Permit CITY OF TIGARD ELECTRICAL PERMIT
TIGARD #: ELC2005 -00083
,11r DEVELOPMENT SERVICES DATE ISSUED: 2/14/2005
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 1S136DC-04500
SITE ADDRESS: 07501 SW DARTMOUTH ST 100 WINCO
SUBDIVISION: PP1995 - 013 ZONING: C -
BLOCK: LOT : JURISDICTION: TIG
Project Description: (8) branch circuits. Dairy cooler remodel.
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: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 7 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:
WAREMART INC ELECTRICAL DIMENSIONS INC
BY BURKE + NICKEL PO BOX 12146
3336 E 32ND ST #217 3961 N WILLAMS AVE
TULSA, OK 74135 PORTLAND, OR 97212
Phone: Phone: 282 - 7255
FEES Reg #: LIC 44008
SUP 2964S
Description Date Amount 26
ELE 26 --432C
[ELPRMT] ELC Permit 2/14/2005 $94.80
[TAX] 8% State Surcharge 2/14/2005 $7.59 REQUIRED ITEMS AND REPORTS
Total $102.39
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws.
All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is
suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -6699 or 1 -800- 332 -2344.
Issued By: T �1, Permit Signature: Sce_, A
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 639 - 4175 by 7:00pm for an inspection the next business day
, la
Electrical Permit Application
Date received �y -p5"" Permit no.: C C � dd
• ma �1�l City of Tigard gl) ProjectiappI.no.: 1`. Expire da te: City of Tigard Addres 13125 S W 22 Date issued: B Receipt no.:
Phone: (503) 639 -4171 "
Fax: (503) 598 -1960 a 14 2005 Case file no.: 3 Payment type.
Land use approval: 11 Y � - Ttf;NRD
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory 'Commercial/industrial ❑ Multi - family ❑ Tenant improvement
Cl New construction -7 5d f ❑ Addition/alteration/replacement Cl Other: ❑ Partial
•
JOB SITE INFORMATION
Job address: . 9-� .X' 11,_c-Ft c; , 1- - 12, . Bldg. no.: Suite no.:, `/j Tax map /tax lot/account no.:
Lot: I Block: I Subdivision: (k a CS
Project name:11«;.° (_,/.1._,,,--
_, _, ( at'11Description and location of work on premises: 'j t ,�. + . dic,i N^ mac; 81 e. i c.r'cc,.
Estimated date of completion/inspection: ' Z Fu
CONTRACTOR APPLICATION FEE SCHEDULE
Job no: / 2'-I 3 I . Fee Max
Description Qty. (ea.) Total no. insp
Business name: �.l_f_} -c i�,,:� 1 D , „v. a.tis$ `� 5 it
r � / New residential - single or multi - family per
Address: f Imp ( I dwelling:mit. Includes attached garage.
City: i j c •; } ' State:0 2l? 1 ZIP: q7-v Serviceincluded:
•
Phone:K€55)Z Z _9' Fax :(So3) trio ..g,tE -mail: 1000 sq. ft. or less . 4
Each additional 500 sq. ft. or portion thereof
CCB no.: • L. tjQ 5 (Elec. bus. lie. no: 2 C L energy, residential 2
City /m • tro lie. no.: �( 7 t-( Limited energy, non- residential 2
,` . . !' -,0_.., .A , Z— Z) Each manufactured home or modular dwelling
Si:naiure • supervising e electrician (required) Date . Service and/or feeder 2
Sup. Services or feeders — installation,
Su
p e z , , i ,,„, —+• g 1 '�� �C License n o:'Zei S alteration or relocation:
PROPERTY OWNER 200 amps or less 2
Name (print):
201 amps to 400 amps 2 401 amps to 600 amps 2
Mailing address: • • 601 amps to 1000 amps 2
City: I State: I ZIP: Over 1000 amps or volts 2
Phone: I Fax: I E -mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services or feeders - . . _
which is not intended for sale, lease, rent, or exchange according to installation, alteration, or relocation:
200 amps or less 2
ORS 447, 455, 479, 670, 701. 201 amps to 400 amps 2.
Owner's signature: Date: 401 to 600 amps 2
• ENGINEER Branch circuits - new, alteration,
, or extension per panel:
. Name: . A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: State: - ZIP: B. Fee for branch circuits without purchase 1 � ,
of service or feeder fee, first branch circuit: I ( , • 2
Phone: Fax: E -mail: Each additional branch circuit: •7- ICI ��5
PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included):
O Service over 225 amps - commercial 0 Health -care facility Each pump or irrigation circle 2
O Service over 320 amps -rating of 1&2 O Hazardous location Each sign or outline lighting 2
family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
Cl System over 600 volts nominal more residential units in one structure alteration, or extension* 2
O Building over three stories 0 Feeders, 400 amps or more *Description: .
O Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
O Egress/lightingplan 0 Other. Per inspection
Submit _ sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Permit fee $ I t$
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application y
O Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ '-• sI
Expires TOTAL as comp TOTAL $ I ' - .
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440.4615 (6/00/COS)
Electrical Permit Fees: Limited Energy Fees:
TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Complete Fee Schedule Below: Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total `, Check Type of Work Involved:
Residential - per unit 4 �] Audio and Stereo Systems
1000 sq. ft. or less $145.15
Each additional 500 sq. ft. or 1 ❑
portion thereof $33.40 Burglar Alarm
Limited Energy $75.00
Each Manufd Home or Modular Door Opener`
Dwelling Service or Feeder $90.90 2
Services or Feeders ❑ Heating, Ventilation and Air Conditioning System*
Installation, alteration, or relocation
200 amps or less $80.30 2 Vacuum Systems
201 amps to 400 amps $106.85 2
401 amps to 600 amps $160.60 2
601 amps to 1000 amps $240.60 2 Other
Over 1000 amps or volts $454.65 2
Reconnect only $66.85 2 TYPE OF WORK INVOLVED - COMMERCIAL ONLY
•
Temporary Services or Feeders Fee for each system $75.00
Ins 200 a a r l e es sn, or relocation $66.85 2 (SEE OAR 918 - 260 -260)
200 amps o less
201 amps to 400 amps $100.30 2 Check Type of Work Involved:
401 amps to 600 amps $133.75. 2
Over 600 amps to 1000 volts,
ri Audio and Stereo Systems
see "b" above.
Branch Circuits . . Boiler Controls
New, alteration or extension per panel
a) The fee for branch circuits n Clock Systems
with purchase of service or
•
feeder fee.
Each branch circuit $6.65 • 2 ❑ Data Telecommunication Installation
b) The fee for branch circuits •
without purchase of service ❑ - Fire Alarm Installation
or feeder fee. „•�
First branch circuit __i__. $46.85- _ HVAC
HVAC
Each additional branch circuit 4- $6.65 4.17::Z)
� - , � '
i f+
Miscellaneous ri Instrumentation •
(Service or feeder not included) Instrumentation
• "
Each pump or irrigation circle _ $53.40 ❑ Intercom and Paging Systems
Each sign or outline lighting $53.40
Signal circuit(s) or a limited energy Landscape Irrigation Control
panel, alteration or extension . $75.00
Minor Labels (10) $125.00 ❑
Medical
Each additional inspection over .
the allowable in any of the above Nurse= Calls:
Per inspection $62.50 ,•
Per hour $62.50" -• -
In Plant $73.75 Ell Outdoor Landscape Lighting'
Fees : - 0 Protective Signaling-
Gc-> -�
Enter total of above fees S 14. - Other
8% State Surcharge $ 4. 561 Number of Systems
25% Plan Review Fee
* No licenses are required. Licenses are required for all other installations
See "Plan Review" section on $
front of application. , -
Fees:..
. Total Balance Due $ 102, 2, Enter total of above fees $
❑ Trust Account # 8% State - Surcharge- $_
• Total Balance Due. $
i :\dsts\fomu\elc- fees.doc 10/09/00 . -- ' -._ - - . .. -
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC200500083
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/14/2005
Phone: (503) 639 -4171 /�� %��Im��ii��)�����
Inspection Requests (24 Hrs.): (503) 639 -4175 ..L.
INSPECTION WORKSHEET FOR DATE: 5/12/2005 TIME: 7 : 08AM PAGE: 122
SITE ADDRESS: 07501 SW DARTMOUTH ST 100 WINCO CLASS OF WORK:
SUBDIVISION: PP1995 -013 LOT #: TYPE OF USE:
PROJECT NAME: ' WINCO
DESCRIPTION: (8) branch circuits. Dairy cooler remodel.
OWNER: WAREMART INC, PHONE #:
CONTRACTOR: ELECTRICAL DIMENSIONS INC PHONE #: 282 -7255
Inspection Request Scheduled For: Date: 5/12/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 006621 =01 503. 282 -7255 N
Corrections /Comments /Instructions:
•
74 PASS n PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ��-� Date:— � - CPhone #: (503) 718-
i r^ F .
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2005 -00083
I I 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/14/2005
Phone: (503) 639 -4171 ir'uj�u�up�liiii
Inspection Requests (24 Hrs.): (503) 639 -4175 _.:�
INSPECTION' WORKSHEET FOR DATE: 5/312005 TIME: 7:14AM PAGE: 112
SITE ADDRESS: 07601 SW DARTMOUTH ST 100 WNCO CLASS OF WORK:
SUBDIVISION: PP199& -013 LOT #: TYPE OF USE:
PROJECT NAME: VViNCO
DESCRIPTION: ( branch circuits. Dairy cooler remodel.
OWNER: WAREMART INC, PHONE #:
CONTRACTOR: ELECTRICAL DIMENSIONS INC PHONE #: 282 -7266
Inspection Request Scheduled For: Date: 5/3/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 006863-01 603-282-7265 N
•
Corrections /Comments /Instructions:
c . PM LY 7 1 0 1- M. ( -‘ L i i') ( - 7 P 9 \ A-IN / t (1_‘' P(v
J
HL \• L-
•
/
n PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: C"-1--- � Date: __ Phone #: (503) 718-