Permit (121) CITY OF TIGARD ELECTRICAL PERMIT
.7- COMMUNITY DEVELOPMENT Permit#: ELC2017-00156
( ARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 �: Date Issued: 03/07/2017
Parcel: 25101 BA00500
Jurisdiction: Tigard
Site address: 7700 SW DARTMOUTH ST 190
Project: Verizon Wireless Subdivision: HERMOSO PARK Lot: 8
Project Description: Electrical for TI:(1)200 amp service,(22)branch circuits,and(1)low voltage data telecommunications system.
Contractor: TRADESMEN ELECTRIC INC Owner: WAL-MART REAL ESTATE BUSINESS TR
PO BOX 128 BY PROPERTY TAX DEPT STORE 5935-00
BATTLE GROUND,WA 98604 PO BOX 8050
ATTN MS 0555
BENTONVILLE,AR 72716
PHONE: 360-666-1199 PHONE:
FAX: 360-666-6124
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 03/07/2017 $100.70
Specifics: amps or less
22 crt Branch Circuits w/Purchase 03/07/2017 $163.24
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea Signal circuit or Limited 03/07/2017 $75.00
Energy Panel
Type of Const: 1 ea 12%State Surcharge- 03/07/2017 $40.67
Occupancy Grp: Electrical
Total $379.61
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 0 R 952-001-0090. Y the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
%y �
Issued By: Permittee Signature: R C--eY -tar'`p`e
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.
CITY OF TIGARD ELECTRICAL PERMIT
11111 COMMUNITY DEVELOPMENT Permit#: ELC2017-00156
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/07/2017
C A GARD g Parcel: 2S 101 BA00500
Jurisdiction: Tigard
Site address: 7600 SW DARTMOUTH ST
Project: Verizon Wireless Subdivision: HERMOSO PARK Lot: 8
Project Description: Electrical for TI:(1)200 amp service,(22)branch circuits,and(1)low voltage data telecommunications system.
Contractor: TRADESMEN ELECTRIC INC Owner: WAL-MART REAL ESTATE BUSINESS TR
PO BOX 128 BY PROPERTY TAX DEPT STORE 5935-00
BATTLE GROUND,WA 98604 PO BOX 8050
ATTN MS 0555
BENTONVILLE,AR 72716
PHONE: 360-666-1199 PHONE:
FAX: 360-666-6124
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 03/07/2017 $100.70
Specifics: amps or less
22 crt Branch Circuits w/Purchase 03/07/2017 $163.24
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea Signal circuit or Limited 03/07/2017 $75.00
Energy Panel
Type of Const: 1 ea 12%State Surcharge- 03/07/2017 $40.67
Occupancy Grp: Electrical
Total $379.61
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 may obtain a co• - - - 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' 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 OFFICI: CSE ON1.1
., City of Tigard I, ; ' Received
MINI13125 SW Hall Blvd.,Tigard,OR 97223 Date/B : �l/�� y
IAlleiffillii
` °, ! Phone: 503.718.2439 Fax: 503.598.1960 Plan Review Related Permit#:
1 i ' Date/B
Inspection Line: 503.639.4175 1^i Ready Date/By: ® See Page 2 for
IIGARD �;.
Internet: www.tigard-or.gov Notified/Method: -] Supplemental Information
VkfrTYPE OF WORK l' a�� PLAN REVIEW
®New construction 0 Addition/alteration/repl*c ; ''-' ' ' Please check all that apply(submit 2 sets of plans w/items checked):
'II',"'..-° '" 0 Service or feeder 400 amps or moreBuilding
0 Demolition 0 Other:
0 over three stories.
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑ 1-and 2-family dwelling El Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder 0 Other:
❑Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
Job#: Job site address: �J ❑Addition of new motor load of system.
/ 600 SO ', LLP+MOu'f`, S.+, 100HP or more. ❑"A","E","l-2","l-3",
City/State/ZIP: T is ar I /0 2 A 2 2 Z 3 o Six or more residential units. occupancy.
0 Health-care facilities.
0 Recreational vehicle parks.
Suite/bldg./apt.#: I Project name: ve rl'.o,„4 (%re,(e.4 s 0 Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: SW 72 nr,( 4v,e, FEE SCHEDULE
Description I Qty. I Each I Total I *:
New residential single-or multi-family dwelling unit.
Subdivision: I Lot#: Includes attached garage.
Tax map/parcel#: 1,000 sq.ft.or less 168.54 4
Ea.add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
�//�� /" (with above ..ft. 75.00 2
t'�/1 Gf'ri c.4.� fine" Ol V g_.,-.Zor in.) h'LLSS Limited energy,multi-family
rlGtoi S t)re residential(with above sq.ft.) 75.00 2
❑ TENANT Renewable Energy ❑ See Page 2
0 PROPERTY OWNER Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 1 100.70 MO.10 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:( ) I Fax:( ) Over 1,000 amps or volts 552.26 2
Email: Temporary services or feeders installation,alteration,and/or
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
0 APpuC T4 a CON,,r4er PusON Branch circuits-c new,alteration,or extension, •er panel
A.Fee for branch circuits with /
Business name: above service or feeder fee, 22 7.42 /b ZN 2
each branch circuit
Contact name: B.Fee for branch circuits without
t.i
branch circuit 56.18
City/State/ZIP: Each add'l branch circuit 7.42
Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular
Email: dwelling,service and/or feeder 67.84
Reconnect only 67.84
CONTRACTOR Pump or irrigation circle 67.84
Business name: a e�
/� �i /� G Sign or outline lighting 67.84
Address: a/ , v D�O /�g Signal circuit(s)or limited-energy ,.S pp
' panel,alteration,or extension. c See Page 2 7 ,
2royi Each additional inspection over allowable in any of the above
City/State/ZIP: L I/7c r)rr hG( AM
i /d1 Additional inspection(1 hr min) 66.25/hr
Phone:(3‘4 ) lo// /ill Fax:(3(O ) 666 - 6(Z 4 Investigation(1 hr min) 90.00/hr
Email: V/1�0 L_ / j�� r� F Industrial plant(1 hr min) 78,18/hr
1 r�a^ "G{Y C�I'� Inspections for which no fee is
CCB Lic.: OElectrical Lic.: p, 27y2 s.-cificall listed %2 hr min ■ 90.00/hr -.
a 2 Cor Suprv.Lic.:
Suprv.Electrician signature,required: �� ELECTRICAL PERMIT FEES
Subtotal: 3 r y
as
Print name: All:,
pa/M A/•-• Date: 3-7_(7 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): ,j i((1 7
Authorized signature: -1 fj�� TOTAL PERMIT FEE:;3 '�7C; 6,(
NNThis permit application expires if a permit is not obtained within 180
Print name: ��� ` Date:
�(t',t,..ttLv� fCiYM( 3-7- /7 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELCPermitApp_ELR ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB
Electrical Permit Application—City of Tigard
Page.74—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
14! $75.00
al ®®,.
Fee for all residential systems comb><ned. °escn lion
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
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
❑ Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance
with OAR 918-309-0040) 552.26 2
❑ 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:
❑ 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
sted
(% mi hr n)
secs Ica ly h
INAir,
.° rhe ,,>. 117 i :1
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1):
(SEE OAR 918-309-0000) * Number of inspections allowed per permit.
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
1:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015