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Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT '`1 £ ' COMMUNITY DEVELOPMENT Permit#: ELR2015-00251 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/22/2015 Parcel: 1S136CD02200 Jurisdiction: Tigard Site address: 7850 SW DARTMOUTH ST Project: Costco Subdivision: PALMER ACRES Lot: 3 Project Description: CCTV system. Contractor: SUPERIOR LOW VOLTAGE LLC Owner: COSTCO WHOLESALE CORPORATION 6548 LIPSCOMB ST SE PROPERTY TAX DEPT 111 SALEM, OR 97317 999 LAKE DR ISSAQUAH,WA 98027 PHONE: 877-336-6213 PHONE: FAX: FEES Description Date Amount Specifics: Restricted Energy Permit 10/22/2015 $75.00 12%State Surcharge-Electrical 10/22/2015 $9.00 Type of Use: COM Class of Work: ALT Total Number of Systems: 1 Audio&Stereo: 0 Boiler Controls: 0 CCTV: 1 Clock Systems: 0 Data&Telecommunications: 0 Fire Alarm: 0 HVAC: 0 Instrumentation: 0 Intercom/Paging: 0 Landscape/Irrigation: 0 Landscape Lighting: 0 Medical: 0 Nurse Calls: 0 Protective Signal: 0 Security Alarm: 0 Other: 0 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. ATTENTI•.• • -.on law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-00 •through OAR • -001-00 You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Iss ed 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 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 ('`- FOR OFFICE USE ONLY Received City of Tigard G %\CI Date/B : /1 ® v 13125 SW Hall Blvd.,Tigard,OR�97 23 91� 1. Plan Review Phone: 503.718.2439 Fax: 503.598.19 ('� nraQ Date/B : Related Permit#: Inspection Line: 503.639.4175 vv` 1,Gf`.` ON Ready Date/By: ® See Page 2 for TIGARD Internet: www.tigard-or.gov ` Ow GDS iVQ1 Notified/Method: /!` Supplemental Information TYPE OF WQQ,�" PLAN REVIEW I*New construction ❑ Addition/altek Lion/replacement Please check all that apply(submit 2 sets of plans w/items checked): ❑Service or feeder 400 amps or more ['Building over three stories. ❑ Demolition ❑Other: where the available fault current ❑Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings. ❑ I-and 2-family dwelling 'El Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural amps for all other installations. buildings. ❑ Multi-family ❑ Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived �ei so �� Do M I ❑Addition of new motor load of system. Job#: Job site address: xv '/1P1tWv/�}1r„' 100HP or more. ❑"A","E","1-2","t-3", City/State/ZIP./State/ZIP: T` (� ('� 12 ❑Six or more residential units. occupancy. y \‘54,f01 I ©(Z q�-�d` J ❑Health-care facilities. ❑Recreational vehicle parks. Suite/bldg./apt.#: Project name: El Hazardous locations. 1:1 Supply voltage for more than Cos�L ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: FEE SCHEDULE Description I Qty. I Each I Total New residential single-or multi-family dwelling unit. Subdivision: Lot#: Includes attached garage. 1,000 sq.ft or less 168.54 4 Tax map/parcel#: Ea.add'I 500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential (with above sq.ft.) 75.00 2 Limited energy,multi-family 75.00 2 residential(with above sq.ft.) _ Renewable Energy ❑ See Page 2 ❑ PROPERTY OWNER ❑ TENANT Services or feeders installation,alteration,and/or relocation Name: 200 amps or less 100.70 2 Address: 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 City/State/ZIP: 601 amps to 1,000 amps 301.04 2 Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation,alteration,and/or Email: relocation Owner installation: This installation is being made on property that I own which is not 200 amps or less 59.36 1 intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2 Owner signature: Date: 401 amps to 599 amps 168.54 2 ❑ APPLICANT 0 CONTACT PERSON Branch circuits—new,alteration,or extension,per panel A.Fee for branch circuits with Business name: S "f pet r 'o V,/ I/o t t I L LC above service or feeder fee, 7.42 2 each branch circuit Contact name: m (ps atiC.c B.Fee for branch circuits without Address: d 1 _ service or feeder fee,first ‘4 Ili LVPY 00J1 'S�— E E branch circuit 56.18 2 City/State/ZIP: 5cAACteA i vg q"3-31-4- Each add'I branch circuit 7.42 2 Miscellaneous(service or feeder not included) Phone:(SO) ) $06 - 31 Fax: :( ) Each manufactured or modular dwelling,service and/or feeder 67.84 2 Email: S "(OOf low Vo 1kyt CY4.1noo•con^ "�T Reconnect only 67.84 2 CONTRACTOR /� Pump or irrigation circle 67.84 2 Business name: 51 V NIAr Loy, V 14t&9e, L. L` Sign or outline lighting 67.84 2 '-`1-,-"11 Signal circuit(s)or limited-energy a c ,p5 C Address: 61511 orn b Si- 5 panel,alteration,or extension. ee Page 2 7 2 ��1©i q�3/ Each additional inspection over allowable in any of the above City/State/ZIP: 5 J Additional inspection(I hr min) 66.25/hr Phone:(y)3) 4i,06- 0,3 3 ) Fax:( ) Investigation(1 hr min) 90.00/hr Email: SbtQoy697 h Vp 9 Aloe.LO in Industrial plant(I hr min) 78.18/hr Inspections for which no fee is t 90.00/hr CCB Lic.: 60`}4 Electrical Lic.A—Nab_C(IE Suprv. Lie.: 30)._LL specifically listed('A hr min) ,�y I ELECIRICAL PERMIT FEES Suprv. Electrician sign ttttte!l�quired: f t7 ,."" w'�!t Subtotal: 7s, Print name: rkpirCO5 f po&{ACv1 Date: I0,1al J5- ❑Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): q, r'6' i` TOTAL PERMIT FEE: uJ Authorized signature: L_ �y"� This permit application expires if a permit is not ob ained within 180 Print name: AqvirGO A za Date:/0/a ?/f(, days after it has been accepted as complete. r * Number of inspections allowed per permit. I.\Building\Permits\ELC_PermitApp_ELR_ERE.doe Rev 06/17/2015 440-4615T(I1/05/COM/WEB Ele.trical Permit Application—City of Tigard Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: RESIDENTIAL WORK ONLY: FEE SCHEDULE Description I Qty. I Each I Total Fee for all residential systems combined: $75.00 Renewable electrical energy systems: Check Type of Work Involved: 5 kva or less 100.70 2 5.01 to 15 kva 133.56 2 n Audio and Stereo Systems* 15.01 to 25 kva 200.34 2 Wind generation systems in excess of 25 kva: H Burglar Alarm 25.01 to 50 kva 301.04 2 50.01 to 100 kva 552.26 2 ❑ Garage Door Opener* >100 kva(fee in accordance 552.26 2 with OAR 918-309-0040) n Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva: System* Each additional kva over 25 7.42 3 ❑ Vacuum Systems* >100 kva—no additional charge 0.0 3 Each additional inspection over allowable in any of the above: n Other: Each additional inspection is 66.25/hr 1 charged at an hourly(1 hr min) Inspections for which no fee is 90.00/hr specifically listed(%2 hr min) COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES Fee for each commercial system: $75.00 Subtotal(Enter on Page I): ' (SEE OAR 918-309-0000) Number of inspections allowed per permit. Check Type of Work Involved: H Audio and Stereo Systems ❑ Boiler Controls n Clock Systems n Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation n Intercom and Paging Systems n Landscape Irrigation Control* n M• edical n N• urse Calls ❑ Outdoor Landscape Lighting* n Protective Signaling Other: C(XV Total number of commercial systems: 1 *No licenses are required. Licenses are required for all other installations 1:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 7850 SW DARTMOUTH ST, TIGARD, OR, 97223 Commercial - Electrical Limited Energy 198 Low voltage ﬁnal PASS - No C of O ELR2015-00251 Jeff Grove Violation Summary: Inspector Contractor