Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
Ill
COMMUNITY DEVELOPMENT Permit#: ELR2014-00063
Date Issued: 03/12/2014
TIGARD 13125 SW Hall Blvd.Tigard OR 97223 503.718 2439 Parcel: 2S101AB01400
Jurisdiction: Tigard
Site address: 7600 SW DARTMOUTH ST
Project: Walmart Subdivision: HERMOSO PARK Lot: 8
Project Description: Low voltage for HVAC&refrigeration controllers
Contractor: NEXREV INC Owner: PACIFIC REALTY ASSOCIATES LP
601 DEVELOPMENT DR 15350 SW SEQUOIA PARKWAY#300
PLANO. TX 75074 PORTLAND. OR 97224
PHONE: 972-578-0505 PHONE: 503-624-6300
FAX: 972-608-3558
FEES
Description Date Amount
Specifics: Restricted Energy Permit 03/12/2014 $75.00
• 12%State Surcharge-Electrical 03/12/2014 $9 no
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 0
Audio&Stereo 0 Boiler Controls 0
CCTV. 0 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. ATTEN Oregon, 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 95 U�90. You may obtain a copy of the rules or direct questions to OUNC by cal 03.232 1987 or 1 800 332.2344
Issue By: fV Permittee Signature: /6"4---...—~
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.
It 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.
From: 03/12/2014 09:58 #090 P.001
Electrical Permit Applic CEIVI ) ft)l' OFF11 f 1 NI.WO l
City of Tigard �,I/��pp c� Received a �an Permit N..Ekiee?O/e/—GL &3
11111 13125 SW Hall Blvd.,Tigard,Olio AR3 �+ 2 4 pywR Review ,�/
= Phone: 503.718.2439 Fax: 503.598.1960
Date/By: Other Permit: // ,o,e 3-aa~`/7
I t,,,!i 11 Inspection Line: 503.639-417CITY OF"f I G A RD Date Ready/By. ray. i e See Page 2 for
Internet: www.tigard_or.gov l n NotifiedMethnd Supplemental Information
TYPE'.91R�NA'ISION PLAN REVIEW
121
New construction ❑Addition/alteration/replacement Please check all that apply(submit j sets of plans wiitenu checked below).
❑Service or feeder 4(1()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.
1 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: 0 Fire pump. ❑installation of 150 KVA or
❑Emergency system larger separately derived system.
JOB SITE INFORMATION AND LOCATION
['Addition of new motor load of ❑"A E 1.2 t 3
Job no.: ~ Job site address:7600 SW Dartmouth ST IOOHP or more occupancy.
❑Six or more residential units ❑Recreational vehicle parks.
City/State/ZiP:Tigard,OR,97223 ❑Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name:Walmart 5935 ❑Service or feeder 600 amps or more
FEE SCHEDULE
Cross street/directions to job site: De,eriprian (qty. 1 Fee. I Taw I
New residential single-or multi-family dwelling unit,
Includes attached garage.
Subdivision: Lot no.: 1,000 sq.ft.or less 168.54 4
Ea.add'I 500 sq ft.or portion 33.92 i
Tax map/parcel no.: Limited energy,residential
75.00 2
DESCRIPTION OF WORK (with above sq_� .00
Limited energy,multi-family 7500 f 2
HVAC Communication to controller,Refrigeration communication to controller residential(with above sq.ft.) _
Renewable Energy - Cl See Page 2
LTG communic Services or feeders installation alteration,and/or relocation
0 PROPERTY OWNER ' I ❑ TENANT 200 amps or less - 100.70 2
201 amps to 400 amps 133.56 2
Name:Walmart -- 401 amps to 600 amps 200.34 2
Address: 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26
City/State/ZiP: Bentonville,AR Temporary services or feeders installation,alteration,and/or
Phone:( ) Fax:( ) relocation
200 amps or less 59.36 1
Owner installation:This installation is being made on property that I own which is not '01 amps to 400 amps 125.08 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 599 amps 168.54 2
Owner signature: _.�-__i_Date: • Branch circuits-new,alteration,or extension,per panel
❑ APPLICANT ® CONTACT PERSON A.Fee for branch circuits with
above service or fueilcr fee, 7.42 '
Business name:NexRev each branch circuit - I
B.Fee for branch circuits without
Contact name:Bryce Reed service or feeder fee,first
56.18 2
-- -- branch circuit
Address:601 Development Dr Each add'I branch circuit 7.42 _ 2
City/State/ZIP:Plano,TX 75074 Miscellaneous(service or feeder not included)
Each manufactured or modular 67.84 2
Phone:(972)3038513 I Fax::(972)6083558 dwelling,service and/or feeder
Reconnect only 67.84 2
E-mail: brycereedCinexrev.com Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name: NexRev /A.I V T Signal circuit(s)or limited-energy / �.� 2
panel,alteration,or extension. ..-7,(z-Page 2 (
Address:601 Development Dr ' Each additional inspection over allowable in any of the above
Additional inspection II hr mm) 66.25i hr
City/State/ZIP Plano,TX 75074 Investigation(I hr min) 66.25/hr
.
Phone:(972)5780505 Fax:(972)6083558 Industrial plant(I hr min) - 78.18/hr
3 -) Inspections for which no fee is 90.00/hr
CCB Lie.:S389 119173 Electrical Lic.: .5,3dr33 Suprv.Lie.: 36945 specifically listed('k hr min) _
ittrrtrg— L
1 --77V/`r& ELECTRICAL PERMIT FEES
Suprv. Electrician signature,required: I
Subtotal ('
Print name: Bryce Reed sate: %v,t'''I Li Plan review(25%of permit fee):
State surcharge(12%of permit fee): CV)
Authorized signature: TOTAL PERMIT FEE: D .0c)
This permit application expires if a permit Is not obtained within ISO
Print name: Bryce Reed Date: 3_'l- (y days after It has been accepted as complete.
* Number of inspections allowed per permit.
l Building-PamitsELC,Permi App.ELR"ERE.doc Rev 05.212013 440-4615711POS.'COM.WEB
From: 03/12/2014 09:59 #090 P.002
Electrical Permit Application-City of Tigard
Page 2-Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Fee for all residential systems combined $75.00 Deseripdas O'. I ree 1 Total__
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 A• udio and Stereo Systems*
15.01 to 25 kva 200.34 2
❑ Burglar Alarm Wind generation systems In excess of 25 kva:
25.01 to 50 kva 301.04 2
n G• arage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance with 55:36 2
❑ Heating, Ventilation and Air Conditioning OAR 918.309-0040) -
System* Solar generation systems in excess of 25 kva:
Each additional kva over 25 7.42
n V• acuum Systems* >100 kva-no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ Other: Each additional inspection is
charged at an hourly(I hr min) 66 r5/hr 1
Inspections for which no fee is 90.00/hr
specifically listed(/hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system $75.00 Subtotal:
(SEE OAR 918-309-0000) Plan review,if required(25%of permit lee).
State surcharge(12%of permit fee):
Check Type of Work Involved: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
nA• udio and Stereo Systems days after it has been accepted as complete.
. Number of inspections allowed per permit.
n B• oiler Controls
❑ Clock Systems
❑ 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: I
*No licenses are required. Licenses are required
for all other installations
I nmldmg Permits ELC.PermnApp ELR ERE der Rev 05,21 201