Permit
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit#: ELR2010-00019
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 01/28/2010
Parcel: 1 S136CD02200
Jurisdiction: Tigard
Site address: 7850 SW DARTMOUTH ST
Subdivision: Lot: 0
Project: Costco
Project Description: Install restricted energy for voice/data.
Owner: FEES
COSTCO WHOLESALE CORPORATION Description Date Amount
PROPERTY TAX DEPT 111, 999 LAKE DR Restricted Energy Permit 01/28/2010 $67.84
ISSAQUAH, WA 98027 12% State Surcharge - Electrical 01/28/2010 $8.14
PHONE:
Contractor:
EIR ELECTRIC INC
PO BOX 2408
BATTLE GROUND, WA 98604
PHONE: 503-407-8771
FAX: 360-484-3621
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: Y Fire Alarm: N
HVAC: N Instrumentation: N Total $75.98
Intercom/Paging: N Landscape/Irrigation: N Required Items and Reports (Conditions)
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N
Other Desc:
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 thr gh AR 952-001-0100. You may obtain a copy of the rules or direct questions to OUNC by calling 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' 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.
S6V BY: EIR ELECTRIC INC; 3604843621; JAN-28-10 3:26PM; • PAGE 1/2
. .•
Electrical Permit A .Iplication RECEIVE 1
Iter ived 1:()I orricr. LE. ()'4L\ ()'4L\ y
•
City of Tigar I x
7 .. • 13125 SW Ilall Blvd. Tigard, ()R 97273
11
Phone: 503.639.4171 F: 503.598.1960 varergv. ,
Man Review
JAN 2 8 2010 onic(By.. 1 Permit No.: n 1 9
(TihrS PeTIllit: •
, •
r I ,..; A os I, Impaction Lac: 503.539.4175 Date kualyIty: liV;16:1 El See rage 2 for
Internet: www.ligard or.gev CITY OF TIGA Notituu.liMethull Supnkmenlal Information
,.'-1:::,...'::,..s.;:i.; '...'..0**
0 14'w construction C.1.'t Addition/alteration/replacement Please Merl an 61 A: Ann' (siihmir a &is et plans WiteilLs ultoek•i klow).
0 Sell/lee or feeder 41AI amps or more 0 !bolding over the !thine
El 1)emolition IN other:
where the available Bolt cumin! 0 Ivlarinaa and boatyards.
;."....,..:•'...'„.:..:::';',:,..:'...,,, ....Ncecdt 10.000 amps at 15(1whs or 0 FIlmUub buildings.
leget or exceeds L4. 0 (..7unitlito 4:141 use. asiivultw al
0 1- and 2-family dwelling, 0: Comrnercial/industial 0 Accessory building ...rips fur all tuba inalolInnims 'wilding%
0 Multi-family It Master builder 0 Other: 0 IT pump 0 rmultsmm of 75 V. VA or
Infga separately tie6ved avuem
:•,;;; :`.. , .....: . ,... ?OMA �j � ..? - ,IP,r7 1 ',: , :;.• -• ;; -. L,:-.■•;;; ! 2:.,',..%`,. - ::r.-..' ' CI Addition of new motor load of
Job no.: 9816-128 i Job sit address:.2 SW DARTMOUTH looiir Oil note. in.tupatley.
0 Si• m more reehlentinl IrIlitl. El Ituucahmal vehicle imlio.
•
City/State/ZIP: Tigard OR 9722 7650 0 ileAlth.c.ue Clcilitie, 0 Supply voltage for mare; than
- .. • 0 kita.oduu* locatiurn. WO Voile nominal.
Suite/bldg./apt. no.: I Projed !IMMO' Contra Hearing Aid Booth 0 sers,ce nr leeder 600 arms or more.
• •
7 : 7 77..0 0 4;* 14 k-0%./ 1 + 1 7"..1:'.•: . ',.. : ,•:; . :' , '.i , ":'::: ...",'::'`.;:..;.:',....-.'.•
Cross stred/directions to job site: InterseCtion SW Pacific Hwy and Da rtmont - D7M:i l igir"'`' . - '' 'ow r : Ft*. 1 14 1 .
Nro rrsidentild siu0c- or multi-flunily dleclfing unit.
Includes attached garage.
Subdivision:
FotTnT.: i .000 sq. it or less 168.54 4
Ea. addi 500 sq. 1 or portion . 33.92 1
Tax map/parcel no.: -..
Limited energy. rcaidadiul
67.84 2
:::.....W,•:.;•;',;•:::::-.;;;:::;:....../,•f...'..'4,,,.;:,::,.....:,';;;/;',.:4$: 2 ? ( IR•kr.'0:'i'?kri0k 14 • ; ! . ."•: . :." , : . ....,..:,`•?',':'..:.1::•...:•.:'..,-'..::::::: (with above sq. II)
- ,
Low voltage cabling to support nodifkutions to existing bearing aid booth in lArnited energynmIti 67.84 2 residentiull (with above sq. ft.)
store Services or feeders Installation, alteratIon and/ot reloc-arlou . .
200 amps or lege 140.70 2
f.:.iiiiiiiititey..:.:6*,.. ...‘ (::-.::,....:,., :::.; 1.:,:; 201 amps to 400 amps 13.56 2
Name: 401 amps 14) 600 amps 200.34 __
601 amps to 1,000 amps 301.04 2
Address:
Ovcr 1,(100 ampa ur vults 552.26 2
Ci ty/Statet7.11': Temporary en-tees or feeders installation, alteration, and/or
... . relocation
l'hone: ( ) Fax: ( j 200 amps or less 59.36 I
Owner installation: This ittstalla ion is being made on projx:rty that I own which is not .2__ 'FP I ' " anWs 125 A)8 2
intended for sale, lease, rein, or e. change. according to ORS 4 449, 670. and 701. 401 amps to 599 amps 16R.54 2
Branch circuits- firm. akeration, or evension, uer panel
0s)/11t.'r Signature: Dale: • • - A. le•i: for branch circuits with
74iiitii? 77.:.:.....:..,;....1.,,..;.:.;,,,::..,:c101534060„,,titti.160...,..".?",:;.:,...z.... alinve wrYiee. ir fertIrr fee.
each branch circuit
Business name:
B. Fee fur branch cirtaids
... .. . . - • •-•-•--
without service or feeder fee.
(7oritact name: 56.18 2
first branch circuit
Address: Raab aild'I branch circuit : 7.42 2
Miscellaneous (service or feeder not included) ..
City/State/ZIP: Each manufactured or modular
67,84 2
dwelling, Nerviee wed/or reador
Phone: ( ) Fax: : ( ) ReC.311nxt only 67.84 2
. . . .. . . . _..._.._ .
1,..-inuil: Pump or irritotion uirolu 67.84 2
::: 01111Citicr(t :::.•:..;.-.''''.',. Sign or outline lighting 67.84 2
---
( -
LItoiness mime: E T R Electric, I c. Signal circuits) or limited
energy panel, alteration. or 67.84
Address: PO Box 2408 ex-tension. Describe: 4 Page 2 2
extend existing ckls
City/Statell.IT': Battle Ground A 98604-2408 Each additional Inspection over allowable :in nay of the abuse
Per inspection 66.25
Plioun. (503) 4078771 rittx: (3611) 4843621
66.23
Investigation per how (1 hr min)
CCI3 Lie.: 99485 11 •trical I .ic.: 37-635C Iluprv. Lie.: 4119S Industrial plant per hour 78.18
_____._.... .
• ••• • • :. ; • ': . : •; .. " ':: : : ! .':! . .: .. . 1.-:". .. 1 tlikteli ' lLik.tkill* I l';: : : ;;;
Suprv, Electrician signature, 'NW .edi-01;/ ) I/ Ruhtotal: 67,81
cc):
Print name: Denise Woodhouse Date: 1/28/2010 Han review (25% of permit f
State surcharge (12% of pamit foe), 8.14
Authorized signatun: s j
! ' 4 1. C )11. ToTAI. PERMIT FEE: 75.98
_....
applkotJan erpires If a pont* h, not obtained
Print mime: Denise Woodhouse Date: 1/28/2010 This permh Lentil., leo
cloy% after h has heal oneeptill an connActc
• Numbur uf mem:hone allowed per perrno
lAihuidingwerrnessil C-f..aniltAup.duc ant/UV 440 4IS 15TO I /Um :i nri!Vith
2 Elee{vic