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Permit (140) • CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT COMMUNITY DEVELOPMENT PERMIT #: ELR2007 -00431 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 11/20/2007 PARCEL: 2S115BA -00100 SITE ADDRESS: 16200 SW PACIFIC HWY Z - ALBERTSONS ZONING: C -G SUBDIVISION: TIGARD TOWNE SQUARE LOT: JURISDICTION: TIG PROJECT: ALBERTSONS Project Description: Low voltage sensor wiring for refrigeration remodel. 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: PROTECTIVE SIGNAL: INSTRUMENTATION: OTHER: ENERGY SYS X TOTAL # OF SYSTEMS: 2 Owner: Contractor: IBJ SCHRODER BANK & TRUST CO SOURCE REFRIGERATION BY ALBERTSONS INC #565 5506 SE INTERNATIONAL WAY ATTN: CORPORATE ACCTG DEPT MILWAUKIE, OR 97222 BOISE, ID 83726 Phone: 208- 395 -4711 Contact #: PRI 503- 849 -6580 FAX 503- 652 -0449 FEES Reg #: ELE 37- 940CRE LIC 149200 Description Date Amount [ELPRMT] ELR Permit 11/20/2007 $150.00 [TAX] 8% State Surcha 11/20/2007 $12.00 REQUIRED ITEMS AND REPORTS Total $162.00 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 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: 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. • Electrical Permit Applicatio ECE % FOR OFFICE USE ONLY r City of Tigard Received - Permit No 1114 • 131 SW Hall lvd., Tigard, OR 97223 NOV 2 `i / • 1 t' / plan R vie %G 0� 7 �°� ©O� QQ y3� Phone: 503.639.4171 Fax: 503.598.1960. Date/By: Other Permit: T I G n It D Inspection Line: 503.639.4175 ti1T OF ! IGAFID Date Ready/By: Juris: 0 See Page 2 for Internet: www.tigard- or.gov BuniNOOIUISIOnI Notified/Method: 77G- Supplemental Information TYPE OF WORK PLAN REVIEW ❑ New construct ion Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below): ❑ Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. less to ground, or exceeds 14,000 ❑ Commercial - use agricultural ❑ 1- and 2- family dwelling ,kCommercial/industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi - family ❑ Master builder ❑ Other: ❑Fire pump. ❑ Installation of 75 KVA or JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ", y / - n IOOHP or more. occupancy. Job no.: Job site address: /O�.� S24) J3 i// F ei Hwy ❑ Six or more residential units. ❑ Recreational vehicle parks. City/State /ZIP: 77/''�� � f.3 Health-care facilities. ❑ Supply voltage for more than ((TT ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: gi.B Q,75oaS J -� ...--- ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: H u> y / 9 Deneriptlon I tom. I Pee. I Total I • New residential single- or multi- family dwelling unit. Includes attached garage. Subdivision: I Lot no.: 1,000 sq. ft. or less 145.15 4 Ea. add'I 500 sq. ft. or portion 33.40 1 Tax map /parcel no.: Limited energy, residential 75.00 2 DESCRIPTION OF WORK (with above sq. ft.) Limited energy, multi - family 75.00 2 /oz.) vgoLr7e._. .4".... r./0 /Ad residential (with above sq. ft.) Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 ❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2 Name: 401 amps to 600 amps 160.60 2 L3i27�� ` � � ' '_ 601 amps to 1,000 amps 240.60 2 Address: Over 1,000 amps or volts 454.65 2 City/State /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 1 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 599 amps 133.75 2 Owner signature: Date: Branch circuits — new, alteration, or extension, per panel A. Fee for branch circuits with ❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, each branch circuit 6.65 2 Business name: 4 L B. Fee for branch circuits Contact name: Q / without service or feeder fee, 46.85 2 l ✓g Y pe207 - Sea ,,r first branch circuit / Each add'I branch circuit 6.65 2 Address: J dG 7 f /...- r70-7" A-4/ Miscellaneous (service or feeder not included) City/State /ZIP: isTa.. LtiU Each manufactured or modular 90.90 2 Phone: ) F ax:: ( ) dwelling, service and/or feeder 4 7 7- 1q Reconnect only 66.85 2 E -mail: Pump or irrigation circle 53.40 • 2 CONTRACTOR Sign or outline lighting 53.40 2 Signal circuit(s) or limited - Business name: 4D�e_� 4 (,._,2(6.4,,47---,-,...) extension. eg aDesct alteration, or Describe: Page 2 / 2 Address: City/State /ZiP: Each additional inspection over allowable in any of the above Per inspection 62.50 Phone: j) Py9'..._ e; _572.6 I Fax: (. $2 3) 65;2 — 2VV' ' Investigation per hour (1 hr min) 62.50 CCB Lic.;4 Electrical Lic.: 7 yfO , g Suprv. Lic.: !' g„�r ?fie Industrial plant per hour 73.75 ELECTRICAL PERMIT MIT FEES Suprv. Electrician signature, required: ,e 0/.......--- y.. Subtotal: /.5'O , re Print name: %l /v Gf/ /L ` r S Date: Plan review (25% of permit fee): I i - 2O -07 State surcharge (8% of permit fee): /a ,,-3 Authorized signature: W TOTAL PERMIT FEE: 76,g, O U This permit application expires if a permit is not obtained within 180 Print name: Mnil ‘4,/, //61.741S Date: / /. 82 days after it has been accepted as complete. ( • Number of inspections allowed per permit. 1:t Building\Permits\ELC- PermitApp.doc 05/23/06 440-4615T(11/05/COM/WEB 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: ,j COMMERCIAL WORK ONLY: I Fee for each commercial $75.00 system (SEE OAR 918- 309 -0000) 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 4x6_ ✓l ftl /�N / ,d/ 1 n�'� C i YS'ri�'>`� Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I: \Building\Permits\ELC- PermitApp.doc 03/23/06 CITY OF TIGARD BUILDING DIVISION �� PERMIT #: ELR2007.00431 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/20/2007 Phone: (503) 639 -4171u i l�l Inspection Requests (24 Hrs.): (503) 639 -4175 . .. INSPECTION WORKSHEET FOR DATE: 3/25/2008 TIME: 7:01AM PAGE: 40 SITE ADDRESS: 1E0.00 SW PACIFIC IHWY Z - ALBERTSONS CLASS OF WORK: SUBDIVISION: TIGARD TOWNE SQUARE LOT #: TYPE OF USE: PROJECT NAME: ALBERTSONS DESCRIPTION: Low voltage sensor wiling for refrigeration remodel. OWNER: IBJ SCHRODER BANK & TRUST CO, PHONE #: 208-391)-4711 CONTRACTOR: SOURCE REFRIGERATION PHONE #: 503 - 849.6590 Inspection Request Scheduled For: Date: 3/25/2008 Pour Time: Code # Inspection Description / • irm -- # Contact # Message 199 Electrical final 067240.01 503-209-6237 N Corrections /Comments/ Instructions: t IL-16 1 16.----- - G Pli c j /' P ❑ PARTIAL APPROVAL CANCEL ❑ NO ACCESS L ❑ CALL FOR INSPECTION I ADDITIONAL FEES ASSESSED Inspector: G9'.. 1.1b66 Le Date: 3 J . 7•6 Phone #: (503) 718- _AYtt