1 ,e � /1
Q, u e.,es Date: ' 3 /Z � * Fee methodology set by Tri County Building Industry Service Board
` • • Number of inspections per permit allowed.
Electrical Permit Application - City of Tigard •
Page 2 - Supplemental Information
•
LIMITED ENERGY PERMIT FEES:
:. 'RESIDENTIAL WORK ONLY:
Fee for all residential systems combined .. $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
g.COMMERCIAL WORK ONLX:
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
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 •
CITY OF TIGARD
BUILDING DIVISION PERMIT #: 1 oa
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 I: . Ili'll I
Inspection Requests (24 Hrs.): (503) 639 -4175 .�'!+�
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
ri00017/
SITE ADDRESS: . � i ' ,Va w S CLASS OF WORK:
SUBDIVISION: T LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE � 2,79._
CONTRACTOR: (V1 Ci PHONE
Inspection Request Schedule For: Date: q 0 co Pour Time: CA-0
Code # Inspection Description Confirm # Contact #
Mess a•
i '" e 't I 41S110,0 • °I „ic
a
orre •ns 'Comments /Instructions (
1,o QC}^
cam, GL.- .. 2 ® ®b • 0 r1/4M
•
►:� PASS 1 PARTIAL APPROVAL n CANCEL U NO ACCESS
n FAIL I I CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: 3 I ° r v - 1 Date: 14 3 oil Phone #: (503) 718- Lig
CITY OF TIGARD
BUILDING DIVISION .- 1'''. PERMIT #:QQG o6°- t ID 0.--y-
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 110.
Inspection Requests (24 Hrs.): (503) 639 -4175 �° �4j ,;
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: 1 Lf 33V A '' PL CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #( )I CC�� L 7 C
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 5-- 3 /' Di° Pour Time:
Code # Inspection Description Confirm # Contact # Message
(,q
- ci ,..,o..Q
Corrections /Comments / Instructions: •
Rli .6 z)'i
Ify\t‘tst , 4- 3 -6, 1=1A
, Bk ist pikd4e.. .
•
_ _____
I I PASS ❑ PARTIAL APPROVAL ►0 CANCEL ❑ NO ACCESS
FAIL n CALL FOR INSPECTION n A i ` ONAL 'EES ASSESSED
Inspector: G ! ` U) Date: 3 1 #: (503) 718 - -2M-La
I r