Permit CITY ®F TIGARD ELECTRICAL PERMIT ii:
' Is , COMMUNITY DEVELOPMENT �` .1, P ermit #: ELC2013 00069
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 arA F / 3 Date Issued: 01/29/2013
Parcel: 1S136DC04500
• Jurisdiction: Tigard
Site address: 7501 SW DARTMOUTH ST 100
Project: Winco Subdivision: 1995 -013 PARTITION PLAT Lot: 2 .
Project Description: (1) branch circuit and (1) low voltage to disconnect and reconnect power to replace refrigerated case. 1/29/13,
reprinted to correct scope of work: (1) branch circuit only.
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 01/29/2013 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 01/29/2013 $6.74
Type of Use: COM ' Electrical
Class of Work: ALT
- 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 acc. • - - - = ' I 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
i days. ATT. • ION: Oregon I requir- you to follow the rules adopted by the Oregon Utility Not" Center. Those rules are set forth in OAR
952 -001- .10 th gh OAR 952 -001 -I' ' I. Yo . y obtain a copy of the rules or direct questions to OUNC b 1987 or 1.800.332. 44.
/
/ ( /
Issu d By: Permittee Signature. fat--&—)
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' j Date:
LICENSE NO.
Call 503.839.4175 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.
CITY OF TIGARD ELECTRICAL PERMIT
i'1 2 COMMU NITY DEVELOPMENT Per #: ELC2013 00069
TiGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/29/2013
Parcel: 1 S136DC04500
Jurisdiction: Tigard
Site address: 7501 SW DARTMOUTH ST 100
Project: Winco Subdivision: 1995 -013 PARTITION PLAT Lot: 2
Project Description: (1) branch circuit and (1) low voltage to disconnect and reconnect power to replace refrigerated case
•
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 ea Limited Energy 01/29/2013 $75.00
Specifics:
1 crt Branch Circuits wo /Purchase 01/29/2013 $56.18
Service or Feeder
Type of Use: COM 1 ea 12% State Surcharge - 01/29/2013 $15.74
Class of Work: ALT Electrical
Type of Const:
Occupancy Grp:
Total $146.92
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law, All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through OA' 9 2 - 001 -00:0. You may 7blain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332 r�
Issued By: d/. -�� , .. / -' .4 Permittee Signature: vey ���� I ��' (U��
•
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Application RECEIVE I volt ol-•Fl(: l: l'si: 0\ IN
114- City of Tigard D °a l 'e d Oar 13 Permit Noet-C - OG f
0 Review
13125 SW Hatt Blvd., Tigard, OR 97223 SAN 2 9 2013 , , �,
Phone: 503.71$.2439 Fax: 503.598.1960 DNB ; other Permit: Y ` u e. P/ 5 r Otto
1 1 i , , r\ l i Inspection Line: 503.639.4175 . ' 1 i. ate Ready/By: lode; ® See 2 for
Internet www.tigard- or.gov MY OF 1 ; ; C . �.tified/Method: "i i ( Supplemental laformadon
j j l _ �¢ y � d r r J . l ;4. 'n'. ; n ;i:_�.' :rti•' 9 tr.' .. t, fir ... h ... � , rirr .: ';9 �ii1'#o l.. %:10. ,.,044 : • ..n �i" .wo - t . i ' .. : t' i...r . •.,: i gri :, .r1 li f i ' :rtiP 1 ;.Al1 .' A iit f'-'' i 1/ - t f a 1, I , . . � '
i ::
i i i ,, '' • � .. Sr.Gt!.>�1,1 .. � I Jn. � . :. •
12 New construction ® Addition/alteration/replacement Please check all that apply (submit? sets of plans w /items c below):
D Smtiioo or feeder 400 amps or more 0 Building over three stories.
❑ Demolitiool ❑ Other: where the available fault current ❑ Marinas and boatyards.
,:F •: , ...0 :M. g w ; d exceeds 1 000 amps at 150 0 udder
:.:ei:51: , ^Itl ....: ta,'' 4 ..• .
' I a p , ;' .., � I .,': ? . .... •: 1C. u � W , N iillo , .. , : ' . ;.. . Nl. 1 ;` sin o, P volts or Floating gs
❑ 1 and 2-family dwelling Commercial/industrial ❑ Accessory building less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
rY dmg amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. 0 installation of 75 KVA or
'jij,i'fr f,n I . - .Fm, 4 1 0
lrl ma I• a ")Itr a n Ili.: ' .' ':' I; .77 ❑ Emergency system. larger separately derived system.
i :v.:. .,gp - • ir, ;i r4. ❑ Addition of new motet load of ❑ - A", "a", "1 -2", „ 1 - s",
Job no.: Job site address: 7501 Dartmouth St. 100BP or more. occupancy.
❑ Six or more residential oaths. ❑ Recreational vehicle parks.
City/State /ZIP: Tigard, OR 97223 Cl Health-care facilities. ❑ Supply voltage for more tbbtn
ID Hazardous locations. 600 volts nominal.
Suite/bldg. /apt no.: I Project name: Winco store N2.3 ❑ Service or feeder 600 amps or more.
• •'' '!'. ' M ",
Cross street/directions to job site: by Costco
in Tigard. i ` ° `° '. `'
e Qty. Fri nu] •
New residential single- or multi - family dwelling unit.
Includes attached garage.
-
Subdivision: L Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map /parcel no.:
Ea. add'l 500 sq, ft, or portion 33.92 1
l; � � rrI Limited energy, residential
'i� • � . v 's .: ry: i, l'i • } L '•1. ,' s!. , . �!l l.
. .. • ' j'.. ; I .v...• (Wid1 above s9• ft, 75.00 2
ctr.I kr L,•. I ' :
...pf�4�u "'. IN, .'
•lR >: ^'
Limited energy, multi -family 75.00 2
Disconnect and reconnect power to repalce refrigerated case residential (with above sq. (t) _
- Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
1 ' nrlkr hr a
: -rim v 1. , C� ( .a ' ' r Ilfl w x 4,y: ,'i'r ):;:;:; j 201 amps to 400 amps 133.56 2
Name: 401 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 /StateJZIP: Temporary services or feeders Installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1 1
Owner installation: This installation is being made on property that 1 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 168.54 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
'ii ' '1r li i . y}] h'l 3 ytlr
I . .ill �. �a•� :I�.✓alaaiu' .:el!'ti S tlh.7..Ce'J �vl� .r- I'(n: �'
7.42 2
. „ each blanch circuit above service or feeder f
Business name: Wytek Controls, Inc. B. Fee for branch circuits without
service or Roder fee, first 1 56.18 56.18 2
Contact name: branch circuit
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder nut included)
Each manufactured or modular
CirylState/ZIP: 67.84 2
dwelling, service and/or feeder
Phone: ( ) I Fax: : ( ) Reconnect only 67.84 2
P -mall: ^ Pump or irrigation circle 67.84 2
• . Sign or outline lighting 67.84 2
: i.e 4.1,!1 i,SI+i,lu+ . ,... 418 rfiiil .n ri,, 'I a ' •:- ∎7 h
Business name: rp W y tek Controls, Inc.
is ' +.,ri' ;.: :.. : t .t4CtfNi;lr,: ?: alteratioi, or sioti. 1 _ Fage 2 2
Each additional inspection over allowable In any of the above
Address: P.O. Box 2510 / 19255 SW Teton Ave. Additional inspection (1 hr min) 6625/ hr
City/State /ZIP: Tualatin, OR 97062 Investigation (1 hr min) 66.25/ hr
_ .. Industrial plant (1 hr mire) 78,18/ hr
Phone: (503) 691 - 9002 Fax: (503) 691 -0313 Inspections for which no fee is
90.00/ hr
s • _ ' call listed 'h hr min
_ CCB Llc.: 127381 Electrical Lie.: 34 -571C - I ... Suprv. L c.: . • :;i .a° ? t
t 4892S � I .1i��11G � i'� .���, rr��l:rd,': r r I
Suprv. Electrician signature, required: A 5 Subtotal: 56 -18
Plan review (25% of permit fbe):
Print name: Asghar Sarp Date: 1.27.2013 State surcharge (12% of permit fee): 6.74
Authorized Signature: TOTA1, PERMIT FEE: _ 62.92
Thies permit application expires if a permit Is not obtai to l within 180
Print name: We l Chamseddine Date: 1.27.2013 days after It has been accepted as complete.
" Number of inspections allowed per permit.
I: \Buildineermus\ELC.Permbgpp.doc 07/01110 440461510 li0s/COM/wge
/ 4‘'. ?-
City of Tigard • COIIIMUNITY DEVELOPMENT DI;PARTMEN N ED
1. Re quest Permit 2013
q � �11t ACt10 �p,N 29
l i C A l: r) 1 3125 SW Hall Blvd. - Tigard, Oregon 97223 - 503.718.2439 • www.tigar wifIGPSO
TO: CITY OFTTIGARD gU1LD
Building Division Services Supervisor
13125 SW Hall Blvd, Tigard, OR 97223
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard -or.gov
FROM: ❑ Owner ❑ Applicant Contractor ❑ City Staff
(check one)
REFUND OR Name: WYTEK CONTROLS, INC
INVOICE TO: (Business ee Individual)
-
Mailing Address: PO BOX 2510
City /State /Zip: TUALATIN, OR 97062
Phone Nn.: 503 -691 -9002
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
El CANCEL /VOID PERMIT APPLICATION.
® REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
❑ REMOVE /REPLACE CONTRACTOR ON PERMIT (do not cancel permit).
Permit #: ELC2013 -00069
Site Address or Parcel #: 7501 SW DARTMOUTH ST TIGARD, OK
Project Name: WINCO STORE #23
Subdivision Name: Lot #:
EXPLANATION: LIMITED ENERGY PANEL BOX CHECKED IN ERROR
Signature: / � Date: 1 - 29 - 13
Print Name:
' • HAMS 'DIN
Refund Polity
1. The Director or Braiding Official may authorize the refund of:
a) any fee which was erroneously paid or collected,
b) not more than 131% of the land use application fee when an application is withdrawn ox canceled before any review effort has been =pouted.
c) not more than 80% of the land use application fee for issued permits.
d) not more than 80% of the braiding plan review fee when an application is Lanceted before any plan review effort has been impended.
e) not more than 80% of the building permit fee for issued permits prior to any inspection requests.
2- Rcfvmds will be returned to the original Payer in the ewe method in which payment was received Please allow 2-4 weeks for processing refunds,
I (:►h oFI IC1, l;tils oNT,S:
Rte to Sys Adanita: Date By Rte to B1• : Admin: Date EMI
Refund Processed: Date B • Invoice Processed: Date
Permit Canceled: Date By Parcel Tag Added: Date By
Receipt # Date Method , Amount $
I: Building \Forms \RegPermitAcoion.doc Rev 05/25/2012