Permit CITY OF TIGARD ELECTRICAL PERMIT
If
PERMIT #: ELC2008 -00586
COMMUNITY DEVELOPMENT DATE ISSUED: 10/14/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1 S136DC -04500
SITE ADDRESS: 07501 SW DARTMOUTH ST 100 WINCO ZONING: C -G
SUBDIVISION: PP1995 -013 LOT : JURISDICTION: TIG
PROJECT: WINCO
Project Description: (1) branch circuit for forklift charger.
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: 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 NORTHSIDE ELECTRIC
650 N ARMSTRONG PLACE PO BOX 12323
BOISE, ID 83704 SALEM, OR 97309
Phone: 208- 377 -0110 Contact #: PRI 503 - 585 -4879
FAX 503 - 364 -0248
FEES
Description Date Amount Reg #: ELE 24 -14C
[ELPRMT] ELC Permit 10/14/200! $46.85 LIC 80593
[TAX] 12% State Surchar 10/14/200! $5.62 SUP 1877S
Total $52.47 REQUIRED ITEMS AND REPORTS
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All
work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for
more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in
OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By: / � �� Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
W 10:49 FAX 5033640248 NORTHSIDE ELECTRIC al 001
e
.
. Electrical Permit Application
FOR OFFICE USE ONLY
„,_
, .
City of Tigard Received
1c1.1) Datet$ ; I MO • pcm,i,No.:
” 13125 SW Hall Blvd., Tigard, OR 97223
11111
Plan Review 4 1 .... , ..• r __
c - Phone: 503.639,4171 Fax: 503.598.1960 , . Date/By Other Permit:
Insp t 0 3 - .6 o 3 rg . o 4 v 175 ct ,,A Dote Ready/By:
57.1 See Page 2 for
TWARD I CY vrt Notitied/moth
Irklal suPptementai information
•
I P I AL'.." , il''''i , '. 1 rttirari ele - AMIN ''•1'.:.••ilt.014):Y,I08.7".'-'. [1''..,..1;;,!1::i:..
0 New construction 0 Addition/alterationfrep - eme b .-\ Please check all that apply (submit 2 sets of plans w/itcins checked below):
1:1 Service or feeder 400 amps or more 0 Ouilding over three stones,
El Demolition 0 Other; . ,& ,0 where the available fault current I:Marina s and boatyards.
.:'''...';-:: ' i:ri •: ' '''- : i :,.: 4 IllEari MAilig ''f!It'',r.'.3'],ii;,'i,''',4746 exceeds 70,000 maps at 150 volts or 0 Floating buildings.
less to ground, m exceeds 14,000 CI Comm cr c ink u s e a
El I- and 2-family dwelling Ei'l Commercial/industrial Illi Accessory building amps for all other installations. buldings.
0 Multi-family U Master builder ill Other: 0 Fire pump. 1:1 Installation a75 KVA or
larger separately derived system,
I . :f.i.00010*M.Viltl'':,7,41k.''1.Llii ElEzdeim tor load of
1001-11; or more, occupancy.
Job no.. i s ! q Job site addrcss: Sv 6 v 9
El six or more residential units. 0 Recreational vehicle parks.
City/State/ZiPiji9 CtrC , (,),R (4- -I . ,,r2) D Finalth.care facilities, 9 Supply voltage fbr more than
1phlrizardous loci-trims, 600 volts nominal.
Sui te/bldg/apt. no.: Project name: i ft hkz, , 9 Service or feeder 600 amps or nore,
Cross street/directions to job site:
Description Qiv. Free, 1 l'olid 1 ^
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
. 77,1547.7 O ::''''' (with above sq. ft.) 75,00 2
Limited energy, multi-family
75,00 2
IL .d4 , . • 0 , residential (with above scLft.)
Services or feeders Installation, altcra ion, and/or relocation
200 amps or less 80.30 2
le' 7 . 7 ..i4i; ) , i,::7, . ,.,..: 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 L 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps _ 100.30 2
i ntendcd 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, per panel 1
Owner signature: Date: -
A. Fee for branch circuits with
''.;:E'' :V. `..!. 7i ■ i'iriPlin",k1,: P: '0k.,ORPAis,i,', above service or feeder fce,
6.65 2 •
each branch circuit
BuSmess name;
D. Pec for branch circuits
without service or feeder fee, 5
g 2
Contact name;
1 LA,
first branch circuit 46.8
Address;
Each H.:MI bral- 2
Miscellaneous (service or feeder not included)
Each manufactured or modular
90.90 2
dwelling, service ancUor feeder
Phone: ( )
- -
Reconnect only 66.85 2
E-mail:
Pump or irrigation circle J 53.40 2 .
.!.' ' !:(^ fl i 1 /t1 1 ' '" :; ' 1 '.1".41: 1 1 Sign or outline lighting 53.40 2
Business name: - Signal circuit(s) or limited-
1 i , _ . — . ' 0 1 ' . . i - 1 ..
energy panel, alteration, or
Address: • ) • ' I -r . . 2,- extension. Describe: Page 2 2
City/State/ZIP: . 77 ire I ' 9C Each additional inspection over allowable in an) of the above
_—_-_____
Phone: (cl ) 1 -1.' le" Fax; ( . 3 )30z11; Per inspection 62.50
0 • I/1j —
investigation per hour (j hr min) 62.50
MEM= Electrical Lit,: 0 _/ Suprv. Lie.; J7i Industrial plant per hour 73.75
11114,714 rt,,EP " -' . '''l '
Suprv. Electrician signature, required: i
....CI .4 -1,r 4./.....i , ' Subtotal:
______
Print name: 0 V\ NO.I.P 1 D; . : Plan review (25% of pcnnit fee):
— State surcharge (12% of permit fcc): 5, _
Authorized signature;
TOTAL PERMIT FEE: . ln
',c.d.+
Print name; i / This permit
Date: application expires it'll permit is not obtained within th0
days after it has been accepted ea complete.
• Number of inspections allowed per permit.
1 :\Building V'ennItAELC•PermliAlip.thie 05/23/05
440-1615TO i/o5/COMAVE5
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CITY OF TIGARD . ..'s ,.
BUILDING DIVISION PERMIT #: ELC2008-00586
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/14/2008
Phone: (503) 639-4171 4 2.4400jiej
Inspection Requests (24 Hrs.): (503) 639-4175 AM- 11.
INSPECTION WORKSHEET FOR DATE: 12/12/2008 TIME: 7:00AM PAGE: 12
SITE ADDRESS: 07501 SW DARTMOUTH ST 100 WINCO CLASS OF WORK:
SUBDIVISION: PP1995-013 LOT #: TYPE OF USE:
PROJECT NAME: wiNco
DESCRIPTION: (1) branch circuit for forklift charger.
OWNER: WINCO FOODS, PHONE #: 20B.377-0110
CONTRACTOR: NORTHSI DE ELECTRIC PHONE #: 503-585.4879
Inspection Request Scheduled For: Date: 12/12/2008 Pour Time:
Code # Inspection Description Confirm # Contact # \ Message
199 Electrical final 079012-01 iO3-991-61i8 Y
Corrections/Comments/Instructions:
Afyl
•
\-- ---- >f----„, •
P cN i A v
•
A PASS 7 PARTIAL APPROVAL 0 CANCEL n NO ACCESS
FAIL CALL FOR INSPECTION 7 ADDITIONAL FEES ASSESSED
Inspector: G N 1 -e Date: I 2 -1 I t ) Phone #: (503) 718- _g_
, .
1 - _
CITY OF TIGARD oi
_ '
BUILDING DIVISION .
PERMIT #: 0_02008-00586
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/u/2m
Phone: (503) 639-4171 kormkoiA
Inspection Requests (24 Hrs.): (503) 639-4175 Aisl; AL
INSPECTION WORKSHEET FOR DATE: 11/17/2008 TIME: 7 PAGE: 26
SITE ADDRESS: 07601 SW DARTMOUTH ST 100 WACO CLASS OF WORK:
SUBDIVISION: pp1995.013 LOT #: TYPE OF USE:
PROJECT NAME: WINICO
DESCRIPTION: (I) branch circuit for forklift charger.
OWNER: WINCO FOODS, , PHONE #: 200_377_0110
CONTRACTOR: NORTHSIDE ELECTRIC PHONE #: 503-585-4879
Inspection Request Scheduled For: Date: 11/17/2008 Pour Time:
Code # Inspection Description Corifirm-# Contact # Message
(/
125 Wall cover 078091-01 603-991-6178 N Y
120 cts:3
Corrections/Comment /I structions:
PA PARTIAL APPROVAL 0 CANCEL El NO ACCESS
n FAIL CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: UM N t8L.‘" , Date: ifilll 101 Phone #: (503) 718- 1,114k)