Permit p CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
1111 I • COMMUNITY DEVELOPMENT Permit #: ELR2013 -00050
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/11/2013
Parcel: 2S 101 CB00500
Jurisdiction: Tigard
Site address: 12670 SW HALL BLVD, BLDG# 3
Project: Canteen Vending Subdivision: 2007 -064 PARTITION PLAT Lot: B
Project Description: (1) low voltage for Data/Telecommunications
Contractor: CALLAHAN ELECTRIC Owner: TCTPI LLC
4830 SE CONG ST 4260 GALEWOOD ST, STE A
PORTLAND, OR 97206 LAKE OSWEGO, OR 97035
PHONE: 503 - 421 -4553 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Restricted Energy Permit 03/11/2013 $75.00
12% State Surcharge - Electrical 03/11/2013 $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 OAR 9 2- 001 -00'0. You ma obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
/ V/1 i4 r � A I
Issued By: A 4 - -l. i ,t' Permittee Signature: Pf _-i ei I ' 0 �V
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.
03/11/2013 10:34 5033530125 MILWAUKIE FEDEX OFFI PAGE 02/06
Electrical Permit Application RECEIVED r(lR ul, ri('I; i sl.: ()NI.\
lit City of Tigard R e y 3 (1 13 Penult No.:1 %L/ vr�13 -cev
• 13125 SW Hall Blvd., Tigard, OR 97223 MAR 1 1 2013 Flan Review f _ �
Phone: 503.718.2439 Fax: 503.598.1960 Date/By osier Permit: /3/ti
1•1 r , .n t n Inspection Line: 503.639.4173 i _ SI See Page 2 for
C pr/ /F IGARD Dntci RBy: lurk Internet www,tigard- or.gov D1 111 *Vt�ijISrQ. Notified/ (1 Supplemental toformatloo
F Y• ;.t`i: i J i ,�,[.yl, A .1�iz7y1 y tihdti.!T'h , ,, �5 L .aF {c {r;- p ,,. -1 :-., j '',`:''mot ^�".'•t �3.,,.2c, � ` .:
`�'t;•` ; :, ..in. -f ii e<+9 '�il`I'.i�J Y 'C "' :Y '`nr,c'..i, .' ..'e' n ,.,. ∎ : f; ; ��: :F ` JdE M' . 6, F 7 I P>f., ;:
.N.. , � .:, •, , t, . `: - J;1 f' A :f, a,.r. ,.4 ,l Y. . ;i },�
0 New construction � A ddition/alteration/replacement Please check all that apply (submit a sets of plans w/items checked below):
❑ Service or feeder 400 amps or more ❑ Building ova three stories.
ID Demolition 0 Other:
where the available fault mein ❑ Marinas and boatyards.
;R-. *, ; ?, - - •ter , i' , ib - %' Y�= ;, ?�,. "' exceeds 10000 at 150 volts or Floating � "� •`- � '.� , £�QR�.`�Otif: •s �• °,�r>�rlloi�' °•,` ' �- f ; sl is ❑ ri8bnildiogs.
„' *'' s less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1 - and 2- family dwelling Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
_
G>.C';" '+Fa:, -4 'Ali ; . r ❑Emer s larger separately derived system.
,v� , a ;'` ' , .. , ' ; ` = ,r,,.., . ,,; QB; : .: ,, ,..l 2( � S, A f_l(I :..:a - ..... d z ❑Addition of new motor load of ❑..A„..g,.,- 1- 2",..1 -3,.
Job no.: r Job site address: / 7 1 e) , u 1 i� L. 61, (✓O s l:HP o m more. occupancy.
❑
❑Six nr more residential write. Recreational vehicle parks.
City/State/ZIP:
..---- t 61,1 fs y( - l Z v ti 3 ❑ Health-care facilities. ❑Supply voltage for more than
1 ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: e gl t M ❑ Service or feeder 600 amps or more.
'm�E:'.1.'`6.;. ;; . ;c, �:�f ���'i „''Llhi�+���. °,i °� -: ?' �:,: <:; _,.
street/directions to job site: y, ::x: r (
�!w/ �'1 �L � [ � ��✓�►l��'1Z � n�+oriaa I ov. I ee� ion, `
Cross street/directions
New residential single- or multi- family dwelling unitt.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft or less 168.54 4
Tax map/parcel Ea. edd'1 500 sq. ft. or portion 33.92 1
- no.: Limited energy, residential 75.00
:;f i `�F
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; �, ;
, - !•yse i
%.., io r gky, O W W� lilf Rk ;• .'4".;:.` ,iw: ;4: V:i.;.w.j (with above . 2
, ,,rt' � 7.-6 :14 - , t. •Or x
:V . ■ ,-„-, , t l ClJiV, V � r� . •TP6`v ,.;� ,.
,' , r ( Y' aQ ft
ft.)
A ,R ,
Limited energy, multi - family 75.00 2
residential (with above sq. ft)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
:,.r;te',. ?. - ''�;; ':;:: - ;:,;, .c;a�_,,�. 201 to400a 133.36 2
} a^Plll -. : ,,, , 7 , ,, d.` ��,.• : W. r ' _`'} ; r, ys�,�` 1, 'i;` "_;; - amps taps
'7.�..,, .%� -< ., . 1 , ; _ . 1 . ,,td - ,. . �, . .��; #� . � ,. ,:;Y� %'. �: -
y 401 amps to 600 amps 200.34 2
Name: 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/ State/ZIP:
Temporary services or feeders installation, alteration, and/or
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
Owner Installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 4 amps to 599 amps 168.54 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee fbr branch circuits with
1-nc `'; . 3 .. ;: - .. i..' . ;; . _ - - [ - _ _; ,: above service or feeder fee 7.42 2
�, i s a W °�I!�4�' �y .; • , - �, � ?�1�1`AG"lt'<5�1�:
. , each branch Circuit
Business name: B. Fee for branch circuits without
service or feeder fee, fast 56.18 2
Contact name: branch circuit
Each add'l branch circuit 7.42 _ 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67.84 2
ry dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail:
Sign outline lighting 67.84 2
�s %i i ,>, : )s: , •: r a, V la ti- .:• •7`,' _ e. .. �. - 'i." „-`x s„� Signal circuits) or limited energy
Business name: / a' (k c 1 •, j -r-e..., panel, alteration, or extension. / Page 2 7 .i 2
1. i Each additional inspection over allowable in any of the above
Address: 4 t, 3 I.i 56 L 0 N it s+. , Additional inspection (1 hr min) 6625/ hr
Ci /Start lZIP: Investigation (1 hr min) 6615/ br
ty ptiy ' "r - � ' _ ` ` Industrial plant (1 hr min) 78.18/ hr
Phone: ($LT)) 1.11, ( t„ ($ 5-) Fax: ( ) Inspections for which no fee is
speciftcallx listed ('h hr mho
CCB Lic.. G 90.00/ hr
l �/ v Electrical Lic.: U Suprv. Lic. 7 Z (f - ;i'.' /C%► ' irar:s.+�,� 5,.rp
J 'p?i •�ll�1+IC, 7l1/LLiD,�i J.- 35'e''.r'- 'k�,�r
Suprv. Electrician signature, required: /j4 (' / btotal:
Plan review (25% of peta fee): 7 S
Print name: 5 h ( ( ( t . h Date: 3 /) 1 iti , State surcharge (12% of permit fee): 9
TOTAL PERMIT FEE: Se Y
Authorized signature: This permit opplleadon expires if a permit 1a not o net within 180
Print name: 51 days after it has been accepted as complete.
.. IU vN � Date: '?' / J f j } /, • Number of inspections allowed per pemuL
L•\Building\Per niMELC- PermitApp.d 07011/10 440.46 15Tp 1(05/COM/WEB
03/11/2013 10:34 5033530125 MILWAUKIE FEDEX OFFI PAGE 03/06
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
El Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other.
Fee for each commercial $75.00
system
(SEE OAR 918 - 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
Data Telecommunication Installation
(❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
El Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems: i
*No licenses are required. Licenses are required
for all other installations
Mulkl inglPermiti\ELGpcnnitApp.d« 07/01 /10
03/11/2013 10:34 5033530125 MILWAUKIE FEDEX OFFI PAGE 01106
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Date )(Li a e Number of pages co (including cover page)
To: From:
Name � L Ur' 1R3 tix Name . S `, ` (14-
Company Company C c, L� t=ic t
Telephone Telephone d 4/1- ( `{S 3
Fax 5 5 1 ( ei 1
Comments
IIII II IIIIIIIlI 1111111111111 IIII I1 11111111111111111111110 I II IIIIIIIIIIIIIHI IIII III
7 90363 00711 1 7 90363 00714 2 7 90363 0072.0 3
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Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12670 SW HALL BLVD BLDG 3, TIGARD, OR,
97223
Commercial - Electricial Limited Energy
135 Low voltage
04/12/2013 00:00
ELR2013-00050
PASS
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12670 SW HALL BLVD BLDG 3, TIGARD, OR,
97223
Commercial - Electricial Limited Energy
199 Electrical final
04/12/2013 00:00
ELR2013-00050
PASS - No C of O
Violation Summary:
Inspector Contractor