Permit •
CITY 0 F T GAR ® ELECTRICAL PERMIT
° PERMIT #: ELC2008 -00464
COMMUNITY DEVELOPMENT DATE ISSUED: 8/11/2008
4 TCGARD, 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1S136DC-04500
SITE ADDRESS: 07501 SW DARTMOUTH ST 100 WINCO ZONING: C - G
SUBDIVISION: PP1995 - 013 LOT : JURISDICTION: TIG
PROJECT: WINCO
Project Description: TI - Low voltage for lighting control panel.
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: 1
MANF HM/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st WIO SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 6 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:
WINCO FOODS LLC WYTEK CONTROLS, INC.
650 N ARMSTRONG PL PO BOX 2510
BOISE, ID 83704 TUALATIN, OR 97062
Phone: 208 377 - 0110 Contact #: PRI 503 - 691 - 9002
FAX 503 - 691 -0313
FEES
Description Date Amount Reg #: ELE 34-571C
[ELPRMT] ELC Permit 8/11/2008 $161.75 LIC 127381
[TAX] 12% State Surchar 8/11/2008 $19.41 SUP 4892S
Total $181.16 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 =: says. A . TION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in
OAR 95 •01 -0010 through • A R • - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issue• By: Permittee Signature: k'�! -
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: ( r DATE: f / / /lJ r
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 Application n r :> ; ; ,� : :` _
' q' HOR OI I IC I 115E O \I 1 �
x
Received �j � J — /
.,, city of Tigard Date/By: u /1 D�
Permit No.: e
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
® Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
Inspection Line: 503.639.4175 Date Ready/By: ----1 0 See Page 2 for
f I C rFFt l�
. Internet: www.tigard or.gov Notified/Method: ! / / e Supplemental Information
F .. c�_.KL
TYPE OF WORK PLAN REVIEW
El New construction 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.
CATEGRY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings .
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
El 1- and 2- family dwelling C ommercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A", "E ", "1 - °, "1 - ",
Job no.: Job site address: r Jspa ;�,,;�.-,�,-," JJ Six or o e res. Recreational �lJj� � ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: - Ti ` , 0 e_ 9'7Z23 ❑ Health -care facilities.
❑ Hazardous locations ❑ Supply voltage for more than
. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: (J ^/n •'} GC>oS ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: 'lw ' 99 Desatptlon 1 Qty. 1 Fee. 1 Total R
( New residential single- or multi - family dwelling unit.
Includes attached garage.
• Subdivision: 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
DESCRIPTION F WO (with above sq. ft.) 75.00 2
Limited energy, multi - family
h �
(/ ()6 / ,461,47......, f 5 residential (with above sq. ft.)
75.00 2
J Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
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: ( ) 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 599 amps 133.75 2
Branch circuits - new, alteration, or extension, . r panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 y/, i1, 2
first branch circuit D
Address: Each add'l branch circuit 6 6.65 39. 6 ) 2
Miscellaneous (service or feeder not included)
City /State/ZIP: Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR • Sign or outline lighting 53.40 2
�,)-�- l Signal circuit(s) or limited -
Business name:
7 (�� CC tilt 4...b .2-I`fe_ energy panel, alteration, or /�
Address: }�, G. 13a�C / �
extension. Describe: / Page 2 (v 2
City /State/ZIP: - - 1,, /Alt , 6C 97 2 Each additional inspection over allowable in any of the above
/ Per inspection 62.50
Phone: (Sd3) 9/ .q06/_- Fax: (5 69i • 03/3 Investigation per hour (1 hr min) 62.50
CCB Lic.: 1 l 3,F Electrical Lic. J`1 5/- v i u Lic.: 4. /g 5 Industrial plant per hour 73.75
Suprv. Electn (a"iW�ature, required: A /0/1 /10 ELECTRICAL PERMIT FEES
subtotal: /�O j• 7 S
Print name: /454,4 A1lOQR,o ,� Date: //• 66P" Plan review (25% of permit fee): V/
State surcharge (12% of permit fee): / 9•
Authorized signature: TOTAL PERMIT FEE: / s%` • /4
This application expires if a permit is not obtained within 180
Print name: -- _ � �c /M 6A-t- Date: OF 6P s permit
after it has been accepted as complete.
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���U�K�����K�K�8��� � PERMIT �-'��""~~� �"°"�"~~"~ #: B_000841464
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 0111/2008
Phone: (5D3)G30'4171 ke .
Inspection Requests (24 Hrs.): (503) A4 � (503) 639-4175 ;���
INSPECTION WORKSHEET FOR DATE: 1102008 TIME: 7 AW PAGE: 22
SITE ADDRESS: DM01 SyVDARTMOUTH ST 100 VNWO0 CLASS OF WORK:
SUBDIVISION: LOT TYPE � PP1�9S'0iJ #: �
PROJECT NAME: wiNc0
DESCRIPTION: T|' Low voltage for lighting control panel.
OWNER: 04NC0 FOODS LLC. PHONE #: 208
CONTRACTOR: WYTFK CONTROLS, INC. PHONE #: 503-G91'80()2
Inspection Request Scheduled For: Date: 11/612008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
136 Low voltage 077660-01 N
36 7 - 9 J[. 3 15'
Corrections/Comments/Instructions: kv\'� �� __
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0 PAS-Z. i | PARTIAL APPROVAL | | NO ACCESS
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FAIL E CALL FOR INSPECTION r7 ADDITIONAL FEES ASSESSED
��~� ������'/ �� �A ^�� Phone #: (503) 718- |napeInspector: `�� '��������� Date: "� �� 1 ���
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