Permit • IN n CITY OF TIGARD E LECTRICAL PERMIT
COMMUNITY DEVELOPMENT Perm #: ELC2013 00384
T [GAR D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/10/2013
Parcel: 1 S136DC04500
Jurisdiction: Tigard
Site address: 7501 SW DARTMOUTH ST 100
Project: Winco Subdivision: 1995 -013 PARTITION PLAT Lot: 2
Project Description: Add (2) branch circuits for self check -out stand
Contractor: ENERGY ELECTRIC LLC Owner: WINCO FOOD LLC
7509 S 5TH ST STE 110 ATTN: TAX DEPARTMENT
RIDGEFIELD, WA 98642 PO BOX 5756
BOISE, ID 83705
•
PHONE: 360- 727 -3394 PHONE:
FAX: 360- 727 -3397
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 07/10/2013 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 07/10/2013 $7.63
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
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 acc• •.. - with approved plans. This permit will expire if work is not started within 180 days of iss.'lice, or if work is suspended for more the 180
days. AT TION: Oreg. - law requires you to follow the rules adopted by the Oregon Utility No ' io Center. Those rules are set forth in OAR
952 -00 -0010 through OAR 952 1 0 1 - 0 'u may obtain a copy of the rules or direct questions to OUN • ■ ca ing • 987 or 1.800.33 .2144.
/
i
�
Iss • d By: — - ' `L ��1 .i . Permittee Sig •ture: !�P/� ��'
•
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' ` L�I Date:
LICENSE NO.
Call 503.839.4176 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.
From:Energy Electric LLC 360 727 3397 07/09/2013 08:53 11103 P.002/002
Electrical Permit A . t;� 1 �� n
t li FOR ()I FI I_ usr c�Ni;:
City of Tigard Received
li Date/B : 7 Permit No.: ike O -OC 3? • • 13125 SW Hall Blvd., Tigard, OR �7g.7,2T 3
7YQJ 9 2 0 Plan Review
Phone: 503.718.2439 Fax: 503. 960 Dahl: : Other Permit:
`T I G P: i'. D Inspection Line: 503.639.4175 Date Ready/Ey: 3uris: ® See Page 2 for
Internet: www.tigard- or,gov l= / CI T O TIGARD Notified/Method: Supplemental Information
,ri,;:;;,I< s.:. ...,.:- .:<;,-,.. <;.v, CITY 1 1.J� 1
.Y: !: fy
- : .. . . ._.,e.:. i,.. -.. ..�.� Mk' 4 ; •U;::gM . __...: ..... ..- . ... .. v,. r: i./ l.._. I: i.:x- 1 ',':'.> :_:��_.:r::g
❑ New construction ® Addition /alteration/replacement Please check all that apply (submit 2 sets of plans wfitems checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: current ,..�;.,......,.....�.••., - - - boatyards.
....,: a- • -• °' ..•,.. � , � CATBGORYOF.i CONSrRUCri .,;x:' :J "' exceeds 1000
z r r:.!fa. -�:..� - :.,:..,�., ,.,..,. , - ONId! -� amps at.. ._._.:. �. .._..... - :. ,_....:_. ....,,.: , ,:.�., , ki "�' ° ° �:..� ❑ Floating buildings.
El 1 - and 2- family dwelling ® Commercial/industrial less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire Pump. ❑ Installation of 150 KVA or
R; ± >:i %r; t 1'rrFP r JOWS? AND :; i "';:'; Emergency system- larger separately derived system.
i r:_.::s1:,,.._,.r.., " h„,-., .., r.:.,r, .s. • „1NFO ATTONi= -•ioCATIciN'e".'w�= z :r, li i•' _ = .
..- � ... '� L. �...:,..,.,. i.........,.. i..,.,.:. •.�.;L..7L,...11.nt:irKci.r.:! :,: -,T. -.
.• .: ...... .. . ...: :, ,..�,.� ❑ Addition of new motor load of ❑ "A ", "E" "I.2 ^, "1 -3 ",
Job no.: Winco#23 Job site address: 7501 SW Dartmouth St 100HPOr occupancy.
❑ Six or more residential units, ❑ Recreational vehicle parks.
City/State/ZIP: Tigard, OR 97223 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: /a, Project name: Wince #23 ❑ Service or feeder 600 amps or more.
Cross street/directions to job site: Exit 293 off 1-5 to 3' = �' ' • _ �, `r ` 9G� �, ' '` 'Ir'' S''°°='. g.
o Dartmouth St - ' `' IILE..F I r ° ,,` [ T�.l f «;
Description I Quv. I Pee. I Total •
New residential single- or multi - family dwelling unit.
_ Includes attached garage.
Subdivision: Lot no.: 1,000 sq. R. or less 168.54 4
Tax map/parcel no.:
Ea. add'I 500 sq. ft. or portion 33.92 I
ss, rcr •rr•u: _ n• „7}v u.g Nyrd residential 75.00
V �,!:,• ::� "'� Isl eof,r, a Limited I ' SME ;'a� ''I l;�r - �sIDEs.C,.R.R,,l_0...._..F �WORit:Wili ;� a •;l i;V I 'xr' (with above ft. 2
Limited energy, multi - family
Adding 2 circuits to Self Check - out Stand residential (with above sq. ft.) 75.00 2
.
ewahleEnerki.4.. -;.• ..; '(O:' BeePtsse :is ?i,:.'':'r .
Services or feeders Installation, Alteration, and/or relocation
a z f
O:War lY : -; , SP �,:',1 , '°. � *�
.Y'�.,,Av S�f � �:vli:�k:4:;;if::�:•�r 1;ltihn ti � nom. .•..< ,..,.,,.m,.,.e,�� ?z 200 amps or less 100.70 2 cc, «�I; r�
Name: Wince
201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Address: 650 N Armstrong Place Got amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City /State/ZIP: Boise, ID 83704 Temporary services or feeders Installation, alteration, and/or
Phone: (208)377 - 0110 Fax: (360)727 - 3397 relocation
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
Owner signature: Date:
Owner „ Da Branch circuits- new, alteration, or extension, per panel
.,-ti"� :N; ;; i'� a_is� ,i `iAi.:- �rc.4tr" : :"i y ` qtr. - ^;.L.� , 7u 1 21.' A. Fee for b
x ::: .• ` ":ildiv�k. ..:.._.`.Fs - a1 sa4.;,,Gi.? 'O , g 3 s4 , sw• ranch circuits with
z. � above service or fader fa,
Business name: ENERGY ELECTRIC LLC each branch circuit 7.42 2
B. Fee for branch circuits without
Contact name: JOHN R ROSENLUND service or feeder fee, first 1 56.18 56.18 2
- _ branch circuit
2I
Address: 7509 S. 5 ST., STE#110 Each add'] branch circuit 1 7.42 7.42 2
City/State/ZIP: RIDGEFIELD WA 98642 Miscellaneous (service or feeder not included)
Each manufactured or modular 67,84 2
Phone: (360) 727 - 3394 Fax : : (360) 727 - 3397 dwelling, service and/or feeder
Reconnect only 67.84 2
E - mail: JOHNR @Q.COM
s ". ii4u i; cam; ;i9n ,u: :r,:" ;r::' a ss� ; : - r :,:, „ Pump or irrigation circle 67,84 2
�.,. ::i:..,.,.it::...Ph. .:i ....i:�Ptsi- „_.,," QIVTRAGTt)$;ti "a.. ;_.v;.
:tR6c:f ]rtc:o,..r,:,,._.-. _: <•,,< sign or outline lighting 67.84
2
,?)./ Business name: ENERGY ELECTRIC LLC Signal circuit(s) or limited -energy See
panel, alteration, or extension. Page 2 2
Address: 7509 S. 5TH ST., STE#110 Each additional inspection over allowable in any of the above
City/State/ZIP: RIDGEFIELD WA 98642 Additional inspection (I hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
Phone: (360) 727 - 3394 Fax: (360) 727 - 3397 Industrial plant (1 hr min) 78.18/ hr
Inspections for which no fee is
1 1 , 0 CCB Lie.: 179089 1 Electrical Lic.: C367 ,�t�,a Suprv. Lic.: 4890S 1,4111 specifically listed (h hr min) 90.001 hr
ittEcror l; i:PERBUT"
Suprv. Electrician signature, required: "` "r ``'`� "i .,• ;i ':4`';i.
Print name: DAN MALLOY t, j / • ate: 7/ /2013 (25%ofpermit bfee _ 63.60
Plan review fee):
j State surcharge (I2% of permit fee): 7.63
Authorized signature: .1 tE /7 J TOTAL PERMIT FEE: 71.23 t
Print name: JOHN R R ENLUND 4 G Date: 7/ /2013 This p ermit application expires if a permit is not obtained within 180
days after it bas been accepted as complete.
• Number of inspections allowed per permit,
1: 1Buildins\ Permus1ELC_PermttApp_ELR_pRE,doe Rev 05/21/2013 440-4615711/05/COM/WEB