Permit (52) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
s COMMUNITY DEVELOPMENT Permit 0: ELR2016-00002
Date Issued: 01/07/2016
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S101 BA00101
Jurisdiction: TIGARD
Site address: 7500 SW DARTMOUTH ST 190
Project: Which Wich Subdivision: WEST PORTLAND HEIGHTS Lot:
Project Description: Fire alarm.
Contractor: PORTER ELECTRIC INC Owner: WAL-MART REAL ESTATE BUSINESS TR
7320 NE ST JOHNS RD BY PROPERTY TAX DEPT STORE 5935-00
VANCOUVER,WA 98665 PO BOX 8050
ATTN MS 0555
BENTONVILLE,AR 72716
PHONE: 360-574-1366 PHONE:
FAX: 360-573-3723
FEES
Description Date Amount
Specifics: Restricted Energy Permit 01/07/2016 $75.00
12%State Surcharge-Electrical 01/07/2016 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio&Stereo: 0 Boiler Controls: 0
CCN: 0 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 $84.00
Other Desc: Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, Stale 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 mayro/bbttain a�copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.33�2.234//4,
Issued By: /�� Permittee Signature: 0.jt`'L
i
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 603.639.4176 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 atthe time of each Inspection.
Electrical Permit ApplicatBF-CEIVED
City of Tigard JAN 7 2016 Received/ 7 /� permit 4:E/O �Jw/ p000�
13125 SW Hall Blvd,Tigard,OR 97223 - Date H . [t h:
g� Plan Review �^ / /�.�
Phone: 503.71%.2439 Fax: 503CITY101 TIGARD late By: Related Permit p: �w��b—fZO
Inspection Line: 503.639.41756UILDING DIVISION Ready Dale:By: Jurls. ® See Page 2 for
Internet: www.tigard-or.gov NotlfiedlMedmd: I I Supplemental Information
TYPE.OF.WORK PLAN REVIEW
❑New constructioncidition/alteration/replacement Please check all that apply(submit 2 sets ofplansw/items checked):
E]Service or feeder 400 amps or more [IBuilding over three stories.
❑Demolition ❑Other: where the available fault current ❑Mannas and boatyards.
CA WRY OF CONSTRUCTION exceeds 10.000 amps at 150 volts or ❑Floating buildings.
❑
]-and 2-family dwellingommercial/industrial ❑Accessory building less to ground,or exceed,14.000 ❑Commercial-use agricultural
amps forali other in,wift ions. buildings.
❑Multi-family ❑ Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately dcrivcd
W ���}m ❑IAddition
OOdHP orof rew
mom, motor load of system.
n
Job#: Job site address: c5 h Por more. []"A',-!,-,"I4"."I3".
J LJ Six crmore residential units. occupancy
City/State/ZIP: a
_rol OR- -�. ❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name: ❑Hazardous locations. ❑Supply voltage fix more than
q ❑Service or feeder 600 amps nr more- 600 volts nonun.l.
Cross street/directions tojob site: i 1,q t- /N{t(L I- Olid v,Id(%� FEE SCHEDULE
Dead tion I Qo. I Each I Tma[
New residential single-or multi-famih dwelling unit.
Subdivision: Lot#: Includes attached garage.
1,000 sq.R.or less 163.54 4
Tax map/parcel#: La-add']500 sq 11 or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
5.00
(with above sq.H.
mO'Z� i4 C�A�2- j N31-Ya b\ �" l(ZL h}lPrfe� Limited energy,multi-Ihmily 75.00
'*fL.N "4 residential(with above SQ.fi -
❑ PROPERTY OWNERRenewable Ener ❑ See Pa e 2
❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 100.70
Address:
701 amps to 400 amps 133.56
401 amps to 600 amps 200.34
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone: ( ) Fax: ( ) Over 1,000 amps or volts 552.26
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 I
intended for sale, (case,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08
Owner signature: Date: 401 amps to 599 amps 1 169.54 -
❑ APPLICANT CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits nidi
Business name: &+9 r � above sen ice or feeder Ice, 74'
each branch circuit
Contact name: bl IO S N'�;o 13. Fee for branch circuits m ahro(
/ cc / service or feeder fee,first 2
Address:
lVe JT hK3 �( branch circuit 56.18
City/S[a[c/ZIP: Hach add'I branch circuit 7.42 2
�OYE.2 Miscellaneous service or feeder not included
Phone: ) Fax: : ( ) Pach manufactured or modular 67 84
Email: dwelling, d
service and feeder
Reconnect ooh67.84
CONTRACTOR Pump or irrigation circle 67.89
Business name: -U F' F ��L -pLTjL ��C_ Sign or outline lighting 67.84 2
73.E � SJ cJ6hf4 - panel,alteration,
or lextensienergyL5 2
Address: anal,alteration,orenited-en. See Page 2 -7
City/State/ZIP: A-pJ U ��_ W f} /, Each additional inspection over allowable in any of the above
ry Additional inspection(I hr min) 66.25/hr
Phone:l� ) '37(1 13cl Fax:(310j) S73 3J� Investigation(I hr min) 9500 IT,
Email: Industrial plant(I hir am) 78,18 hr
Inspections Cor which no fee is 90.00/hr
CCB Lic.: Electrical Lic.: -33Y Suprv. Lic.:a SQei S spserifically listed('':hr mint
ELECTRICAL PERMIT FEES
Suprv. Electrician signature,required: C Lit-x-t-L Z, Subtotal: 7 S
Print name: 144111 Oo...L I Date: '1 _ 5 ❑Plan Review Required(25%of permit fee):
State surcharge(11%of permit fee):
Authorized signature:
TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within IRO
Print name: Date: days after it has been accepted as complete.
Number of inspect tom allowed per permit.
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Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
R ti.. � MU"- Q"l K ah71T.','.1 ..-•
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: 5 kca or less 100.70
5.01 to 15 kva 13356
❑ 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 k,a 301.04
50.01 to 100 kca 552,26
❑ Garage Door Opener* >I00 kca(Cee in accordance
kith OAR 918-309-00411) 55_^.26 _
❑ Heating, Ventilation and Air Conditioning Solar generation sslems in excess of 25 kva:
System*
Bach additional kce ovcr25 7.42 3
❑ Vacuum Systems* >100kva-no additional charge 0.0 3
Each additional inspection over allowable in amof the above:
❑ Other: Each additional inspection is 66.25,hr I
chareed at an hour],(I hr mm)
Inspections for ohich nn fee is 90.00/hr
s eci ficalh listed(1,hr min)
COMMERCIAL WORK ONLY: EL CMCAL rERMir FEES
Fee for each commercial system: $755,00 Subtotal(Enter on Page I):
(SEE OAR 918-309-0000) Number of inspections allowed per permu.
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
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
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