Permit � + CITY OF TIGARD
ELECTRICAL RESTRICTED ENERGY PERMIT
,.. I DEVELOPMENT SERVICES PERMIT #: ELR2006 - 00071
n.� lI DATE ISSUED: 4/4/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1 S136CD -02200
SITE ADDRESS: 07850 SW DARTMOUTH ST ZONING: C - G
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: DATA/TELE
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: X NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: : HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
COSTCO WHOLESALE CORPORATION PNWTG CABLING SERVICES
ATTN: EXCISE TAX DEPT 111 3000 MARKET ST #541
999 LAKE DR SALEM, OR 97303
ISSAQUAH, WA 98027
Phone: Contact #: FAX 503- 393 -3800
PRI 503- 393 -3391
Reg #: ELE 29944
FEES LIC 168128
Description Date Amount
Total 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.
•
Issued By : , `_� 4 / 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.
Electrical App#i ni o ! FOR WF ICE ' USE ° ONLY
v u � -- 1
City of Tigard Received e: ' ' D , /
Date/By: Permit No : ./L� ��� ��
13125 SW Hall Blvd., Tigard, OR 97223 p
Phone: 503 639.4171 Fax: 503.598.1960 APR R ® 4 2006 /1ma�fl ifi c;; 1 • A D eB Plan y Review
Other Perm.
Inspection Line. 503.639.4175 ' Date Ready/By I 10 See Page 2 for
Internet: www.tigard-or.gov
CITY `ITY Q F j 1 j `, Notified/Method L Supplemental Information
P.PITIPT9M.WiRTVISIOI\I PLAN REVIEW.
❑ New construction Q Addition/alteration/replacement Please check all that apply:
['Service over 225 amps, comm'I ❑Hazardous location
❑ Demolition ❑Other:
❑Service over 320 amps — rating ❑ Buildng over 10,000 sq ft.,
'CATEGORY OF CONSTRUCTION of l- and 2- family dwellings 4 or more new residential
❑ I -and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi family ❑Master builder ❑Other: ❑Building over three stories ['Feeders, 400 amps or more
DOccupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park
Job no.: Job site address: ❑Health -care facility ❑Other:
7£dS ').W.. D in nu L 1 A vG. Submit 2 sets of plans with any of the above.
City /State /ZIP: ! 7- �r / C� r 9 '721 23 The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: FEE* SCHEDULE '
Co s�t;,c, ' Description I Qty. I Fee. I Total
Cross street/directions to job site: 99 - 2 1 '7 New residential single - or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea add'l 500 sq. It or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66 85 2
City /State /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( )
200 amps or less 66.85 1
Owner installation: This installation is being 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 600 amps 133.75 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
❑ APPLICANT ' . I ❑ CONTACT" PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: „ / branch circuit
!! B. Fee for branch circuits
Contact name: / �/ without service or feeder fee, 46.85 2
Address: (j first branch circuit
/ Each add'I branch circuit 6.65 2
City /State/ZIP: J Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone:( ) Fax::( )
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
� extension Describe: Page 2 2
Business name: PA/ � j 77'-- re , . /) .
Address: `` Each additional inspection over allowable in any of the above
�DdG�^� G ��- Sv„ Per inspection 62.50
City /State /ZIP: SCc kwf ®r 97 303 Investigation per hour (I hr min) 62.50
Phone: (33) 3 '2'3 _33 7/ Fax: (5a3) 3 7 3 _ 3 806 Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lie.: /eg /Zg Electrical Lie.: 299'/ L a Suprv. Lie.: Subtotal
Suprv. Electrician signature, required: ��� Plan review (25% of permit fee)
Print name: "l,,/_e ZLe 4 ,/ Date: y_y - 4 State surcharge (8 %ofpermit fee)
!� / TOTAL PERMIT FEE
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: * Fee methodology set by Tn- County Building Industry Service Board
** Number of mspecnons per permit allowed.
I \Building \Permlts\ELC- PermitApp doc 12/30/05 440-46 I5T(I 0/02/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 -.Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
K ] Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
•
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1 \Buddmg\Permus \ELC- PermaApp doc 12/30/05
.,---- --
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2006-00011
13125 SW Hall Blvd., Tigard, OR 97223 A, , .,t DATE ISSUED: 4/4/2006
Phone: (503) 639-4171 Awykootill?'
Inspection Requests (24 Hrs.): (503) 639-4175 '
INSPECTION WORKSHEET FOR DATE: 5125/2006 TIME: 7:03Alvi PAGE: /5
SITE ADDRESS: 07850 SW DARTMOUTH ST CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: COSTCO
DESCRIPTION: DATA/TELE
OWNER: COSTCO WHOLESALE CORPORATION, PHONE #:
CONTRACTOR: PNWTG CABLING SERVICES PHONE #: 503-393-T391
Inspection Request Scheduled For: Date: 5/25/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low voltage 030543-01 971-21&616
Corrections /Comments/ Instructions:
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PASS I I PARTIAL APPROVAL El CANCEL 0 NO ACCESS
FAIL 7 CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED
Inspector: G" 0 6 Lia" Date: 6- 2-Z6 Phone #: (503) 718-
. " N
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR200Ei-0001
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/4/2006
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 4/21/2006 TIME: 7:02A1V1 PAGE: 1
SITE ADDRESS: 07850 SW DARTMOUTH Sr CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: COSICO
DESCRIPTION: DATA/TELE
OWNER: COSTCO WHOLESALE CORPORATION, PHONE #:
CONTRACTOR: PNIATIG CABLING SERVICES PHONE #: 503
Inspection Request Scheduled For: Date: 4/21/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
136 Low 'voltage 028491-01 503-.409-7509
Corrections/Comments/Instructions:
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cti 0(2._ M I 14.. tY\ c in
I I PASS 01 PARTIAL APPROVAL LII CANCEL Fl NO ACCESS
I I FAIL n CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
Inspector: G--pa Date: 14 14 6 Phone #: (503) 718- .1111111‘.
CITY OF TIGARD
• BUILDING DIVISION PERMIT #: ELR2006. 00071
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 114/2008
Phone: (503) 639 -4171 ir
Inspection Requests (24 Hrs.): (503) 639 - 4175`__..
INSPECTION WORKSHEET FOR DATE: 512/2006 TIME: 7:01AM PAGE: 1
SITE ADDRESS: 071 SW DARTMOUTH ST CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: CO STCO
DESCRIPTION: DA f NTELE
OWNER: COSiCO WHOLESALE CORPORATION, PHONE #:
CONTRACTOR: PNWTG CABLING SERVICES PHONE #: 50:3-393-3.'39 I
Inspection Request Scheduled For: Date: 51212006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
1 :.15 Low voltage 02912(0'1 503-.409-7609 N
Corrections /Comments /Instructions: �.ffos.1
ca�-cA rK►1�w 6N) 5-1 2 3 j o 6 l) $ 6 Lr.F1' ►'h �s5 t e w' R,�`4�. L&tJ y �.
ti
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N 8 k \-a ; Oo\ 0 ' s I MC,
I I PASS I I PARTIAL APPROVAL XCANCEL NO ACCESS
I I FAIL I CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
Inspector: Date: Phone #: (503) 718-