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Permit (182) • CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT COMMUNITY DEVELOPMENT PERMIT #: ELR2007 -00369 TIGARD DATE ISSUED: 9/20/2007 . 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S1156A -00100 SITE ADDRESS: 16200 SW PACIFIC HWY Z - ALBERTSONS ZONING: C -G SUBDIVISION: TIGARD TOWNE SQUARE LOT: JURISDICTION: TIG PROJECT: ALBERTSONS Project Description: Installation of low voltage for energy management system. Job No.7416E A. RESIDENTIAL B. COMMERCIAL AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING: BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT: GARAGE OPENER: CLOCK: MEDICAL: HVAC: DATA/TELE COMM: NURSE CALLS: VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE: OTHER: : HVAC: X PROTECTIVE SIGNAL: INSTRUMENTATION: OTHER: TOTAL # OF SYSTEMS: 1 Owner: Contractor: IBJ SCHRODER BANK + TRUST CO STONER ELECTRIC BY ALBERTSONS INC #565 1904 SE OCHOCO STREET ATTN: CORPORATE ACCTG DEPT MILWAUKIE, OR 97222 BOISE, ID 83726 Phone: Contact #: FAX 503- 659 -2824 PRI 503- 462 -6500 FEES Reg #: ELE 26 -122C LIC 44823 Description . Date Amount SUP 3496S [ELPRMT] ELR Permit 9/20/2007 $75.00 [TAX] 8% State Surchar€ 9/20/2007 $6.00 REQUIRED ITEMS AND REPORTS Total $81.00 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 mo han 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are orth in OAR through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at 503.24. 699 or 1.800.332.. f c Issu d By: , v _# jmay!_ Permittee Si _�M 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'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. • 09/20/2007 10:44 F . •, r r a 5 / p^y �� q � _ P TONER ELECTRIC 10001 Electrical Permit App ices o loll • ( ) 1 : 1 . 1 ( 1 - l ,, i- 0\1.1 City of Tigard SEP 2 0 2007 914y 7 ,AX Permit No.: g'410o?-QO369 13125 5W Hall Blvd., Tigard, Plan Review Phone: 503.639.4171 Fax 3 . 1 a ° "'`t�t ^ Date/B ; Other Permit: or Inspection Line: 503.639.417 IL DIN T '�' • 4 Notified/Method: od MI 9 See Pag 2 iWerm9tion Internet: www.ci.tigard V1LiJ G DrVI ;, OF WORK t „ PLAN REVIEW ., ❑ New construction Addition/alteration /replacement Please check all that apply; ❑Service over 225 amps, carom' I ['Hazardous location ❑ Demolition ©Other ['Service ovcr 320 amps — rating ❑ Buildog over 10,000 sq. ft., . *,:•::..... CATEGORY ' OF. CONSTRUCTION ' • .: . ,. ' : ' of 1- and 2 - family dwellings 4 or more new rtsidential ❑ 1- and 2- family dwelling ommercial/mdushial ❑ Accessory building ❑Sys over 600 volts nommol units in one structure ❑Building over three stories ❑ Feeders, 400 amps or mote ❑ Multi -family ❑ Master builder [] Other: ❑occupant load over 99 persons ❑Manufactured structures or -., `. JOB : SITe'INFOR11MATION k41) LOCATION, ` - ' ' ['Egress/lighting phut RV part Job no 7'4j(p 6 I Job site address: I (o74 6w 'Roy-4. C (.(4Y y ❑Hcaltft�ara facility ['Other. Submit 2 sets °fetus with any of the above. City/Stale/ZIP: T( 4 k tt o 0 .. q '7 2' construction above are nor applicable to temporary construon service. ( FEE", SCII6DUL'E •' ,j ' Suite/bldg. /apt no.: Project name: 9 5 A L Fx-i .*, i b ue>cripnan I • Qv, Rea T°Id Cross street/directions to job situ: New residential triage- or multi -family dwelling unit. Include, attached garage. 1,000 sq. ft. or less _ 145.15 4 Subdivision: I Lot no.: Ea. adds 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 • , ' , • . .. D,FSCRII'TXON OF WORK ' .. • ' ' -' ' Each manufactured or modular ,� v� dwelling, service and/orfboder 90.90 2 6 N It4 MAID 4b1WAI 64 M ipj"Th (/ Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 ;,',Q - PROPERTY 'OWNER `' I • _ . •❑ TENANT 201 amps to d00 amps 106.85 2 401 amps to 600 amps 160.60 2 Name: 601 amps to 1,000 amps 240,60 - 2 Address: _ Over 1,000 amps or volts 454.65 2 _Reconnect only 66.85 2 City/Stale/ZIP: Temporary services or feeders installation, alteration, and/or relocation Phone: ( ) I Fax: ( ) 200 amps 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 Owncr signature: Date: Branch circuits — new, alteration, or extension, per panel .,••.' .' ; , ; ,❑+'APPLICANT , ' , 1" ' "CONTACT'ERSOI!t' A Fee fbr branch circuits with service or feeder fee, each 6.65 2 Business name: breach circuit , {���� 9, Pee for branch circuits Contact name: Dee 1hi5 without service or feeder fee, 46,85 2 first branch circuit Address: Each add't branch circuit _ 6.65 2 City/State/ZIP: Miscellaneous (service or feeder not included) Pump or irrigation circle 53.40 2 Phone: ( ) I Fax: = ( ) Sign or outline lighting 53.4 2 E - mail: signal circuits) or limited- , ' ', ', . • • ' •'' : • • ' ' - CONTRACTOR • • ' ' energy panel. alteration, or 1 extension. Describe: ! Page 2 - 2 Business name: STONER ELECTRIC Address: 1904 SE OCHOCO Each additional inspection over allowable in any of the above Per inspection 6230 . City /State/ZIP: MILWAUKEE, OR Investigation per hour (1 hr min) _ 62.50 _ Phone: (503) 462 -6500 I Fax: (503) 6594968 industrial plant per hour 73.75 • . ELEC LCAIL 'PER IT FEES* '.; . CCB Lie.: 44823 I Electrical Lie.: 26 -122C I Suprv. Lie.: 3496 Subtotal 75 Suprv. Electrician signature, required: m A.„,_ Plan review (25% of permit fee) Print name: MICHAEL FALCONER I Dom: q ,� D State surcharge (8 % of permit fee) 6 `"� / / TOTAL PERMIT FEE 15 I Authorized signature: This permit application expires if a permit is not obtained within 180 - days after ft has been accepted as compktr Prim name: I Date: • Fer,uriivutn!n+v cat lw'rrtd',n R,nl,lina iroina,v Srnrirt Rnsnt CITY OF TIGARD - BUILDING DIVISION PERMIT #: Eutaw). O VA 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: O 2 on Phone: (503) 639 -4171 /mc- 4,n�Fll�l l F Inspection Requests (24 Hrs.): (503) 639 -4175 �__.. / INSPECTION WORKSHEET FOR DATE: 1 - -61 , 0t2 TIME: PAGE: •.1 SITE ADDRESS:16Z0(0 6 W Nu G I I1Wl Z w CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: ikA1. 1■1 S . DESCRIPTION: W Jel-Ti `J � e OWNER: PHONE #: CONTRACTOR: s PHONE #:,O1 - 5'2 $ Inspection Request Scheduled For: Date:1.31,t 8 Pour Time: Code # Inspection Description Confirm # Contact # Message ` C I F IW AL Corrections /Comments/ Instructions: , \ \ c \ \\r° \1 ' r .. \ \ \.\\ (4\ \ / \ \ \ ,. *SS III PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: • N 0(6 Date: I ' 31' 0 B Phone #: (503) 718- x • CITY OF TIGARD BUILDING DIVISION PERMIT #: ELR2007-00369 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/70/2007 Phone: (503) 639 -4171 4 y q Ill Inspection Requests (24 Hrs.): (503) 639 -4175 ' IL. INSPECTION WORKSHEET FOR DATE: 1/30/2008 TIME: 7 :02AM PAGE: 43 SITE ADDRESS: 16200 SW PACIFIC HWY Z - ALBERTSONS CLASS OF WORK: SUBDIVISION: TIGARD TOWNE SQUARE LOT #: TYPE OF USE: PROJECT NAME: ALBERTSONS DESCRIPTION: Installation of low voltage for energy management system. Job No.7416E OWNER: IBJ SCHRODER BANK + TRUST CO, PHONE #: CONTRACTOR: STONER ELECTRIC PHONE #: 503- 462 -6500 Inspection Request Scheduled For: /Date: 1/30/2008 Pour Time: Code # Inspection Description (TConfirm4 Contact # Message 199 Elechical final \ 064185-01 '' 503 -807 -7531 N Corrections /Comments /Instructions: 140 ANSLZE(k. - 1 kG \i‘k0 g" b i ct 1 b 0 F60- ■ NS EF o r. ❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS Ic FAIL KCALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED 71 02 t/44 Inspector: G' ' N 4 (5 L' Date: l • .60' el) Phone #: (503) 718- 1- •