Permit Er CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00412
.T1GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/27/2011
Parcel: 2S110DCO2200
Jurisdiction: Tigard
Site address: 15570 SW PACIFIC HWY
Project: Safeway Subdivision: 1997 -016 PARTITION PLAT Lot: 2
Project Description: (6) branch circuits for pharmacy expansion.
Contractor: STONER ELECTRIC Owner: TRC MM LLC
1904 SE OCHOCO 5973 AVENIDA ENCINAS STE 300
MILWAUKIE, OR 97222 CARLSBAD, CA 92008
PHONE: 503 - 462 -6500 PHONE:
FAX: 503 - 659 -4968
FEES
Quantity Description Date Amount
6 crt Branch Circuits wo /Purchase 07/27/2011 $93.28
Specifics: •
Service or Feeder
1 ea 12% State Surcharge - 07/27/2011 $11.19
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $104.47
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. 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 the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through O • -00•0. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
`
Issued By: I ! I Permittee Signature: 9A/ '/ �L� 669-7-70,1
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' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
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.
Jul. 22. 2011 9:14AM Stoner Electric Group No. 9052 P. 1
pperllED .
Electrical Permit Application 0 FOR OFFICE l.ISE (ONLY
C i 31 of SW H Tigard lv Ti JUL 2 2 2011 Received � % • P er,nitN�:�LC 4/ OD %/
I , ". 125 all Ad„ Tigard, OR 97223 Pl R ' O) �� � / �
g Platt Review -
• Phone: 503.639.4171 Fax: 50g Ins 359 TI`�%�� DateB : OthcrPcnnil —!�O/3
peetion Line: 503.639.4175 tat 1 11+ t t ' t Date Ready/By! 6:1 See Page 2 for
I L&.ARD g g BUI LDING DIVISION
Interact: www.ti and -or, vv DING Notified/Method; IMI Supplomenlnl Ynrortn9tion
_:_4`F_3 `'1YpE:01? Vi'ORK'. 9t ''•:_'. PLAN REVIEW: ias _ a
❑ New construction I . ddition/alteratton /replacement Please check all that apply (submit j seta of plans wfitems checked below):
❑Service or feeder 409 amps or more ❑ Building over three stories.
❑ Demolition 0 Other
where the available fault current ❑ Marinas and boatyards.
g545 - `« ` CATJ 017 F : ;:,.- s`'
"c '''° J4':•C_ a5rk'' exceeds 10,000 amps at 150 voles or ❑ Floating buildings,
"�- "':�:" -• ' C41vST12 t .:'� ", _ " " -: { "`" less to ground. or exceeds 14.000 ❑ C onunctcia l �rtee ag riculnrral
LI 1- and 2- family dwelling ,Conunercial/industrlal ❑ Accessory building amps rorall other installations. buildings.
El Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
k , -rvw , .,.._ ,, _._,• _. .. ❑ Emergency system. larger separately derived system.
. . .' JOB,SITE tT�Th 4jNQ O,L' �0 :. `'• • ❑ Addition anew nwuor load of ❑ 'A „
Job no.: I _ Job site address: / 70 5-1, prl.Ll r c J�� /�A�/ t00Hpor occupancy.
(Q ,--13,„<„, I r /7 - 7 ❑Six ormore residentialunits. ❑ Recreationalvehicicparks-
City /State/ZIP � A a �'72 0Heahhcarefatililihs. ❑Supply voltage for Mere than
--zD i 0 Hazudon*loaners. 600 volts nominal.
Suite/bldg. /apt. no.: I Project name: J,o'cFE,1V A, i ! 471g ❑ Service or feeder 600 amps or more.
Cross street/directions to job site: De,crieuon I oty. I fee. I Tetat ►. ', . ,
New residential single- or multi- family dwelling unit. •
Includes attached garage.
Subdivision: 1 Lot no.: 1.000 sq. ft, or less 161.54 4
Tax map /parcel no.: Ea. ndd'l 500 sq. ft. or portion 33,92 1
Limited energy, residential
_'- `` l -'�'' ' : : ' . pkl ,� ` • 0 - 'j:WiO� •0* % Wore (with above aq. tt.) ?5.00 2
Limited energy, multi- family 75.00 2
PO 1 RE' F'c R RI ARM ACV X, PAWS' i D V residential (with above sq, B.)
Services or feeders Installation, alterntlon, and /or relocation
• 200 amps or less 100.70 2
"' -' ' = TY Q X -: - ❑: TENANT - 201 amps to 900 amps 133,56 2
Name: 901 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1.000 amps or volts 552.26 2
City/State/ZIP: • Temporary services or feeders installation, alteration, and/o
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
Owner ius talialion; This installation is being made on property that I own which is not
201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps L 168.54 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Dale: A. Fee for branch circuits with
X c . - - - " CONY PERSON;: above service or feeder fee,
0 APP ICANT�,'' - ; .: =° , ...._?:Q:._.... AcT. • each branch circuit 7.42 2
Business name: B. Fee for branch circuits trithoid 1
service or f fee, first 1 56.18 51, , / 2
Contact name: branch circuit
Each add'i branch circuit S 7A2 271 I 0 2
Address: Miscellaneous (service or feeder not Included)
City/State/ZIP: Each manufactured ormodular 6784 2
dwelli :, service and/or feeder
Phone: ( ) Fax :: ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E-mail: Sigh or outline lighting 67.84 2
_ „ 1, >_ _:,:;';__ - . :,,.;;y_. •, ,., CONTRACTOR _spa Signal circuit(a) or limited- energy
Business name: STONER ELECTRIC, INC. panel, alteration, or extension. Paget 2
Each additional las ecllon over allowable In an • of the above
Address: 1904 SE OCHOCO Additional inspeclion(1hrmin) 66.25/ hr
Investigation (1 hr min) 11 66.25/ hr
City /Siate/ZIP: M I LWAU KI E, OR 97222 Industrial plant (1 hr min)
Phone: ( 503) Fax: ( 503) . 9 -4968 Inspections forwhich no fee is 90,00/ 78.18/ h h r
r '
•
s• i &call listed 'h hr min
CCB Lie.: 44823 Electrical Lie -: 26 -122G sUprv, Lie,: 3496S .. £LECTRICA,L ERMII EES -_ :'
m Su fie) $-'
Suprv. Electrician signature, required; � Plan review (25% of permit it fee): --
Print name: MICHAEL FALCONER Date: 77 /z r,) /J State surcharge (12%of permit fee); 1 j, 19 /
TOTAL PERMIT PEE: 164, 47 1,
Authorized signature: This permit application expires if a permit is not obtained within ISO
days after it has been accepted ea complete.
Print name: Date: ► Number of inspections allowed per permit.
I: laui :din$wenrd1aLC- PemulApp.doc 07/01/10 4to- 4615T(11/os /COM/WRS