Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2012 -00148
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/17/2012
Parcel: 1S 136CD00100
Jurisdiction: Tigard
Site address: 11705 SW PACIFIC HWY Z
Project: Petco Subdivision: 2006 -016 PARTITION PLAT Lot: 3
Project Description: Installing Data and VOIP wires (CATS) for TI
Contractor: CALLAHAN ELECTRIC Owner: PACIFIC CROSSROADS PROPERTIES IN
4830 SE CONG ST BY WYSE INVESTMENT SERVICES CO
PORTLAND, OR 97206 1501 SW TAYLOR ST STE 100
PORTLAND, OR 97205
PHONE: 503 - 421 -4553 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Restricted Energy Permit 07/17/2012 $75.00
12% State Surcharge - Electrical • 07/17/2012 $9.00
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
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N Total $84.00
Other Desc: 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- 00 - 0 You may o tain aa copy
" of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.33 l `'
Issued By: N1.CY may
PermitteeSignature: AL # /PLI Tl
D
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.
2012 -07 -16 23:52 SERVICECOU t ®, 4979018 » 5035981960 P 1/3
Electrical Permit Aaplicati '
■ i t A ' ` '�. rtn; nil i Id I: t cl /)\1 1
City of Tigard Renewed 1 (1 la- Sr Permit No 00/ oa(,
_ • 13125 SW tan Blvd., Ti JUL 17 2012 P Review
Phone: 503.718.2439 118: 503,598
Imi it pg („her lrennil
• r i i s A l:. D pe 'on Line: 503.63 . F BUILDING QtU TIGARD Date Ready/By: hos. el See rage 2. For
Internet www.tigard.ot.gov BUILD i'rt ° rSo�l Notttled/Merhotl: i CO Supplemental Information
�tEl 1 !
TYPE OF WORK PLAN REVIE --
❑ New construction KAddition /alteration /replacement Please else& all that apply (s-bTriil l seta of plans whicma chmJurl below):
I] Service or feeder 400 amps or more ❑ Building over dime stories.
0 Demolition ❑ (d
where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUC17ON exceeds 10,000 amps at 150 volts or ❑ Floating build egc.
lee to ground, or ecceads 14.000 ❑ Commercial -use agricultural
❑ 1 and 2 family dwelling Commercial /industrial ❑ Actmssory building
❑ Multi at�sfor all odmrxirmtallerirms. buildings.
Y ❑ Master builder 0 Other O 1Vie pump. ❑ hmallatiun of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency sysremn, larger separately derived system.
❑ Addition of new motor load of ❑ "A ", " 8 "1 -2• "1 -3"
Job no.: , Job site address: t (1 WS Sin) P,u441 1o0liP or more. eoagnucy.
L l v" ❑ Six or more residential units. ❑ Recreational vMkk parka
City/State/ZIP: - G„,- 0K, O11 1,..7,' ✓ °HeaW►cme Cu ililies. ❑ G voltage for more than
C Itmmaoua locations. 600 volts nominal.
Suite/bldgJapt. no.: Project name: 15.a 0 d Sevier or feeder 600 amps re mute.
FEE SCHEDULE
Cross street/directions to job site: L i Qtr. I Fee. I i I I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. R or less 168.54 4
Tax map/parcel no.:
Fa. add'I 500 sq. it. or portion 33.92 l
Limited orgy, residential
DESCRIPTION OF WORK ( above sq, It.) 15.00 2
*�, Limited energy, multi - family
_ j 1 . a. r P II ( t'{A - residential (with above sq. ft.) 75.00 2
II,,,, Services or feeders installation, alteration, audio r relocation
I Y�1/I, r r\e. Al. y4) 200 amps or less 100.70 2
❑ PROPERTY ) WNEIL I ❑ TENANT • 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200 3 2
^ --�-- 601 amps to 1,000 amps 301.04 2
Address: V Over 1.000 amps or volts 55226 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 I
Owner installation: This installation is being made on property that 1 own which is not
201 tamps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. - 401 craps to 599 amps 168.54 2
Branch circuits- new, alteration, or extension, per.paaet
Owner signature: Date: A. Fec for branch circuits with
^
APPLICAMI' ❑CONTACT PERSON above service or feeder fix 7.42 2
W ..�� each breach cinvit
Business na111e: A. Fc0 fur branch circuits wehnr4
� �/..i C ( l�� � � t c or ircuit fee first
1"- [ et (, 56.18 2
Contact name: 5
_
( Each add'I branch circuit 7.42 j 2
Address:
U 5r co N 6 51-, Miscellaneous (service or feeder not indnded)
• City /State/ZIP: pdV 116,, --Cif 0 C.1 i i. u 4 Eachmg,serviceancrer
modular h7Rd z
dwelling service anNor fade
Phone: (SZ3) Lt Z, ( q5 - 5 - ) Fax:: ( ) Reconnect only , x7,84 2
(� /� / I Pump nr irrigation circle c7 .R4 2
E-mail:
5i'I/V`t (Zra(ta4 ,lit',1L. aC0I'vt or outline lighting 67.84 2
CONTRACTOR Signal circuigs) or limited-energy ]
w Businessname; 04 i( & v vu z `� L. pmmmcl,ahcrarion,orextanainn. _ ParGe2 l 2
_ Each additional inspection over allowable In any of the above
Address: .y z 3 0 .5 LO A/6 - Additional inspection (I hr min) 66.25/ hr
City/Stat /ZIP: l o v f4.cri' Q /i C ? 1 - 0 industrial pi
O b nvtse (I hr min) 6ti.ma (t hr mud) 7g.1 g18 /ht
/ ht
Phone: (5e, ( Vf
T 7 5'3 3 Fax: ( 1 ,�1, 4i (O 1ltspowan is
for which no fcc voao/ hr
specifically listed ('r4 h .
r min) _
CCB Lic.: / f) r t () I Electrical Lk.: V O 7 Suprv. Lic.: 72, (5 ELECTRICAL PERMIT FEES
ulrtotal:
Suprv.41; signature, required:
--- �� . - -^ plan re view (25 %afpemdit fe .—
Print name: 51.60-{ Date: - 7 . r 7, Slmc surv:harp a (12% of permit fee): 1 , 1
02 4 / TOTAL PERM ff Mkt!, `
Authorized signature: . � `
at ILo permit appGcatioo expires if a permit is not obtained vrithia 190
,,� days after it has been accepted as comphh
Print 5' L q ` CA (1 'J I Date: 1 (' 7 ()t , • Millibar of inspections allowed per permit
L uwlldingwenoitat,C- PermitApp.doc ovine 446.4615TO1/051CfM/WEB
2012-07 -16 23:52 SERVICECOUN8D 7634979018 » 5035981960 P 2/3
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 Ale
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other.
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SRE OAR 918 - 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑, Boiler Controls
❑ Cluck Systems
Data Telecommunication Installation
❑ Fire Alarm Installation
❑ IIVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems: I
*No licenses are required. Licenses ate required
for all other installations
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