Permit CITY OF TIGARD ELECTRICAL PERMIT
g COMMUNITY DEVELOPMENT Permit #: ELC2013 00193
• T[GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/25/2013
Parcel: 1 S 136DC04500
Jurisdiction: Tigard
Site address: 7501 SW DARTMOUTH ST 100
Project: Wnco Subdivision: 1995 -013 PARTITION PLAT Lot: 2
Project Description: (1) sign or outline lighting
Contractor: VANCOUVER SIGN COMPANY INC Owner: WINCO FOOD LLC
2600 NE ANDRESEN RD #50 ATTN: TAX DEPARTMENT
VANCOUVER, WA 98661 PO BOX 5756
BOISE, ID 83705
PHONE: 360 - 693 -4773 PHONE:
FAX: 360 - 693 -2747
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 04/25/2013 $67.84
Specifics:
1 ea 12% State Surcharge - 04/25/2013 $8.14
Electrical
Type of Use: COM
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $75 98
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 2 -001- 090. You m y obtain a copy of the rules or direct questions to OUNC by calling 503 .2 2 1987 or 1 00
Issued By: 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' 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.
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard Received
DateB : - 9- .1--- Permit No.: ( �(,c 3.00( 93
• 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
= Phone: 503.639.4171 Fax: 503.598.1960 Date/B : Other Permit: 64 Pd7 / 3 _ '( o'
TI G A R D Inspection Line: 503.639 Date ReadyBy: H See Page 2 for "�
Internet: www.tigard - or.gov Notified/Method: Supplemental Information V•
TYPE OF WORK PLAN REVIEW
❑ New construction El Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
El Demolition El Other: where the available fault current ❑ Marinas and boatyards. W
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. 0
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural O
❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings. C
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITL INFORMATION AND LOCATION ❑ Emergency system larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E " I -2 ", ' 1 -3 ",
p� (- 1 IOOHP or more. occupancy.
Job no.: Job site address:
7560 5w l) eat 111 G l l ►SOT ❑ Six or more residential units. ❑ Recreational vehicle parks.
City / State/ZIP: l te ed , OA Ci 7 Z Z3 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: 1.,...; 1/60 F603. ❑ Service or feeder 600 amps or more
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. f Total I
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map /parcel no.. Ea. add'I 500 sq. h. or portion 33.92 1
Limited energy, residential
67.84 2
DESCRIPTION OF WORK (with above sq. ft.)
( i) 1 i / Limited energy, multi - family / / /u,iM 1 Itter icL Lt Nti1( S! 0 residential (with above sq. f.) 67.84 2
1J Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
g PROPERTY OWNER I JE3 TENANT 201 amps to 400 amps 133.56 2
Name: W 116.0 FFDO� 401 amps to 600 amps 200.34 2
++-� J 601 amps to 1,000 amps 301.04 2
Address: - 7c 04) ,5 ix) b6Lrt rvvcut`tcl R Over 1,000 amps or volts 552.26 2
City /State/ZIP: .T 6. 1 o 7 ZZ Temporary services or feeders installation, alteration, and/or
J relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I 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
Branch circuits — new, alteration, or extension, per panel
Owner signature Date: A. Fee for branch circuits with
APPLICANT I ® CONTACT PERSON above service or feeder fee,
7.42 2
,I C J each branch circuit
V
Business name: 0l.Yl.l,OtA1) P.'� c71G�t(1 B. Fee for branch circuits
without service or feeder fee,
Contact name: A 6 1� St() c(r7 first branch circuit 56.18 2
Address: zoo AI A e, ei RI IrJo Each add'I branch circuit 7.42 2
Miscellaneous (service or feeder not included)
City /State/ZIP: tJ u _v ex A gg6l I Each manufactured or modular
67.84 2
dwelling, service and/or feeder
Phone: (3 6,0) (9 3 2/7 7 3 Fax: : ( 360 6 q 3 Z7 `l 7 Reconnect only 67.84 2
E -mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting (I) 67.84 2
Business name: Signal circuit(s) or limited -
� t 1 .1.1) u ve S ` � ia ( Y7 energy panel, alteration, or
J extension. Describe: Page 2 2
Address: 2 c.n o N e A root e�e_n id. Sp
City /State/ZIP: U.,L G 0 t ko es., W C / $ �, (� 1 Each additional inspection over allowable in any of the above
B Per inspection 66.25
Phone: ( 340) 6q 3 1-177 Fax: ( 3 60 6 { 3 17'Y 7 Investigation per hour (1 lrr min) 66.25
CCB Lic.: to g 5 1 Electrical Lic.: 37_ yro c Su . Lic.: 52& _ 516 Industrial plant per hour 78.18
ELECTRICAL PERMIT FEES
k _,--- Suprv. Electrician signature, required: 5�. Subtotal:
t
Print name: g4
Date: 3/z rh3 Plan review (25% of permit fee):
!J r / State surcharge (12% of permit fee): C
Authorized signature /, /�� TOTAL PERMIT FEE: tO
I This permit application expires if a permit is not obtained within 180
Print name: ge ; /X� st Date: -3 L ? days after it has been accepted as complete.
" Number of inspections allowed per permit.
I:\ Building \PermitsV?I.C- PermitApp.doc 10/01/09 440.461_ (11/05/COM/WEB