Permit •
CITY OF TIGARD ELECTRICAL PERMIT
S� PERMIT #: ELC2006 -10094
� ��� DEVELOPMENT SERVICE DATE ISSUED: 3/30/2006
s� 13125 SW Hall Blvd., Tigard, OR 97223 503 639 - 4171
PARCEL: 2 S 115AB -01901
SITE ADDRESS: 16200 SW PACIFIC HWY Z- ALBERTSONS ZONING: C -G
SUBDIVISION: TIGARD TOWNE SQUARE LOT : JURISDICTION: TIG
Project Description: 1 SERVICE /4 BRANCH CIRCUITS. •
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: 1 W /SERVICE OR FEEDER: 4 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: 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' INC ELECTRICAL DIMENSIONS INC
250 PARK CENTER BLVD PO BOX 12146
BOISE, ID 83726 3961 N WILLAMS AVE
PORTLAND, OR 97212
Phone: Contact #: PR1 503 282 - 7255
FAX 503 - 280 -1619
FEES
Description. ,. Date Amount Reg #: ELE 26 -432C
[ELPRMT] ELC Permit 4/6/2006 $106.90 LIC 44008
[TAX] 8% State Surcharge 4/6/2006 $8.55 SUP 29645
Total $115.45 REQUIRED ITEMS AND REPORTS
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 -0100. You may obtain copies of these rules or direct questions to OUNC at 503 - 246 -6699 or
1- 800 - 332 -2344.
Issued By: � � Permittee Signature: 9 -7 et � D'
� �,
OWNER INSTALLATION ONLY �� !l r" "`
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'N: DATE:
LICENSE NO:
Call 503- 639 -4175 by 7:00 a.m. for an inspection that business day.
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 Applif Ew � !/
FOR OFFICE USE O \Ll
City of Tigard 3Q 4 j Permit No.:1 , - — 19
13125 SW Hall Blvd., Tigard, OR 97223 Plan Revie
;i ,
Phone: 503.639.4171 Fax: 503.598.1960 k 3 0 21 '' /' ' I �; Date/By: Other Permit:
Inspection Line: 503.639.4175 i � „ Date Ready/By: ruro: El See Page 2 for
Internet: www.ci.tigard.or.us CITY OF TIGARD Notified/Method: I Supplemental Information
TYJJ6IEWRIDIVISION PLAN REVIEW '
❑ New construction VI Addition/alteration/replacement Please check all that apply:
❑Service over 225 amps, comm'I ❑Hazardous location
❑ Demolition ❑Other;
❑Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling aCommercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑Building over three stories ['Feeders, 400 amps or more
❑ Multi- family ❑ Master builder ❑ Other: ❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION DEgress/lighting plan RV park
1 Job no.:. 105/42 o r Job site address: 16,760 SGt( - p ci c l,Ci Illy ❑Hearth care facility ❑Other
Submit i sets of plans with any of the above.
City/State/ZIP: &Aj° �_ The --7 ?„? The above are not applicable to temporary construction service.
Suite/bldg./apt. no.: Project name: / , ! v" ( J4 S6� FEE *. SCIIEDULE
Description I Qty. I Fee. ' I Total I ••
Cross street/directions to job site: New residential single- or multi- family dwelling unit.
Includes attached garage
1,000 sq. ft or less 145.15 4
Subdivision: I Lot no.: Ea. add'( 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map/parcel no.: Limited energy, non - residential 75.00 2
• DESCRIPTION OF WORK Each manufactured or modular
, V(I R/ 7 ,�y ynn Q n S erv ic es service and/or feeder
alteration, and/or relocation
it 90.90 2
G �(.f�l - �' l'UA "L GO t/ �� ).//l ' ! •�'� Services or feeders installation,
(91_, 9-,
�} d JJ J � J , Q ' 200 amps or less 1 80.30 2
l "s�r�.� �►/ �.n/� P� ���a�� �!�" - 201 amps to 40o ate 1o6.gs 2
ROPERTY',OWNER - - ❑ TENANT '
l = : - 401 amps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps 240.60 2
Address: Il 10' I Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) ]Fax: ( ) 200 >� or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2'
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
• _ A. Fee for branch circuits with
, ..: ❑ 'APPLICANT ` 0 PERSON " . service or feeder fee, each
Business name: / /� J Y 492 / � ""e/idiAv9f) branch circuit
4 6.65 05 2
g C e ,,S/a f/ B. Fee for branch circuits
Contact name: (ic�t4 !/• l 6-M-el J without service or feeder fee,
each branch circuit 46.85 2 -
Address: (j 760 / I/ / G &W 4 Each add'l branch circuit 6.65 2
City/State/ZIP' d'a-1,6+4.14 Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) °3,, '-7(- Fax: : ( ) Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited-
CONTRACT t energy panel, alterttion, or
extension. Describe: Page 2 2
Business name: — lLI .. I Jai , f. z -
9 Each additional inspection over allowable in any of the above
Address:
`� / � y � t /J������.�� Per inspection 62.50
City/StateJZIP: �� tetI l r�7 z _ Investigation per hour (I hr min) 62.50
Phone: ( ) ..,-r-, —7 -;- I Fax: ( ) " I 9 Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: 414 /008' 008' I Electrical Lic.: 1 Suprv. Lic.: 1.„ / f� Subtotal 4 I %( 90
Suprv. Electrician signature, required: �A / �i V Plan review (25% of permit fee)
State surcharge (8% of permit fee) 3.
ss
Print name:
d. - Date:
r, . ,: i ,.^ a #1 3 — a �— TOTAL PERMIT FEE I (s. eiG
Authorized si / ►fl -� / � This permit application expires if a permit is not obtained within 180
� - days after It has been accepted as complete
Print name: r , Date: • Fee methodology set by Tri- County Building Industry Service Board
_ r • • Number of inspections per permit allowed.
Electrical Permit Application - City of Tigard
\Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other
- COMIMERCIAL WORK ONLY
Fee for each commercial system ._ $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑
•
Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC200 S 10034
*3125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/300003
Phone: (503) 639 -4171 Aza't
Inspection Requests (24 Hrs.): (503) 639 -4175 `'I i
�..
INSPECTION WORKSHEET FOR DATE: 4/11/2006 TIME: 7:07AM PAGE: 60
SITE ADDRESS: 16200 SW PACIFIC HWY Z- ALBERTSONS CLASS OF WORK:
SUBDIVISION: TIGARD TOWNE SQUARE LOT #: TYPE OF USE:
PROJECT NAME: Al.BERTSON
DESCRIPTION: 1 SERVICE/4 BRANCH CIRCUITS.
OWNER: INC, ALBERTSON' PHONE #:
CONTRACTOR: ELECTRICAL DIMENSIONS INC PHONE #: 503.362 -72;5
Inspection Request Scheduled For: Date: 4/11/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
109 Electrical final 027717 -01 503-282 -7255
Corrections /Comments /Instructions:
ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: (12--141) Date: L f — 1 ( 0 l7 Phone #: (503) 718-