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Permit (67) CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit#: ELC2016-00338 T[GARD[GA13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/27/2017 Parcel: 25101 BA00101 Jurisdiction: Tigard Site address: 7500 SW DARTMOUTH ST 130 Project: Icon Nails&Spa Subdivision: None Lot: None Project Description: Sign lighting for(1)sign. Contractor: GRAPHIC D'SIGNS LLC Owner: WAL-MART REAL ESTATE BUSINESS TR 9125 NE SANDY BLVD BY PROPERTY TAX DEPT STORE 5935-00 PORTLAND, OR 97220 PO BOX 8050 ATTN MS 0555 BENTONVILLE,AR 72716 PHONE: 503-256-2064 PHONE: FAX: FEES Quantity Description Date Amount 1 ea Sign or Outline Lighting 04/25/2016 $67.84 Specifics: 1 ea 12%State Surcharge- 04/25/2016 $8.14 Electrical Type of Use: COM Class of Work: OTR 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 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 ma obta'. - •.y of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: Permittee Signature: 4,46,-C40 Zf- ,41 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 503.639.4176 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 at the time of each inspection. Electrical Permit Application FOR OFFICE CSF.011.1' Received City of Tigard L/ �� Permit#: A i Date/B : ti.,-Ey.,-)7 ' • 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review II Phone: 503.718.2439 Fax: 503.598, 4 f Related Permit#: Q O .r te" Date/By: , �I,4 Inspection Line: 503.639.4175 %t .. Ready Date/By: auris: 0 Seepage 2 for 1 I C, R D Internet: www.tigard-or.gov �� Notified/Method: Supplemental Information PR b TYPE OF WORK , Inn PLAN REVIEW ❑New construction ❑Addition/alteration/T �j reltw ' t Please check all that apply(submit 2 sets of plans w/items checked): )t `l k y,,,,,,,,,, 0 Service or feeder 400 amps or more 0 Building over three stories. ❑Demolition ❑Other: ° , 1-,,,p4 is ;1 where the available fault current 0 Marinas and boatyards. CATEGORY OF COI4 I k ION exceeds 10,000 amps at 150 volts or 0 Floating buildings. El1-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 ❑Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION . 0 Emergency system. larger separately derived JobCAD#: Job site address:i F' '$ DA"Ii� hint-- --Addition of new motor load of system. W l fV t t "100HP or more. ❑"A„ "E„ "1-2„ "1-3„ City/State/ZIP: ❑Six or more residential units. occupancy. 1 Lc/IA.. `�{� DP"I g .4.K/ ❑ ❑Recreational vehicle parks. Health-care facilities. Suite/bldg./apt.#: Project name: ►CA (1cam+ �Q 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: Cyd �1k ,.,., - . /! 2,tA4 FEE SCHEDULE ry, • Description I Qty. I Each I Total 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'l 500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential 01•4._ Url,r`tiw� y �-, 13Dt (withd ne ge,q. t) 75.00 2 l w Limited energy,multi-family 75.00 2 fr residential(with above sq.ft.) __ Renewable Energy 0 See Page 2 0 PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation Name: 200 amps or less 100.70 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:( ) 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 0 APPLICANT ( 0 CONTACT PERSON Branch circuits—new,alteration,or extension,per panel Il A.Fee for branch circuits with Business name: / 4\. , "l i b S tit. (c ��e ' above service or feeder fee, 7.42 2 ��11 //'���ti I! V�1�► each branch circuit Contact name: B.Fee for branch circuits without Address: service or feeder fee,first branch circuit 56.18 2 City/State/ZIP: Each add'l branch circuit 7.42 2 n,., Fax: : Miscellaneous(service or feeder not included) Phone: (519) "P`b — i ( ) Each manufactured or modular G�-Q dwelling,service and/or feeder 67.84 2 Email: Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name: (l t g1)F.1,.tG 1) "� I �C- Sign or outline lighting / 67.84 �r?..iji 2 11 C� r V t`('t Signal circuit(s)or limited-energy Address: I i Tr �r t Qc M bi g w panel,alteration,or extension. ❑ See Page 2 2 ��2 *.hji> © . C)4U ,�.. Each additional nal inspection inspection over allowable in any of the above City/State/ZIP: � U Additional inspection(l hr min) 66.25/hr Phone:(sl ) _ 4 Fax:( ) Investigation(1 hr min) 90.00/hr Email: Industrial plant(1 hr min) 78.18/hr Inspections for which no fee is 90.00/hr CCB Lic.: IS-214v2_, Electrical Lic.: 123 rC prv.Lie.: specifically listed('/z hr min) Wj gill. ELECTRICAL PERMIT FEES Suprv. Electrician signature,required: 101 1 t Subtotal: 7 Print name: 14,..„-- --14, (,Q) ` Date:A 2/_(C, 0 Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): i. /4 Authorized signature: ��� �� TOTAL PERMIT FEE: 7y,, :. This permit application expires if a permit is not obtained within 180 Print name: .4Ai'. n1�1 IV HuyDate: ii ._1/ _.`1 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/ OM/WEB Electrical Permit Application—City of Tigard Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: t<<6 „,: .. `'` } s + :'; r :, Yst °:� Renewable oi a IV .. .. '. � DescriptionQty. Each Total I * Fee for all residential systems combined: $75.00electrical 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 552.26 2 with OAR 918-309-0040) ❑ 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 charged at an hourly(1 hr min) Inspections for which no fee is 90.00/hr specifically listed('/z hr min) i� .r :. T n,- � . v<- : Subtotal 'F1FEES?�% �° �' 1 rel _�... otal(Enter on Page 1): Fee for each commercial system: $75.00 * Number of inspections allowed per permit. (SEE OAR 918-309-0000) 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 I:\Building\Permits\ELC_PertnitAppELR_ERE.doc Rev 06/17/2015