Permit (67) CITY OF TIGARD ELECTRICAL PERMIT
11 -1 - COMMUNITY DEVELOPMENT Permit#: ELC2016-00847
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/02/2016
Tic,Alt.[� g Parcel: 2S 101 BA00101
Jurisdiction: Tigard
Site address: 7500 SW DARTMOUTH ST 110
Project: Joy Teriyaki Subdivision: None Lot: None
Project Description: TI for existing tenant.
Contractor: POLARIS ELECTRIC LLC Owner: WAL-MART REAL ESTATE BUSINESS TR
22380 NW SELLERS RD BY PROPERTY TAX DEPT STORE 5935-00
BANKS, OR 97106 PO BOX 8050
ATTN MS 0555
BENTONVILLE,AR 72716
PHONE: 503-681-8013 PHONE:
FAX: 503-647-9099
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 11/02/2016 $67.84
Specifics:
1 ea 12%State Surcharge- 11/02/2016 $8.14
Electrical
Type of Use: COM
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $75.98
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 othe 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 , wor is,suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification 'enter T .se rules are set fo.. '- •
952-001-0010 through 952-001-0090. You ma obtain a copy o direct questions to OUNC by calling 50 . 32.198 or 1.:4 r - .234'
Issued By: c Permi es 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 Io12 01,1'1(1. t SE oyl.v
„-- Received
City of Tigard ,, D .. II '
� , s,� r Date/B , �
111
• 13125 SW Hall Blvd.,Tigard,OR °,' Plan Review
,1114
Related Permit#:, /
Phone: 503.718.2439 Fax: 503.5 1J4 = Date/B : Y j(fJ' _0
Inspection Line: 503.639.4175 '°. Ready Date/By: Amis: ® See Page 2 for
l l�' It D Internet: www.tigard-or.gov \3 \\b- Notified/Method: Supplemental Information
pp,,9 �- PLAN REVIEW
TYPE OF WOI2 471"41 I�
[a New construction 0 Addition/alterallturJfl3 $a eml rf Please •check all that apply(submit 2 sets of plans w/items checked):
F, ` "a� ‘a 0 Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition 0 Other:
�,,. � '' where the available fault current 0 Marinas and boatyards.
CATEGORY OF C 0 s:I ION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑ 1-and 2-family dwelling ❑' 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: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
❑Addition of new motor load of system.
n
Job#: Job site address: i co e 5-14/ hal f#1a u (n y'e * tt o l o0HP or more. ❑"A","E","1-2","l-3",
City11 U� Z L 7 ❑Six or more residential units. occupancy.
ty ( t t{ 6;t� / 7 ❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: '10 Project name: ''(gyp'' 1&'k.(`61 r 0 Hazardous locations. 0 Supply voltage for more than
.1 ❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
`'�t �1 / Description ,.. Qty. Each Total I *<
�'v3 �GQ►�tti o N-tin Y>+ L' C. 4 V€ New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: '
Ea.add'I 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
(with above sq.ft.) 75.00 2
4 /p e.:0 v\P eC t(i Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Renewable Energy 0 See Page 2
❑ PROPERTY OWNER TENANT Services or feeders installation,alteration,and/or relocation
Name: ,Sats-('t'vl j-((,v W n.k` 200 amps or less 100.70 2
Address: 11 ca
's $ 0 ext't 41 1(� 201 amps to 400 amps 133.56 2
t'"' t S 401 amps to 600 amps 200.34 2
City/State/ZIP: 'IT t 'cl f?As11 '3 601 amps to 1,000 amps 301.04 2
Phone:(5-0 ) CI 11 — (8 Q1, Fax:( ) Over 1,000 amps or volts 552.26 2
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 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
APPLICANT CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
/ � A.Fee for branch circuits with
Business name: Ke cJl oc� 11,--n'idf' above service or feeder fee,
7.42 2
each branch circuit
Contact name: ....J—at (-e c- B.Fee for branch circuits without
Address: Q service or feeder fee,first 56.18 2
( V 6 40 S w kiwi
V branch circuit
Each add'l branch circuit 7.42 2
City/State/ZIP: > 'p �. 91.° ) Miscellaneous(service or feeder not included)
Phone:( cod ) 1 _ o(9 j Fax: :( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: rot,,,.- , F,e G -c r' c._ Sign or outline lighting f 67.84 6-i„ $ty. 2
Signal circuit(s)or limited-energy
Address: ZV10 /NA/ s'G//t 1,s 12) panel,alteration,or extension. 0 See Page 2 2
City/State/ZIP:
Each additional inspection over allowable in any of the above
G1,.r .S U r q��U�
Additional inspection(1 hr min) 66.25/hr
Phone:(563) 6g/ FC 13 Fax:(S-03 ) 9 7- dc-17 Investigation(1 hr min) 90.00/hr
Email: 0. Industrial plant(1 hr min) 78.18/hr
`c-tLiaice&f A. i- Cli 4 / Inspections for which no fee is
CCB Lic.: jcf/p t�3 Electrical Lic.:C G 2 Suprv.Lic.:536 S specifically listed('/hr min) 90.00/hr
r� ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: (( r _>�. Subtotal: 6 '7,71-7
i
Print name: Oc, le 7- ,-,y /cc... Date: fildy, A g0/l
0 Plan Review Required(25%of permit fee):
/ State surcharge(12%of permit fee): r 11
Authorized signature: TOTAL PERMIT FEE: '
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(l1/05/COM/WEB
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 s stems combined: $75.00 neQty.7 Each Total *
�' Rene
wawa ble 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
50.01 to 100 kva 552.26 2
❑ Garage Door Opener* >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
El Vacuum Systems* >100 kva-no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
111 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
specifically listed('/z hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
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
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 110, TIGARD, OR,
97223
Commercial - Electrical
199 Electrical final
PASS - No C of O
November 4, 2016 at 10:03:30
AM
ELC2016-00847
Jeff Grove
Violation Summary:
Inspector Contractor