Permit ..� q CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2008 - 00324
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 11/24/2008
PARCEL: 1 S 136DC -04500
SITE ADDRESS: 07501 SW DARTMOUTH ST 100 WINCO ZONING: C -
SUBDIVISION: PP1995 -013 LOT: JURISDICTION: TIG
PROJECT: WINCO
Project Description: Low voltage for data cabling.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: X NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: : HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
WINCO FOODS LLC VALLEY TEL SERVICES, INC.
650 N ARMSTRONG PL 4080 SE INTERNATIONAL WAY B -10
BOISE, ID 83704 PORTLAND, OR 97222
Phone: 208-377-0110 Contact #: PRI 503- 353 -1644
FAX 503- 353 -1694
FEES Reg #: ELE 10 -97CLE
L1C 76528
Description Date Amount SUP 931LEB
[ELPRMT] ELR Permit 11/24/200E $75.00
[TAX] 12% State Surch 11/24/200E $9.00 REQUIRED ITEMS AND REPORTS
Total $84.00
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: _ ` - Permittee Signature : e /�Gmt�L
4/11./
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.
NOV/24/2008/MON 11 27 AM VALLEY TEL SERVICE FAX No, 1 888 459 1610 P. 001
Electrical Permit Application � eq► F'Oi( C*FICE USE ONLY .
City of Tigard `� Da : / A B PerntitNo.!' �._ UU
IN. - ' ° 13125 SW Ball Blvd_, Tigard, OR 972 �'��777 Plan Review
Phone: 503,639.4171 Fait: 503- t'` - Date/By: Other Permit: (Ai Z1..-( X 71
. i ; t f. ART) Inspection Line: 503.639.4175 a r- p '"A' Date Ready /By: Jurist El See Page 2 for
Internet: www.tigard- or.gov `1 tt Y liied/Method. Supplemental Information
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rvn��4 d r.. �': 8d5�(!,' r�hPY��M1�,Yq���_,.��.1i^�: �.r�. 'h ✓� A .,M ]ti9,? 1 �' ... �fY1:�j�S }'S:.�� �'1� 1�'� � "' ..1�1��11'4� '!�
❑ New construction �A,ddition /alteration . �` % Please check all that apply (submit Z sets of plans w /items checked below);
Y . .) in service o r A3eder 400 amps or more ❑ Building over three stories.
Demolition ❑Other: ��e" where the available fault current ❑ Marinas and boatyards.
.i f S,red' e t .+>, y7:,aF :;,n...�w u.�; °,.�, ".� „� ,,.... F . :v
Ic ' K l':' ,hfl it` ,. r l } � e xceeds 10,000 amps at 150 volts or f] Floating buildings.
i`Si'i,: go cbri";t"t7tS1 $lr, i'r +' ^i4
�. J , .u. y .. , . r .. aa; , ., .,...,. rn..,, r ,.r x,.,,,r<,,.:,.r•�•:J t nr ..: r, Y;P: f�� .T �i n d�'( P
r` ' � i ' !' 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.
r,.; b builder ; m, }
❑ Multi �,y� ❑ Master builder ❑Other: ❑ Fire pump. ❑ Installation of 75 KVA or
o ° : , F '' }r . i f�li,,ytt t f Y pA IIIGY, r f SG ' i . ; t51' ❑ kmertlency system. larger separately derived system.
ICai.�,.1�7041: 4tr.bbah.a•0, ,.:.v; 0 .04,TK, $- � sr .,..,, ,..�,.a..,. ei�! &tt5i0:016,!}!i l dAddi6on new motor load of �..A....8., ..l- 2....1,,3”,
Job no.: Job site address' 9 560 t oar} Bl d'h i '�d 1 Six or e residential Recreational c eaton.
• ..... CI Six or more t'e3idetttial unite. 0 R veltiole parks.
City/State/4T! rd �7 /� t-^� d H azardous facilities. ❑ Supply voltage lbr more titan
State � l Q P L t ^ � li, I �� ❑Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: 1 Project name: 1 ,�) «t Q Service or leader 600 amps or mote. Y1}� '
lJ" 1;'�v'<i� ; '��'11 1 `! ' 'rI,�jl rs� -`, E 5, ?HE P4H", ;': +7 s� 1 , ";fwti'd 4 � i % y �i at�;: a
Cross street/directions to job site: Them ( j Fee. I Teal I •
' New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less I45.15 4
Tax map /parcel no.: Ea, add'l 500 sq. ft. or portion 33 .40 1
Limited energy, residential
, '' f�>7 3 9 � f . w �.�f<, C4Z ��Q'"k�,.i,�aA, :�I Y�Nii °.dWV�s�f'PoIN irRls�
aI f it ' ;t1 ' ' OW I aartr kt 1 i ' I, t tll�N�l�} I s'j� uPj1 �yv1t (with above sq. ft) ) 7 5.00
-
` /�/ (( // /� �� � :II: ited atiergy multi - fan cily 7 5.00 2 l/ (/ (�' i t e /� /TTY � xe9ideAtlal ((with ab ove eq. R) '
`�4'�V (r/ --^ [/ vices or feede a s l nstallation,.alterakfon, and /or relocation(
A v,x,, � N` t k l ` �. r / i 200 amps or less 80.30 2
�q:� a rn ,a w e !^ , lt 3 J Yu:,r;, „
4 € 1 m:** i , y a ... P S k i `A l ill 201 amps to 400 amps 106 - 85 2
Name: ti :NCI" 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: • Over 1,000 amps or volts 454.65 2
City / State/ZIP: Temporary services or feeders installation, alteration, and /or
relocation _
Phone: ( ) Fax: ( ) 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 599 amps 133.75 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
. _ x t l i+ 7 1 , >' 1 ` i -aft f +.� !Ir t c Y � o: i, +�i a I :s_k r v above service or feeder fee, 6.65
each branch circuit •
Business name: P. Fee for branch circuits
without service or feeder fee, • Ent bra circuit 46.85 2
Contact name:
Address: ~ ^ Each add'l branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City /State/ZIP: Each manufactured or modular 90.90 2
Pax: dwelling, service and/or feeder
Phone: ( ) I ax:: ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
y�!� ` T r, r FF, y r V W � i7'; Y � an S 4: ',+i°:r411
'
1 1a1 n+f C 11�i+4E11�a ,gt'.'.E1C l,�kKji1t 48,0. `J 1L{E?,U}li;O;yY„„S`!{{�P1Tn4$;1 "�� ' it {{��,,ll CP:'Fr'ji�YJl.,t �i 0it Sign or outline line liOtiag 53A0 2
�INly f kY"u�>srt�: •�913f�C o .� 1,. .l11��:1,Y'F'<cp�'- jrviv��.a;Ti •16Ij1'lIa}�flf?Ir. QE' "JV. �Y•.4"7F't�,} .13.I
Business
name: ' LC , , _ . , Signal circuit(s) or limited
a _ energy panel, alteration, or
Address: Q r h • 1 1 .. w .. • - . extension. Describe: Page 2 7�— 2
•
City / State/ZIP: l n R q `7 a..,,), Each additional Inspection over allowable In any of the above
I / Per inspection 62.50
Phone: (� ) C�3 , f b Fax: �o3) 5 3 / L Y Investigation per hour (1 hr min) 62.50
/ _C� J „ ndu t a l plant per hour • 73.75
i
CCB Lie.: � 9 Plecn7cal Lic.:��� �� Suprv. Lie.: p p a, � r
,,11;¢inh i' ^' ° i ? ",FEL"ECG',L2: gair 1 ,I' EESc��� R kr�,ty�s
Suprv. Electrician signature, required: Subtotal: ) 1 5 ° --
-^^- _ Plan review (25% of permit fee):
u
t Date: State surcharge (12% of permit fee): • .9, 0()
+ / r 1 a nt i J o --
12%
Print name: j YQUi,S ' 1 •
tt��
Authorized signature: I . TOTAL PERMIT FEE: 4 Z Li W..
ef This permit application expires If a permit is not obtained within 150
Print name: vimmal+..-- Date: days after it has been accepted as complete.
. c Number of inspections allowed per permit
k \Bull Ring \Permi PemitApp.doe. 05/23/06 410 - 46151(1! /U5 /COM/WrS
NOV/24/2008/MON 11:27 AM VALLEY TEL SERVICE FAX No.1 888 459 1610 P. 002
• .
Electrical Permit Application - City of Tigard
•
Page 2- Supplemental Information •
LIMITED ENERGY PERMIT FEES:
;:77.:7.§..:;:ir.j,W*41V,;".,,MMOSIMPRZWINMEMAI
Fee for a residential systems combined ... $75.00
Check Type of Work Involved:
El Audio and Stereo Systems*
I] Burglar Alarm
Garage Door Opener*
El Heating, Ventilation and Air Conditioning System*
El Vacuum Systems*
0 Other:
RAORNEWC. iquivismammo
Fee for each commercial $75.00
•
system
(SEE OAR 918-309-0000)
Check Type of Work Involved:
El Audio and Stereo Systems
•
o Boiler Controls
El Cock Systems
yL Datairelecommunication Installation
El Fire Alarm Installation .
I HVAC
. .
• . .
• El Instrume ntation •
•
El Intercom and Paging Systems
n Landscape Irrigation Control* •
17 Medical
. Nurse
El Outdoor Landscape Lighting*
El Protective Signaling
El Other
Total number of commercial systems:
• *No licenses are required. Licenses are required
for all other installations
1:\13attletWzoital-C-PermitApp.doc 03/23/D6
CITY OF TIGARD ir
BUILDING DIVISION PERMIT #: FLR2008- Ot)324
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/24/2008
Phone: (503) 639 -4171 av otii
Inspection Requests (24 Hrs.): (503) 639 -4175 °:..
INSPECTION WORKSHEET FOR DATE: '12/5/2008 TIME: 7:00AM PAGE: 15
SITE ADDRESS: 07601 SW DARTMOUTH ST 100 WINCO CLASS OF WORK:
SUBDIVISION: PP1g95.013 LOT #: TYPE OF USE:
PROJECT NAME: wi NC ;)
DESCRIPTION: Low voltage for data cabling.
OWNER: WNCO FOODS LLC, PHONE #: 208 - 377.0110
CONTRACTOR: VALLEY TEL SERVICES, INC. PHONE #: 503- 353.1644
Inspection Request Scheduled For: Date: 12/5!2009 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low voltage 0713805 -01 503 - 353 -1644 N
Corrections /Comments /Instructions:
NN N
i
r ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
pi FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: N dB LIZ Date: 2.'6% O Phone #: (503) 718 - 2»4*
a
CITY OF TIGA►R® ;•
A '-
BUILDING DIVISION { PERMIT #:
LLl008 0034
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/24/2008
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 -iii __..
INSPECTION WORKSHEET FOR DATE: 1.1/25.12000 TIME: 7 :00AM PAGE: 30
SITE ADDRESS: 07501 SW DARTMOUTH ST 100 WINCO CLASS OF WORK:
SUBDIVISION: pp-1995413 LOT #: TYPE OF USE:
PROJECT NAME: WINCO
DESCRIPTION: Lew voltage for data cabling.
OWNER: WINCO FOODS LLC, PHONE #: 208-377-0110
CONTRACTOR: VALLEY TEL SERVICES, INC. PHONE #: 5503. 353 -1644
Inspection Request Scheduled For: Date: 11/26/2008 Pour Time:
•
Code # Inspection Description Confirm # Contact # Message
136 Low voltage 078548-01 503 - 353-14 N
Corrections/Comments/Instructions:
.s-14€-- tl l/
• i
PASS ❑ PARTIAL APPROVAL n CANCEL ❑ NO ACCESS
FAIL n CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: � C � � Date: Lt` - Phone #: (503) 718-