Permit p CITY OF TIGARD ELECTRICAL PERMIT
S COMMUNITY DEVELOPMENT Permit #: ELC2012 00722
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/18/2012
Parcel: 1 S 136DC04500
Jurisdiction: Tigard
Site address: 7501 SW DARTMOUTH ST 100
Project: Winco Subdivision: 1995 -013 PARTITION PLAT Lot: 2
Project Description: (1) branch cirtcuit to install weather proof receptacle on outside wall in the front
Contractor: WYTEK CONTROLS, INC. Owner: WINCO FOOD LLC
PO BOX 2510 ATTN: TAX DEPARTMENT
TUALATIN, OR 97062 PO BOX 5756
BOISE, ID 83705
PHONE: 503 - 691 -9002 PHONE:
FAX: 503 - 691 -0313
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 12/18/2012 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 12/18/2012 $6.74
Type of Use: COM Electrical
Class of Work: OTR
Type of Const:
Occupancy Grp:
Total $62.92
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 OAR 2 01 -0090 You may obtain a copy of the ules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By:
� J � J4,
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' 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.
Electrical Permit Application RECEIVE FOR OFFICE USE ONLY . �� 7 City of Tigard 1� Received r l' I C / j 3 Permit No. � rl��� '(w7.'
Date/B o^ b �`
III
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 DEC 18 201 Date/B : Other Permit:
I I G A R D Internet: n www tigard or gov75 Date R y e th luri 1 S See upplemental Information
CITY OF TIGARD
TYPE OF WtLD�G DIVISION PLAN REVIEW
❑ 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.
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 ® Commercial /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 ", "I -2 ", "l -3 ",
Job no.: Job site address: 3 (1 Dartmouth Rd. lootiP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: Tigard, OR. 97223 /4 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: Winco store #23 ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: by Costco Description I Qty. I Fee. f Total I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 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
install weather proof receptical on the outside wall in the front residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER l ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name:
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and /or
City/State /ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits - new, alteration, or extension, l er panel
Owner signature: Date: A. Fee for branch circuits with
® APPLICANT ❑ CONTACT PERSON above service or feeder fee 7.42 2
each branch circuit
Business name: Wytek Controls, Inc. B. Fee for branch circuits without
service or feeder fee, first 1 56.18 I 2
Contact name: Wael Chamseddine branch circuit
Each add'I branch circuit 7.42 2
Address: P.O. Box 2510 Miscellaneous (service or feeder not included)
City/State /ZIP: Tualatin, OR 97062 Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: (503) 691 - 9002 Fax: : (503) 691 - 0313 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail: wael @wytekcontrols.com Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
Business name: Wytek Controls, Inc panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: P.O. Box 2510 Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: Tualatin, OR 97062 Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18 / hr
Phone: (503) 691 - 9002 Fax: (503) 691 - 0313 Inspections for which no fee is 90.00 / hr
specifically listed (%: hr min)
CCB Lic.: 127381 Electrical Lic.: 34 -571C Suprv. Lic.: 4892S ELECTRICAL PERMIT FEES
/- .. (25% Subtotal: 56.18
c
Suprv. Electrician signature, required: c" 5 Plan review (25 %o of permit fee): 0.0
Print name: Asghar Sarparast Date: I2 17. /7 State surcharge (12% of permit fee): 6.74
TOTAL PERMIT FEE: 62.92
Authorized Signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Wael Chamseddine Date: 1 7 /7 ) 7 • Number of inspections allowed per permit.
I:\ Building \Permits\EL.C- PermitApp.doc 07/01/10 440- 4615T(11 /05 /COM/WEB