Permit (116) CIT OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
P ° ' ` COMMUNITY DEVELOPMENT PERMIT #: ELR2007 -00433
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 12/3/2007
PARCEL: 2S115BA -00100
SITE ADDRESS: 16200 SW PACIFIC HWY Z - ALBERTSONS ZONING: C -G
SUBDIVISION: TIGARD TOWNE SQUARE LOT: JURISDICTION: TIG
PROJECT: ALBERTSONS
Project Description: 1) Relocate (16) cameras & (6) monitors.
2) Install (3) door control units (not card lock), (6) contacts & (1) smoke detector.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: : HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER: SEE DESC X
TOTAL # OF SYSTEMS: 2
Owner: Contractor:
IBJ SCHRODER BANK & TRUST CO FOCUSMICRO
BY ALBERTSONS INC #565 4640 CAMPUS PL., STE. 100
ATTN: CORPORATE ACCTG DEPT MUKILTEO, WA 98275
BOISE, ID 83726
Phone: 208 - 395 -4711 Contact #: PRI 425- 293 -0436
FAX 425- 349 -5214
FEES Reg #: ELE CLE109
LIC 176457
Description Date Amount
[ELPRMT] ELR Permit 11/20/2007 $75.00
[ELPRMT] ELR Permit 12/3/2007 $75.00 REQUIRED ITEMS AND REPORTS
[TAX] 8% State Surcha 11/20/2007 $6.00
[TAX] 8% State Surcha 12/3/2007 $6.00
Total $162.00
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: L.� ( : ..( Permittee Signature: e")^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'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.
NOV -20 -2007 08:55 FocusMicro Inc. 425 293 0393 P.02
R . ` Electrical Permit A hhca CELVED FOR OFFICE USE ONLY '
City of Tigard V D ad /� 0 o 7 • A pMn++ IA . — 0053'
' 13125 SW Hall Blvd.. Tigard. OR 9704 V 2 0 / I(• Plan Resic+s
Phone: 503.639.4171 fax: 503.598.1960 Date'8 .: Other Permit.
TIGARD Inspection Line 503.639 CITY Of- I ItiAtiD Oaie keady/D p3 See Page 2 for
Internet: www.tioard•or.ptty BUllOINGD1VtSION Nutifiedlbtetlnd. Supplemental Information
' - ' TYPE OF WORN: PLAN REVIEW
Please cheek all Arai apply (submit 3 sets of plans w'items checked below):
1:1 New construction
• ❑ Service or feeder 400 amps or more ❑ Budding over three stories,
❑ Demolition Other: where the available fault cumin ❑ Marinas and boatyards.
•
.CATEGORY. OF CONSTRUCTION esceedsl0,000 amps et150vousor ❑ Floating buildings.
less to ground, or CNceeds 14,000 ❑ Commereial•ase agricultural
❑ I- and 2- family dwelling ❑ Commercial/industrial ❑ Accessoy building amps for all other installations, buildings.
❑ Multi- family ❑ Master builder ❑ Other: El Erg pump. 0Inoaltatiottof 75 t:VA or
JOB SITE INFORMATION AND LOCATION • ❑ Emergency system. larger separately derived system.
.�. ❑ Addition or new mnttx toed of
Job no Jub site address: + r , IOOHP or more. occupancy.
�!G`d�GY).SLC� PLtI I
1,. If/,jkYl ❑Sir u<moreresirkiuial,mils. ❑ Recrwlionat vehicle parl,s.
Girl' /Stoic /ZIP: Q d + � Q Q' ❑ Ha o ue facilities.
0 Srmph voltage for more than
"..,r— 1 b e 7 ❑ Itsardus locations. 600 volts nominal. '
Suite/bldg. /apt. no.: ,— Project name: Al ben 54,5" ❑ Service w feeder 600 amps or more.
FEE SCHEDULE '
Cross street/directions to job site: Description I 9 _ Fre. I rant I •
New residential single- or mulll•fanlily dwelling unit.
• Includes attached garage.
Subdivision: Lot no.: 1,000 sq. R. or less 145.15 4
• Ea. add'I 300 sq. ft. or portion 33.40 1
Tai map /parcel no.: . Limited energy, residential
' DESCRIPTION OF WORK (pT' �/ fp� S )IS ) (s+'i th above . fi.)
�r3G 1. 75A0
i A - I t� Limited energy. multi - family `
� t tc^ � f) �, (11G7'S J 1, ( ___,.........",,:,,,y) /7 c' /�-vf� 5 residential (with abo%_e SQ. R.) 7:.00 2
a Services or feeders installation, alteration. and/or relocation
o G e.Dr ) �+ . ,r.ie,lee` , - a 200 amps or less 80.30 2
❑ PROPERTY OWNER ' 0 TENANT- 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
kddress: Ovet 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 Ids 66.85 1
Owner installation: This installation is heing made on property that 1 own which is not 201 amps to 400 amps 100,30 2
intended for sale, lease, rent, or exchange. according to ORS 447. 449. 670, and 701. 401 amps to 599 amps 133.75 _
Branch circuits— new. alteration. nr extension. per - panel
Owner signature: Date: A. Fee for branch circuits wish
.. • . ja APPLICANT .. • ❑ CONTACT PERSON • above service or feeder fee,
645 2
y � each branch circuit
Business name: ji.ii. , ,. f kern B. Fee for branch circuits
Contact name: \ja.ct (Gl` #40_4,_.÷ m ,- I,,,i without service or feeder fee,
er first branch circuit 46.85 2
Address: 4.4,40 ds7'7 u5 pietee �ie -�1e.+ A Each add'I branch circuit 6.65 2
M P j 'Miscellaneous (service or feeder not in
City /State/ZIP: r' 1 1� , ' i e . )/1 r , Each manufactured or modular
-I �,., r — dwelling. service and/or feeder Phone: _
90.90 2
Phone: ('r �r93 G - I Fax: : (4,1S1 3 i ' / Reconnect only
66.85 2
Email: .i.S:pn t O P EGt'ur... ('rifC:!'o. 02i/y) i Pump or irrigation circle _ 53.40 _ 2
• CONTRACTOR . . Sign or outline lighting 53.40 2
t Signal circuits) or limited -
Business name:
rOe (LS M1C,(sO energy panel. alteration, or
Address: bore- extension. Describe: / Page 2 75, oG 2
Ci ty /State /ZIP: / r 0 � ► — Each additional inspection roar slims able in any of the alone_
Per inspection 62.50
Phone: ( fax: ( ) h • hives per hour t l la min) 62.50
CCB Lie.: /71 'is./ ! Electrical Lie.: CLE Suprv. Lie.: Industrial plant per hour 73.75 ,
p ELECTRICAL PF.RDIt FEES
• - Cllptw. Electrician signature, required: 6//o / . Subtotal: 7$, • . r
Print name: Date: Plan review (25 °t, of permit fee): - — t
q,, State surcharge (8% of permit feel; ( p • I�•�
• Authorized gignttturtc i y pt TOTAL PERMIT FEE: 3. / �
Print name: ,i_ IJ• 7L Sell _ D ate' • �/
This permit application espied if a penult la not ohtnirtkd within 1 rs
\ l/4e 1 .� 1 n r 5 1 days after li has been accepted as complete.. 1 bV
I: \aU:le:n 1Per mgslflLC• c 1 • Number of inspeetions allowed per permit. Y permil,AM.dae 0.1!./06 440.401 ST411/09'COM:'WED
TOTAL P.02
CITY OF TIGARD
BUILDING DIVISION - PERMIT #: ELR2007.00433
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 17/312007
Phone: (503) 639-4171
Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 3/20/2008 TIME: 7:02AM PAGE: 54
SITE ADDRESS: 16200 SW PACIFIC HWY Z - ALBERTSONS CLASS OF WORK:
SUBDIVISION: TIGARD TOWNE SQUARE LOT #: TYPE OF USE:
PROJECT NAME: ALI3ERTSONS
DESCRIPTION: 1) Relocate (16) cameras & (6) monitors.
2) Install (3) door control units (not card lock), (6) contacts & (1) smoke detector.
OWNER: IF3J SCHRODER BANK & TRUST CO, PHONE #: 208 - 395-4711
CONTRACTOR: FOCUSMICRO PHONE #: 425 293 - 0436
Inspection Request Scheduled For: Date: 3/20/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
'199 Nlectiical final 066978-0/ 425-269-5684 N
Corrections /Comments/ Instructions:
S mot, - {r
v ►Li;) a o(L
N\N\
7 PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Vd
Inspector: Date: 32O ' Phone #: (503) 718- �4L