Permit 1
S' �' 3. ELECTRICAL PERMIT
C ITY OF TIGARD 1 COMMUNITY DEVELOPMENT Permit #: ELC2012 00730
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/24/2012
Parcel: 2S110DCO2200
Jurisdiction: Tigard
Site address: 15570 SW PACIFIC HWY
Project: Safeway Subdivision: 1997 -016 PARTITION PLAT Lot: 2
Project Description: (3) branch circuits to wire for consultation room - 2 5/20/13 REPRINT (17) branch circuits to wire center of
store remodel
Contractor: STONER ELECTRIC Owner: TRC MM LLC
1904 SE OCHOCO 5973 AVENIDA ENCINAS STE 300
MILWAUKIE, OR 97222 CARLSBAD, CA 92008
PHONE: 503 - 462 -6500 PHONE:
FAX: 503 - 659 -4968
FEES
Quantity Description Date Amount
20 crt Branch Circuits wo /Purchase 05/20/2013 $197.16
Specifics: Service or Feeder
1 ea 12% State Surcharge - 05/20/2013 $23.66
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $220.82
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 9p2 -0090. You may obtainthe rules or direct questions to OUNC by calling 503.232.1987 or 1.800.33
Issued By: J� / /j ,( p ',tl,,'(//�� �� e,( Permittee Signature: 0 I 4 (; t l 0 a.
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 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.
CITY OF TIGARD ELECTRICAL PERMIT
s • COMMUNITY DEVELOPMENT Permit #: ELC2012 -00730
T F GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/24/2012
Parcel: 2S 110DCO2200
Jurisdiction: Tigard
Site address: 15570 SW PACIFIC HWY
Project: Safeway Subdivision: 1997 -016 PARTITION PLAT Lot: 2
Project Description: (3) branch circuits to wire for consultation room - 2
Contractor: STONER ELECTRIC Owner: TRC MM LLC
1904 SE OCHOCO 5973 AVENIDA ENCINAS STE 300
MILWAUKIE, OR 97222 CARLSBAD, CA 92008
PHONE: 503 - 462 -6500 PHONE:
FAX: 503 - 659 -4968
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo /Purchase 12/24/2012 $71.02
Specifics: Service or Feeder
1 ea 12% State Surcharge - 12/24/2012 $8.52
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $79.54
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 OA 952 -0 1- 0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.19 or 1.800.332,2344.
Issued By: At Q 1 Permittee Signature: D�I PP PuC, / 4. / ()A1
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 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.
May. 17. 2013 2:44PM Stoner Electric Group No. 6276 P. 1
Electrical Permit Application FOR OFFICE 11SE ONLY
City of Tigard Received Penult No.: Ej •e_zni - .00 3 o
n 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
' = Phone: 503.639.4171 Fax: 503.598.1960 Dat r - Other permit:
T I C, A I(Il Inspection Line: 503.639.4175 Dalc Ready/Br kris: ® See rage 2 for
Internet: www.ligard•or.gov Notified/Method; Supplemental Information
TYPE OP WORK • , PLAN REVIEW
Please check all that apply (submit sets of plans w /Items checked below):
❑ construction Addition/alteration/replacement ❑ Service or feeder 400 amps or more LI Building over threetlorics.
1:1 Demoli Demolition ❑ [her: where the available fault current ❑ Marinas and boatyards.
• CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground. or exceeds 1000 ❑ Commercial -use agricultural
❑ 1 - and 2- family dwelling iComtnercialJindusttial ❑ Accessory building amps 1br all other installations, buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 kVA or
1:IEmcrgency cm. separately system.
. JOB SITE INFORMATION AND LOCATION
❑ Additionornew motor load of ❑ "A ",'B" "1-2". "1-3",
lob no.: 71, 73e, I Job site address" 5s o / six or more more. occupancy.
❑ Six ormom resldenelal units. ❑ ttecreat(Ona1 vehicle park;.
D []Healih•eatefacilities. ❑ Supply voltage fbr more dean
City/State/ZIP:....---772:44,A=7) /7 / /za ❑ HOU rood locations. 600 volts nominal,
�� � /4 Ell Service or feeder 600 amps or more.
SuitePoldg. /apt, no.; Project name: �G""YT�' 7 �
FEE. SCHEDULE
Cross street/directions to job site: Descrtpuoa 14w. I Fee. I Total 1 *
New residential single. or multi-family duelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. R. or less 168.54 4
Es. add'l 500 sq. It or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
• with above sq. R.) 75.00 2
DESCRIPTION OF WORK . • (
Limited energy, multi- family 75.00 2
l te0 CEE esi-..1 ,eetS , p o oEc__ residential (with above sq. R.)
Services or feeders Installation, alteration, and/or relocation
,A 'TO r • I - el-C_ Z b i 2. r 0 D 3?) 200 amps or less 100.70 2
LI PROPERTY OWNER D TENANT . 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name:
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders Installation, alteration, and/o
: r
Y relocation
Phone: ( ) I Fax: ( ) 200 amps or loss 59.36 1
201 amps to 400 amps 125.08 2
Owner Installation: This installation is being made on property that I own which is not
401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits - new, alteration, or extension, er panel
Owner signature: Date: A. Pee for branch circuits with
above service or feeder fee,
❑ APPLICANT. - CONTACT PERSON each branch circuit 7.42 2
B. Fee for branch circuits witlortt
Business name j p - � »Q/ Cam'IMe service or theder fce, first / 56.18 '.�, 2
branch circuit
Contact name: �(/� /S wl//Tt� - 7.42 Each add branch circuit J 2 2
Ad dress: /991 .5 - 6 - C,c44, Cd Miscellaneous (service or feeder not included)
Ci tateZ: Q y �2 Eachmanuthcturedormodular
ty /S/IP 47f/ /L�44}/‹ R / dwelling, service and/or feeder 67.84 2
Phone: ( 3)41 I Fax :: (563)659-4948 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail: Z VN Slrl/ ( ,/l/ G /PO (,/00. coot'"? Sign or oullino lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
13usiness STONER ELECTRIC, INC. panel, alteration, or extension. Paget 2
Each additional inspection over allowable In any of the above
Address: 1904 SE OCHOCO Additional inspection (I hr min) 66.25/hr
investigation (I hr min) 66.25/ hr
City /State/ZIP: MILWAUKIE, OR 97222 Induotijat plant (1 hr arm) 78.I8/hr
Phone: ( 503) Fax: ( 503) 659 -4968 Inspections for which no Reis 90.00 / hr
specifically listed ('A hr min)
CCE Lie.: 44823 Electrical Lie.: 26-122C Suprv. Lie.; 34965 ELECTRICAL PERMIT FEES
r " ie - Subtotal: t'! .'
Suprv. Electrician signature, required: mxflue/44,4 Plan revi (zs% ofpcmtit it fee): �-
Print name: MICHAEL FALCONER Dato :s 13 State surcharge (12%ofperositfee): ?0.
/ TOTAL PERMIT PEE: 4 ,195;89
Authorized signature: This permit application expires If a permit Is not obtained within 180
Print name: I Date:
days after It has been accepted ns complete.
: N umber of inspections allowed per peneti i,
1:1 9utldtngpamn , PerrnliApp.doc 01/01/10 440.1615T(11/O15/COMUWEA
Dec. 21. 2012 7:12AM Stoner Electric Group No.4771 P. 1
Electrical Permit Application RECE� • FOR OFFICE l{ usI: ()NIA
City oi'Tigard DEC 24 201rDateiB : 1- (d PcrmitNo A la• 0073o
11111 13125 SW Hall Blvd., Tigard OR 97223 Plan Review ,
C Phoue: 503.639.4171 Pax 50 3.598.1960 �aate : Oilier tf. 7/4 — 00
I I<:111 ) 1n 3 pccrionLino: 503.639.4175 CITY s OFTIGA ' J ci 8 see age for
Internet www.ligard- or.gov BUILDING DNIS IL 1
.. -_':. -.' - TYPE Or WORK :. .. , - ::, .':.::,:; .:'...4-4- - 4 'l s :..PLAH REVIEW
El New COn9IruCIiOn kAdditionlaltcration/rCpla
prone c h e ck a ll Ihat apply (submit 2 sets of plant w /halts checked below):
❑ Service or Feeder 400 amps or mots ❑ Brdlding over duce stories.
El Demolition El Other: where the svo,Ioble fault current ❑ Marina: end boatyards.
: ., 4 r krg ' (i g „ §1iAN . 'r s r exceeds 10,000 amps 150 vol,s or cl Floating btutdingi.
� l I "^ a less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling 1 1:Lcommercial/industrial El Accessory building amps for oil other installations, buildings,
❑ Multi - family I] Master builder ❑ Other: ❑ Fire pump. ❑ lnslallalion of 7S KVA or
❑ Emcrgnuy system. larger aepueldy derived system.
❑ Addition duew motor load of ❑ "A ". "E ".'12 ", "1 -3 ",
Job no.: 70,4;00 , I Job site address: J5 77 5 ,,4c_ L/ ,} 10011P or more.
e reai occupancy.
! ❑ Six or more residemial unite. C7 Recreational vehicle parks.
1:1 Health-care facilities. El Supply s ottaga for more than
City/State/ZIP: ❑ Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no,: Project name: / y ❑ Service or feeder 600 amps or More. .
job site �c - 4 : ku » ST W O ,,
Cross street/directions to
J Dearriplior 1 Oq. I Fee. j •1
New residential single- or multi- fa rnlly dwelling unit
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 14
Ea add'I500 sq, if or ponion 33.92 1
Tax map /parcel no.: Limited energy, residential
. , ; , DESCRIPTION OF WORK (wish above sq ft.) 75.00 2
Limited energy, multi- family 75.00 2
e 1L >47Q 4.74 Uz 471176W --2 residealio!(Withabove sq. ft.)
Services or feeders installation, alteration, and /or relocation
200 amps or less 10030 2
. L =PR P f` i. •, ' : • _ . F r • '•0 irimANT : 201 amps to400amp: 133.56 2
Name 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City /State/ZIP:
Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125,01 2
Owner installation: This installation is being made on property that I own which is not
401 amps to 599 amps I68.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Pee for branch circuits trirh
>„' •�+,�1�q r�,,�++ * ±, t r above service or feeder fee, 74' 2
:'. 7:Ak �TlCiell:r,l�?_.e•.} r each branch circuit
Business name: B. Pee for branch circuits widow
service or feeder fee, first (
Contact main: branch circuit 56.18 5""e, 2
Each edd'1 branch circuit 2_ 7.42 / .V , 2
Address: 111lsecllancous (twice or (ceder not included)
Each manufactured or modular
Ci[p /Slate/ZIP dwelling. service an Nor feeder 67 2
Phone: ( ) Fax: : ( ) Reconnect only 67.14 2
— Pump or irrigation circle 67.84 2
E -mail:
c. Y,i '. s "f_u, — 'p'�0-2 rf ' Sign or outline lighting 67.84 2
-. ` , .. '4 0 Signal circuit(s) or limited- energy
Iusiness narne: STONER ELECTRIC, INC. - panel, alteration, or extension. Page 2 2
Each additional inspection over allowable In any of the abov
Address: 1904 SE OCHOCO Add i tionalinspec lion (1 hr min) 66.25/hr
Investigation (I hr min) 66.25/ he
City /State/ZIP: MILWAUKIE OR 97222 lndtislrialplant (lhrmin) 78.18/ hr
Phone: ( 503) I Fax: ( 503) 659 -4968 Inspections for nhich no fee is 90.00/ h<
speciftcall l iste d ('h h r min)
CCB Lie.: 44823 Electrical Lic. 26 -122C Suprv. Lk.: 344965 , ' 1E R,ICAL PERMIT FEES
A r �� Subtotal. 7/, 02-
Suprv_ Electrician signature, required: /l am( ,.......1 Plan review (25% of permit fee): '
Print name: MICHAEL FALCONER Date: i Lizil/ Z State surcharge (12% ofpennit fee): g - 5—z_ l TOTAL PERMIT FEE: #Z ! , 54-
Authorized signature:
This permit application rcplres If a permit is not obtained w ithin 110
Print name: I Date: • d a) snfler has been accepted ascomplete.
• Number of inspections allowed per penmi.
LtDoitthng \PcemniELC- pemdrnpp.aoe 07)01/10 440 ottrift1/09COMM'Pn