Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
3111 t C OMMUNITY DEVELOPMENT Permit #: ELR2013 -00169
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/17/2013
Parcel: 1 S136DC04500
Jurisdiction: Tigard
Site address: 7501 SW DARTMOUTH ST 100
Project: Winco Subdivision: 1995 -013 PARTITION PLAT Lot: 2
Project Description: Data cabling for installation of new self check stands with minor electrical revisions.
Contractor: TECHNOCOM INC Owner: WINCO FOOD LLC
7929 SW BURNS WAY SUITE F ATTN: TAX DEPARTMENT
WILSONVILLE, OR 97070 PO BOX 5756
BOISE, ID 83705
PHONE: 503 - 682 -4195 PHONE:
FAX: 503 - 682 -2781
FEES
Description Date Amount
Specifics: Restricted Energy Permit 07/17/2013 $75.00
12% State Surcharge - Electrical 07/17/2013 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: 0 Boiler Controls: 0
CCTV: 0 Clock Systems: 0
Data & Telecommunications: 1 Fire Alarm: 0
HVAC: 0 Instrumentation: 0
Intercom /Paging: 0 Landscape /Irrigation: 0
Landscape Lighting: 0 Medical: 0
Nurse Calls: 0 Protective Signal: 0
Security Alarm: 0 Other: 0 Total $84.00
Other Desc: 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 952- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 orr 80�
1.800.332.2344.
5 .11 -� `y '
Issued By: Permlttee Signature: g G /(t9-77v" ^_ /
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 603.639.4175 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 A lica cEivED FOR OFFICE ,SL 11 ONE\
City of Tigard Received
D '7 /7 /3 4eii ,P°t""t 3 4,2_ei - 400/ C?
IN - .
. q 13125 SW Hall Blvd., Tigard, OR 9724UL 1 5 2013 I'lan Review , Other Perntirdal : ad, ,
: . . Phone'. S03.7i 1.2410 Fax: 503.598.1360 Date/Etv:
InSpection Line: 503.639.4175 Date Ready/By: I lei3 See Page 2 for
TIGA1U3 CITY OF TIGARD ii.fific,vm.thod, 7 / ci--i Supplemental Information
Internet www.tigard-or.gov
:: :i';;.;;.; 7.77-7 ....... ...:t,..:;,;;;"I'j..1::. i
El New construction Addition/alteration/replacement
0 Service orl feeder 400 amps or more El Building over three stories.
0 Demolition ID Other: w the v2ilable fault e7..orrent CI MAtittrA and boatyards.
• .... ...„ .,.
,':: ::.:•:!:,:!::':':; ;!:;':!: !:::::E'; :•;•'••' •:•'''. br coisttittitis:,,i,,::::i,.;:..:i::,7:1::;7;.:.!,.::,.,.::;:...:;4!!:,::.:1::.: exceeds I ,000 maps at 150 volts or El Floating buildings.
,''.'•:,•!.:'::•.;. ,!:.::'''::::::-Hri ,....- ;•,...,..,..:,:q...,', - .....,,.. • .. :::',.. .: ' • ..........:%:.:;.;.;:. . .:.:•",.--:-.- less to grdmid, or exceeds 14,000 D Commercial-use agricultural
0 1 - and 2 dwelling .0 Commercial/industrial 0 Accessory building a mps for i othw installations. buildings.
0 Multi-family 0 Master builder 0 Other. 1:IFira piant4. : 0 Installation of 150 KVA OT
larger separately derived system.
.'•:.:::•:-.!.:.'•: -; :.!' 4(i.ii AND CI Addition Of new Motor IOW Of 0 "A", "Er " I -2-,..1-3
:- .::::--," :::;.....:-:::',:::1!.-, ......• .-,. • - . . . . . .
100111 ofir:0171. ; orropsmr.y
4
Job no.: I;v13 A. Job site address: 7 p jo ..,/ ;i A ge i A , - if
• .: I I:3 Six or m o residental units. El Recreational vehicle parks.
_.
h 0 ...... 0 Health-calv fheilMes.
13
0 Hazordori MO.-MM. Supply voltage for more than
City/State/ZIP: e / OA
600 volts nominal,
/ Suite/bldg./apt. no.: /CO Project name: winci) 0 Service at feeder 600 amps or more. _
',
Cross street/directions to job site: onerintion I J Qtr. I Fee. I Total I "
New residential single- or multi-family dwelling unit.
Includes attached garage.
Suhdivisim: I 1 no.: 1,000 sq. ft. or less , 168.54
4
Ea. add'l sop sq. ft.:or portion 33,92 1
Tax map/parcel no.: Limited energy, residential 75,00 2
:•:!!:.::!'i! N'''::! :'H:...:,;.1:.;.' ''''' :'' "'''',;ljtkitOtIOR!'160:*iijiti.;;::::.'::::;:::.E.F....:.:.•::•':::':•::1'•*•.:!''::::!.';':::;;::!:: (with abdve sq. ft) .
'' ' ' ' Limited energy muttt-thmlly '
1
• / ,0 ' ieY 4 1.-, '.... . "
4 it -- - - . ,- residenti tha
al (wibove sq. ft 75.00 2
if
.) , .
iS i .!Red6Withlt: EnettiY4ink41'1: $.,CPSL '.)i:10
Services oi feeders installation and/or relocation
200 amps o
..:!:;,;i,.:!:.:I .:Ei'7.::::'; i less :. 100,70 2 201 amps tc 400 amps 133.56 2
Name: 401 n1111.15 Lli 600 am ps 200,34 _
2
Address: 601 amps hi 1,000 amps 301,04 2
Qvcr 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
Phone: ( ) Fax: ( ) relocation'
200 amps ot less 59.36 1
Owner installation: This installation is heats made on property that I own which is not 201 amps td 400 amps 125.08 ' 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps td 599 amps 168.54 2
Owner signature: Date: Branch eit‘cuits new, alteration, or - extension, per
..
,:,.:::..!,:: A, Pee fbr branch eircuias with
':';:'::,;E:,,:!!: ".;:t';,1,:c4:=!F.Im. ••;.711 !••• • •
rt.oNtiktr above service or feeder fee,
Business name: -r-pj-1,,,n,com-Lon-- each branch eircbit 7.42 2
0, re for branch circuip. without
Contact name: 50() Tr t
#11.4) service dr feeder fee, first
56.18 2
' branch circuit :
Address:79 51 ; Lix
• t t i . t 3 4Z) ,,.. , h F Each add'l iranch circuit 7.42 2
City/State/ZIP: f/) o t ic.., al y 1 , 1 L CY -. 10 cc:$.0 mi5c manufactured lar di..40.$ (service or fee )___ der not included
Eac or modu •
' 67.84 2
Phone: i .$) t it, 1. . Fax: : g G 9_ ... t I dwelling, service atid/or feeder
Reconnect Only 67.84
2
E . , TOVC ' ._.°TXrrdF4SVIF,07'..A 4 0 al/ OM Pump or irrigation circle 67.84 2
.;:•:;:•;;';';' :1 :.:. :.r.i::•...C! • I ' - - PPR. - , - ..,• • ,,, • ;': ! , : :;:• . :::gii:T.,..!•. : ,!: '.':':'•:; &f or ot one *ri 67.84 2
Business name: I. 0 A A ■ ,) Signal citedit(s) or limited-energy I See
an . . • ...1 1 0 4,.. pm-
_ panel, altertition, or extension. 1 Page 2 1.6.00 2
, t) Address: .
•2 Each additional inspection over allowable in any of the above
Additional nspectien (1 66.25/ hr
City/State/ZIP: 1 toto
investigatiO (1 hr m hr rein) , 66.25/ hr
r "
Phone: ( ) . ilV I Fax: ( ) industrial plant (1 hr min) 7R.I R/ hr
- Inspections for which no fee is
CCB Lic.. g Electrical Lic ' • . . rv. Lic.. A' i specifically listed OS hr min) 90.00/ hr
I r .,,r;,'!•! . .1.:EllECTIRICAVTE.tRINOEFEES::"::.:;;::::::::::::;:!F:::.'::';..,
y. Suprv. Electrician signature, required: Subtotal: I 5, 00
Print name: S a fl•rr 4 , ,
1 I Date:6 7' 1 1 sj 1.3 Plan review (25% of permit fee); ei
LAr...± , • Otatc surcharge (12% of permit fee):
X Authorized signature: , TOTAL PERMIT FEE: 54 . o
Print nameSACrir 1 , / Date: 07//51.1 This Permapplication explive. li'll permit is not obtained within ISO
days after it hue been attested oe complete.
• Number Of inspettions allowed per permit.
,
1:15011ding\POIThitsSLC_PcnnitApp_ELPJ11,Edoc Rev 05/21/2.13 440.4615r11/05/COM/WEB
Electrical Permit Application — City of Tigard
Page 2— Supplemental Information
Limited Energy Permit Fees: Renew ble Energy Permit Fees:
:7! .
Fee for all residential systems combined. $75.00 Deteriptien ' Qty. I Yee I Total I •
RenewabIC electrical energy systems:
Check Type Of Work Involved: 5 kva or lcsi 100.70 2
5,01 to 15 Ica 133.56 2
AudiO and Stereo Systems*
15.01 to 25 Irve 200.34 2
Wind
Burglar Alarm gendradon 'systems in excess of 25 War
25.01 to 501cva • 301,04 2
Garage Door Opener* 50.01 to log kva 552.26 2
>100 Icva (fee in accordan ce with
R. 918-309-0040) 552,26 2
I=1 Heating, Ventilation and Air Conditioning 0A R918-309-0040
System* Solar gene 'Systems In excess 01 25 kva:
Each additiclnal Icv; over 25 7,42 3
LI Vacuum Systems* >100 Icva — ito additional chargc 0.0 3
Each additional inspection over allowable in any of the above;
1=1 Other: rAch tidditinnol love-Alm is
6625/ hr
charged at ail hourly (1 hr min)
Inspections ror which no fix is
9000/ hr
specifically Iistcd hr mm)
:.'.•';.." ; , • .•!
Fee for each commercial system....................... $75.00 Subtotal:
(SF.F. OAR 91 R-309-000t1) Plan review. if required (25% of permit fee):
tats surcharge (12% of permit fee):
_
Check Type of Work Involved: : TOTAL PERMIT FEE:
Thb permit appliudiun expire. ire permit b not obtained within 180
Audio and Stereo Systems days atter It has been accepted as complete
• Number if inspections allowed per permit
El Boiler Controls •
Li Clock Systems
•
Data Telecommunication Installation
El Fire Alarm Installation
LI HVAC •
Li instrumentation •
•
Intercom and Paging Systems
El Landscape Irrigation Control*
p Medical
1=1 Nurse Calls
111 Outdoor Landscape Lighting*
0 Protective Signaling
17 Other
•
Total number of commercial systems: L
*No licenses are required. Licenses are required •
for all other installations
lAiluildingTermitsIELC_PermitApp_EIR_EREdot Rev 05/21/2013