Permit CITY OF T I G A R D ELECTRICAL PERMIT
PERMIT #: ELC1999 -00476
L Ai'
* ' DEVELOPMENT SERVICES DATE ISSUED: 8/24/99
Ai
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S115BA -00100
SITE ADDRESS: 16200 SW PACIFIC HWY Z
SUBDIVISION: ZONING: C -G
BLOCK: LOT : JURISDICTION: TIG
Project Description: Electrical for the Albertson's expansion.
RESIDENTIAL UNIT • TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: • SIGNAL/PANEL:
MANF HM/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: 9 W /SERVICE OR FEEDER: 311 PER INSPECTION:
201 - 400 amp: 3 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: 1 EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
ALBERTSON'S TUALATIN ELECTRIC
250 PARK CENTER BLVD PO BOX 655
BOISE, ID 83726 WILSONVILLE, OR 97070
Phone: 208 - 395 -6283 Phone: 682 -2955
Reg #:. LIC 00065650
SUP 3483S
• ELE 3 -26C
FEES • Required Inspections
Type By Date Amount Receipt Ceiling Cover
PRMT GEO 7/30/99 $2,627.10 99- 317102 Wall Cover
5PCT GEO 7/30/99 $183.90 99- 317102 Underground Cover
PLCK GEO 7/30/99 $656.78 99- 317102 Elect'I Service
Elect'I Final
• Total $3,467.78
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 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -1987.
gi
PERMITTEE'S SIGNATURE ISSUED BY:
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
1
SIGNATURE OF SUPR. ELEC'N: /9 /U 0r1 DATE _
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
•
CITY OF TIGARD Plan Check #
i_�D
Electrical Permit Application Recd By •�p
13125 SW HALL BLVD. Date R J �9
TIGARD OR 97223 B
Date to P.E. - 40 1 "[ 1
Phone (503) 639 -4171, x304 Date to DST ; "
Inspection (503) 639 -4175 ' Print of Type Permit #EL.0 / '-
•
Fax (503) 598 -1960 Incomplete or illeg will not be accepted Called y -9 / /4, ak
. 1.u/ /h.t t /�
1. Job Address: 4. Complete Fee Schedule Below: •
Name of Development Number of Inspections per permit allowed
Name (or name of business) Service included: Items Cost Sum
Address 4a. Residential - per unit
City/State /Zip 1000 sq. ft. or less $ 117.75 4
Each additional 500 sq. ft. or
portion thereof $ 26.25 1
Commercial ❑ Residential ❑ Limited Energy $ 60.00
Each Manuf d Home or Modular
2a. Contractor installation only: Dwelling Service or Feeder $ 72.75 2
(Prior to permit issuance, applicants must provide contractor license 4b. Services or Feeders
information for COT data base). Installation, alteration, or relocation i c7 , 1 `�//
Electrical Contractor 200 amps or less $ 64.25 5 7-D, Z 2
Address 201 amps to 400 amps $ 85.50 Z5, SD 2
401 amps to 600 amps ) $ 128.50 12i;., S() 2
City State Zip 601 amps to 1000 amps $ 192.50 2
Phone No. Over 1000 amps or volts $ 363.75 2
Job No. I Reconnect only $ 53.50 2
Elec. Cont. Lice. No. Exp.Date 4c. Temporary Services or Feeders
OR State CCB Reg. No. Exp.Date Installation, alteration, or relocation
• COT Business Tax or Metro No. Exp.Date 200 amps or less $ 53.50 2
201 amps to 400 amps $ 80.25 2
°Signature of Supr. Elec'n 401 amps to 600 amps $ 107.00 2 •
Over 600 amps to 1000 volts, .
see "b" above.
License No. Exp.Date
4d. Branch Circuits
Phone No. New, alteration,or extension per panel
' a) The fee for branch circuits
2b. For owner installations: with purchase of service or
feeder fee.
Print Owner's Name Each branch circuit 7 71 ( $ 5.35 � ) �� ∎ 2
Address b) The fee for branch circuits
without purchase of service
City State Zip or feeder fee.
Phone No. First branch circuit $ 37.50
Each additional branch circuit $ 5.35
The installation is being made on property I own which is not 4e. Miscellaneous
intended for sale, lease or rent. (Service or feeder not included)
Each pump or irrigation circle $ 42.75
Owner's Signature Each sign or outline lighting $ 42.75
Signal circuit(s) or a limited energy
• (if required):* panL alteration or extension $ 60.00
3. Plan Review section
( Minor Labels (10) $ 107.00
Please check appropriate item and enter fee in section 5B. 4f. Each additional inspection over
4 or more residential units in one structure the allowable in any of the above
Service and feeder 225 amps or more Per inspection $ 50.00
Per hour $ 50.00
System over 600 volts nominal In Plant $ 59.00
Classified area or structure containing special occupancy as
described in N.E.C. Chapter 5 5. Fees:
5a. Enter total of above fees $ Z (p Z7, 0
* Submit 2 sets of plans with application where any of the above apply. 70,8% Surcharge (.05 X total fees) $ l . GPQ
Not required for temporary construction services. Subtotal $
5b. Enter 25% of line 5a for Nl
NOTICE Plan Review if required (Sec. 3) $ (p5 (p, @
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED Subtotal $
IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR
WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS ❑ Trust Account # 22
AT ANY TIME AFTER WORK IS COMMENCED. Total balance Due $ ) 1- 11 1 - 1 , 7g
11
i:\dsts\forms\electric.doc
v
CITY OF TIGARD Electrical Permit Application Plan Check & y l
13125 SW HALL BLVD. Rec'd By ��/
TIGARD OR 97223 Date Rec'd �/LI /
Date to P.E.
Phone (503) 639 -4171, x304 Date to DST
Inspection (503) 639 -4175 Print or Type
#
Fax �P+
(503) 684 -7297 -_D Incomplete or illegible will not be accepted
Called
•
-
1. Job Address: / ' 4. Complete Fee Schedule Below:
Name of Development .7 I �.�--d3 m -t f A D .4t cFif / Number of Inspections per permit allowed
Name (or name of business) A / b C. '- a n 3 Service included: Items Cost Sum
1
Address / 6 ao 0 i L- + (, la k.- 4a. Residential - per unit
�
City /State/Zip T��R. r d O L 9 7) cl 1000 sq. ft. or less
Each additional 500 sq. ft. or $110.00 4
Commercial a Residential 1=1 Limited thereof $25.00 1
Limited Energy $25.00
Each Manuf'd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
(Attach copy of all current licenses) / 4b. Services or Feeders
Electrical C tractor I (.c. u ( of i - id-t. Y.-.- (.. Installation, alteration, or relocation
Addres ' 16 ol - G ..c..5- 201 200 amps or less ° a ) $60.00 -S � 2
Milos to - 4 - do amps $80.00 . �� 2
�
City (..1 S" vw.l State 0 k Zip rt '701 -0 401 amps to 600 amps $120.00 I .)o 2
Phone No. 2°I ,..5-... 601 amps to 1000 amps $180.00 2
Job No. � g ,..5-... S`I C, Over 1000 amps or volts $340.00 2
Elec. Cont. Lice. No. 3 -.2 C C- Exp.Date 10/ . 9 Reconnect only $50.00 2
OR State CCB Reg. No. 6 ,) a S ° Exp.D • to 4 oj6 ' 4c. Temporary Services or Feeders
COT Business Tax or Metro No. / %p.Date Installation, alteration, or relocation
/� ��/ 200 amps or less $50.00 2
201 amps to 400 amps _ $75.00 Signature of Supr. Elec'n 401 amps to 600 amps $100.00 2
p / D / O! / / Over 600 amps to 1000 volts,
s
License No. 3 g3 Exp.Date see "b" above.
Phone No. - , . 7
4d. Branch Circuits
New, alteration or extension per panel
2b. For owner installations: a) The fee for branch circuits with
purchase of service or
Print Owner's Name feeder fee.
Address Each branch circuit 3 / / $5.00 ) SS.S 2
b) The fee for branch circuits
City State Zip without purchase of
Phone No. service or feeder fee.
First branch circuit $35.00 2
The installation is being made on property I own which is not Each additional branch circui $5.00 2
intended for sale, lease or rent. 4e. Miscellaneous
(Service or feeder not included)
Owner's Signature Each pump or irrigation circle $40.00 2
Each sign or outline lighting $40.00 2
3. Plan Review section (if required):* Signal circuit(s) or a limited energy
panel, alteration or extension $40.00 2
Minor Labels (10) $100.00
Please check appropriate item and enter fee in section 5B.
4 or more residential units in one structure 4f. Each additional inspection over
Service and feeder 225 amps or more the allowable In any of the above
System over 600 volts nominal Per inspection $35.00
Classified area or structure containing special occupancy Per hour $55.00
as described in N.E.C. Chapter 5 In Plant $55.00
* Submit 2 sets of plans with application where any of the above apply. 5. Fees: «Y SS
Not required for temporary construction services. 5a. Enter total of above fees $ ) 2
5% Surcharge (.05 X total fees) $ r
NOTICE Subtotal $
5b. Enter 25% of line 5a for '!3 7
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review if required (Sec.3) $
NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK Subtotal $
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY
TIME AFTER WORK IS COMMENCED. ❑ Trust Account # $ 3� -�
Total balance Due
I: \DSTS\ELC96.APP Rev 9/96
04/17/2000 Activities for Case #: ELC1999 -00476 •
9:15:14 AM
•Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELCC001 Application received 07/21/1999 BON RECD No Hold GEO 07/30/1999
ELCC003 Permit created - - 07/30/1999 GEO DONE No Hold GEO. 07/30/1999
ELCC102 Plans routed to Plans Examiner 07/30/1999 GEO SENT No Hold GEO 07/30/1999
ELCC110 Plans checked /approved by PE 08/19/1999 CD PASS No Hold CD 08/19/1999
. ELCC115 Approved plans routed to DSTs 08/19/1999 CD PASS No Hold CD 08/19/1999
ELCC700 Ceiling Cover 08/19/1999 08/19/1999 09/22/1999 CD PASS No Hold AKJ 09/22/1999 ceiling cover for high ceiling deli .
Note: need low voltage insp
•
• before final
ELCC720 Wall Cover 08/19/1999 08/19/1999 09/09/1999 • CD PASS No Hold AKJ 09/09/1999 deli area
ELCC725 Underground Cover 08/19/1999 08/19/1999 No Hold CD 08/19/1999
ELCC730 Elect'l Service 08/19/1999 08/19/1999 10/12/1999 CD FAIL No Hold JS 10/12/1999 1. All grounding must be done
in service disconect.
. - 2. Extend grounding electrode
. cordinator to service disconect
. instead CT
3. Isolate grounds neutrals in
. • surf puned
4. bond all metal piping bakery
waling cover approved
ELCC799 Elect'l Final 08/19/1999 08/19/1999 11/08/1999 BP FAIL No Hold VT 11/08/1999 no - inspection
not ready •
ELCC920 Miscellaneous action 08/19/1999 CD No Hold CD 08/19/1999 .
- ELCC117 DST Post - Review complete 08/24/1999 , DEB DONE No Hold DEB 08/24/1999
ELCC400 (F)Ready to issue 08/24/1999 DEB DONE No Hold DEB 08/24/1999 All fees paid.
ELCC500 (F)Issue permit 08/24/1999 DST DONE No Hold DST 08/24/1999
ELCC700 Ceiling Cover 10/07/1999 10/07/1999 10/07/1999 CD PASS No Hold AKJ 10/07/1999 deli area
ELCD700 Rough -in V 10/12/1999 10/12/1999 10/12/1999 CD FAIL No Hold JS 10/12/1999 See Service 10/12/99.
ELCA720 Wall Cover 10/25/1999 10/25/1999 10/25/1999 BRP PASS No Hold ST 10/25/1999 Meat & Fish Dept.
ELCC720 Wall Cover • 11/01/1999 11/01/1999 11/01/1999- BP PASS No Hold . DGW 11/01/1999 Rough in Pass
ELCC700 Ceiling Cover 11/22/1999 11/22/1999 11/22/1999 BRP PASS No Hold DGW 11/22/1999 Fixture mounting method -
Pass
ELCC700 Ceiling Cover 01/18/2000 01/18/2000 01/18/2000 BRP PASS No Hold AKJ 01/18/2000 floral area
ELCC799 Elect'l Final 02/22/2000 02/22/2000 02/22/2000 CD PASS No Hold AKJ 02/22/2000
ELCC800 Case Finaled 02/22/2000 AKJ DONE No Hold AKJ 02/22/2000
Page 1 of 1
•
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
\ / BUP
Date Requested /v,/Q_7 AM K PM BLD
Location l 2 ,v ' L( Suite MEC
Contact Person Ph (D7K - Zi2iZ - 7 PLM
Contractor ' , �, Ph SWR n �,
BUILDING Tenant/Owner �atAI vi. i _ �) Q [ 9- ° 0 J 7b
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler �i✓c� % ��
Fire Alarm
Susp'd Ceiling q/� Roof / Misc: /
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
CTRICAt
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
4(if?•
PART FAIL
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk Date A 9 Q Inspector Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.