Permit (8) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
' a. COMMUNITY DEVELOPMENT Permit#: ELR2023-00127
T I G A R.D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/9/2023
Parcel: 2S101 BA00500
Jurisdiction: Tigard
Site address: 7600 SW DARTMOUTH ST
Project: Walmart Subdivision: HERMOSO PARK
Lot: 8
Project Description: Fire alarm and CCTV systems.
Contractor: POWERSOURCE TELECOM INC Owner: WAL-MART REAL ESTATE BUSINESS TRUST
525 2ND AVE SW#866 ATTN PROPERTY TAX DEPT
ALBANY, OR 97321 PO BOX 8050 MS 0555
BENTONVILLE,AR 72716
PHONE: 541-981-2556 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Restricted Energy Permit 11/09/2023 $150.00
Type of Use: COM 12%State Surcharge-Electrical 11/09/2023 $18.00
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: 1
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 $168.00
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 952-001-0090. You ma o • a copy les or direct questions to OUNC by calling 503.232.1987 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'N 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 Applica +
City of Tigard �;1`� Permit#:
ill
13125 SW Hall Blvd.,Tigard,OR 97�2 1 1 ; Date/By::IIIII!11/1lMqMilMIIIIIIIIIIReceived
_ L(_'_A__ .}��-7
Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Related Permit#:
1 I c,A ,t) Inspection Line: 503.639 4175 CITY OF TIGARD Ready Date/By: Juris: El See Page 2 for
- Internet: www.tigard-or.gov y Notified/Method: t Supplemental Information
3i)JLDING DIVISrN tl���� -/�-
TYPE OF WORK ' l'VL74itoli41 LAN REVIEW
0 New construction ®Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more ❑Building over three stories.
El Demolition 0 Other:
t where the available fault current El Marinas and boatyards.
w CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑ 1-and 2-family dwelling 1:4 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 gl Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder ❑Other: ❑Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency syste larger separately derived
Job#: Job site address: ❑Addition of new mm.otor load of system.
7600 SW Dartmouth St IOOHP or more. ❑°°A° "E","1-2",°`1-3'
City/State/ZIP: Tigard, OR 97223 ElSix or more residential units. occupancy.
❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: Walmart Limited Remodel 0 Hazardous locations. 0 Supply voltage for snore than
0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SGIIEDULE "
Description I Qty. I Each I Total I *
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
Tax map/parcel#: 1,000 sq.ft.or less 168.54 4
Ea.add'I 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
Limited Remodel of CCTV system and Fire alarm (with above sq.fr.) 75.00 2
Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
K`PROPERTY OWNER 0 TENANT; Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
Name: Walmart 200 amps or less 100.70 2
Address: 2001 SE 10th Street, mail stop 5520 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: Bentonville, AR 72716-5520 601 amps to 1,000 amps 301.04 2
Phone:(479 )277-2270 Fax:( ) Over 1,000 amps or volts 552.26 2
Email: Temporary services or feeders installation,alteration,and/or
daniel.vanhecke@walmart.com 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
14 APPLICANT 0 CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: PowerSource Telecom Inc. above service or feeder fee,
each branch circuit 7.42 2
Contact name: James Butrlakorn B.Fee for branch circuits without
Address: 525 2nd St. SW#866 service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP: Albany, OR 97321 Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(907) 631-3433 Fax: :( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: Jbutrlakorn@pstiak.com
Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: PowerSource Telecom Inc. Sign or outline lighting 67.84 2
Address: 525 2nd St. SW#866 Signal circuit(s)or limited-energy ru See Pa 2
panel,alteration,or extension. age 2 2
Each additional inspection over allowable in any of the above
City/State/Z1P: Albany, OR 97321
Additional inspection(1 hr min) 66.25/hr
Phone:( 907)631-3433 Fax:( ) Investigation(1 hr min) 90.00/hr
Email: Jbutrlakorn Industrial plant(1 hr min) 78.18/hr
@pstiak.com Inspections for which no fee is
CCB Lic.: 234467 Electrical Lic.: CLE609 Suprv.Lic.: 5839 LEA specifically listed(/2 hr min) 90.00/hr
Suprv.Electrician signature,required: ELECITRICAL PERMIT FEES
Subtotal: 150.00
Print name: James Butrlakorn Date: 6-6-23 0 Plan Review Required(25%of permit fee): 37.50
n State surcharge(12%of permit fee): 18.00
Authorized signature: 4 (/ TOTAL PERMIT FEE: $205.50
This permit application expires if a permit is not obtained within 180
Print name: Terry Choe Date: 6-6-23 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermiiAppELR ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL A� i ;7l17��I V FEE SCHEDULE
RESIDENTIAL WORK ON 3 ' Description I QtY. I Each I Total
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
5 kva or less 100.70 2
Check Type of Work Involved:
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ 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)
❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over 25 7.42 3
El Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ Other: Each additional inspection is 66.25/hr
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(' hr min)
ELECTRICAL PERMIT FEES
COMMERCIAL WORK ONLY: Subtotal(Enter on Page 1):
Fee for each commercial system: $75.00 * Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
X❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ M• edical
❑ Nurse Calls
❑ O• utdoor Landscape Lighting*
❑ Protective Signaling
❑X Other: CCTV
Total number of commercial systems:
2
*No licenses are required. Licenses are required for all
other installations
1:\Building\Permits\ELC_PermitAPP_ELR ERE.doc Rev 06/17/2015