Permit CITY OF TIGARD ELECTRICAL PERMIT
111111 t • COMMUNITY DEVELOPMENT Permit#: ELC2015-00777
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/28/2015
Parcel: 25101 BA00101
Jurisdiction: TIGARD
Site address: 7500 SW DARTMOUTH ST 190
Project: Which Wich Subdivision: WEST PORTLAND HEIGHTS Lot:
Project Description: Sign lighting for(3)signs.
Contractor: ELECTRIC AVENUE SIGN&LIGHTING Owner: WAL-MART REAL ESTATE BUSINESS TR
16005 NE 12TH ST BY PROPERTY TAX DEPT STORE 5935-00
VANCOUVER,WA 98684 PO BOX 8050
ATTN MS 0555
BENTONVILLE,AR 72716
PHONE: 360-903-5447 PHONE:
FAX:
FEES
Quantity Description Date Amount
3 ea Sign or Outline Lighting 09/28/2015 $203.52
Specifics:
1 ea 12%State Surcharge- 09/28/2015 $24.42
Electrical
Type of Use: COM
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $227.94
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 sus“ -- for more the 180
days. ATTENTION: Oregon law requires you to follow the ruleessj adopted by the Oregon Utility Notification Center. T •se es are et forth in OAR
952-001-0010 through OAR 952-001-0090. You ma obtain a pe rules or direct questions to OUNC by calling 503.2• 1.84.... .2344.
Issued By: Permittee Signature:
Qv 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.
r _a�, r
Electrical Permit Application I ()K O t I I l l 1 '■l (►\11
City of Tigard `'�O Received �.; Permit No.:
V DateB :
• 13125 SW Hall Blvd.,Tigard,OR 97� Plan Review
' II Phone: 503.718.2439 Fax: 5 \ + DateB : Other Permit: r(_iP,. •(5= .r.- •
H., Ft i Inspection Line: 503.639.417 n'LQ\� Date Ready/By: 0 See Page 2 for
I Internet: www.tigard-or.gov c�p D (� O Notified/Method: Supplemental Information
TYPE OF WdRK O f.d(V`raC�� PLAN REVIEW
❑New construction ❑Addition/alt:i t. . :., I1f nt Please check all that apply(submit 1 sets of plans w/items checked below):
❑Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition Other: where the available fault current ❑Marinas and boatyards.
CATEGORY OF C STRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
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
JOB SITE INFORMA AND LOCATION ❑Emergency system. larger separately derived system.
❑Addition of new motor load of ❑"A","E ,`9-2^,"1-3"
Job no.: Job site address: t Six or or more. occupancy.
+� Stu�k e+MO Writ '5 T- ❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: -�-�b�R-i? O R `Z ❑Health-care facilities. ❑Supply voltage for more than
9-7 ❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: 1 l a Project name:C_ }.I 1 44.1 w e c+ ❑Service or feeder 600 amps or more.
— FEE SCHEDULE
Cross street/directions to job site: PAo m { IF Darripdo. I (Its'. I Fee. I Total 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 1
Tax map/parcel no.: Limited energy,residential
DESCRIPTION OF WORK (with above sq.ft.) 75.00 2
Limited energy,multi-family
75.00 2
•5l 643 I-`ock- VP residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
pp PROPERTY OWNER I ❑ TENANT 200 amps or less 100.70 2 i
r y 201 amps to 400 amps 133.56 2 -
Name: a C R t TQ• 401 amps to 600 amps 200.34 2
Address: a 6 01 pAc4 .ice(L for 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP: -rkCOMA- w A (7 69 oZ Temporary services or feeders installation,alteration,and/or
(00 ) 25 3_ (p�-�6� ( ) relocation
Phone: J J 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. •
401 amps to 599 amps 168.54 2
Owner signature: Date: Branch circuits-new,alteration,or extension,per panel
JI APPLICANT I ❑ CONTACT PEILSON A.Fee for branch circuits with
above service or feeder fee, 742 2
Business name: 13 EA VERib' '3(6„0 5 each branch circuit
B.Fee for branch circuits without
Contact name: m I ke oct rs'R to service or feeder fee,first 56.18 2
branch circuit
Address: 30 of q S(y (4 A I I p L v 1) Each add'l branch circuit 7.42 2
City/State/ZIP: /�LAV�� et q1 603 Miscellaneous(service or feeder not included)
L7 Each manufactured or modular 67.84 2
Phone:(51 ) 4,7 2.9-03-7 Fax: :(503 ) 574# 4/74// dwelling,service and/or feeder
Reconnect only 67.84 2
E-mail: M 1 la f is Eitu $/6A). coop? Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 j,5-,z 2
Business name: tLIzCrVAL AVE 51 ,5 Signal circuit(s)or limited-energy See
panel,alteration,or extension. Page 2 _ 2
Address: (Loco S uE 12.1V%f sr. Each additional inspection over allowable in any of the above
City/State/ZIP: VA p x) !1— ( , t,A 9 B/_9 Additional inspection(I hr min) _ 66.25/hr
V Pi 9 B p v-t Investigation(1 hr min) 66.25/hr
Phone:( )3100 -903 54K7 Fax:( ) Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is
90.00/hr
CCB Lic.: t q 341(o Electrical Lic.: S 1[T.4,II Suprv.Lic.: CLS -2 3 specifically listed(%:hr min)
7 / ELECTRICAL PERMIT FEES
Suprv.Electrician rC,required: %' j V � Ii iii 1 Subtotal: 5-A
Print name:/� e#,,E./AffAzi !�'� Date: 9,25_45
Plan review(25%of permit fee):
State surcharge(12%ofpermit fee): rl.II, ••
Authorized signature /y[� zr y TOTAL PERMIT FEE: f
r
This permit application expires if a permit is not o aiaed within 180
Print name: /cog/, Date: js-�3 days after it has been accepted as complete.
l
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 Description I Qty. I Fee I Total I •
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
❑ Burglar Alarm Wind generation systems in excess of 25 kva:
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 552.26 2
OAR 918-309-0040)
❑ Heating,Ventilation and Air Conditioning
System* Solar generation systems in excess of 25 kva:
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
charged at an hourly(1 hr min) 6625/hr 1
Inspections for which no fee is 90,00/hr
specifically listed(V2 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 fee):
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
❑ Audio and Stereo Systems days after it has been accepted as complete.
• Number of inspections allowed per permit.
❑ 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
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
7500 SW DARTMOUTH ST 190, TIGARD, OR,
97223
Commercial - Electrical
199 Electrical final
PASS - No C of O
ELC2015-00777
Jeff Grove
Violation Summary:
Inspector Contractor