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Permit CITY OF TIGARD ELECTRICAL PERMIT 111-. COMMUNITY DEVELOPMENT Permit#: ELC2018-00576 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/24/2019 Tri.; It[� g Parcel: 2S101 BA00500 Jurisdiction: Tigard Site address: 7600 SW DARTMOUTH ST Project: Electrify America Subdivision: HERMOSO PARK Lot: 8 Project Description: Install eight(8)electric vehicle charging stations: (1)over 1,000 amp service and(8)branch circuits. Contractor: ADK ELECTRIC, INC. Owner: WAL-MART REAL ESTATE BUSINESS TR 9000 NE 90TH STREET BY PROPERTY TAX DEPT STORE 5935-00 VANCOUVER,WA 98662 PO BOX 8050 ATTN MS 0555 BENTONVILLE,AR 72716 PHONE: 360-546-5155 PHONE: FAX: 360-576-6975 FEES Quantity Description Date Amount 1 ea Services or Feeders-Over 09/19/2018 $552.26 Specifics: 1000 amps or volts 8 crt Branch Circuits w/Purchase 09/19/2018 $59.36 Type of Use: COM Service or Feeder Class of Work: ALT 1 ea Plan Review Electricial 09/19/2018 $152.91 Type of Const: 1 ea 12%State Surcharge- 09/19/2018 $73.39 Electrical Occupancy Grp: Total $837.92 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 /ou to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR -001-0090. Y- may obtain a opy of the ru or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: sr-r 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.Ec Folz of t ici: I;si:ONL\ Ciligty of Tigard 1 VV CC Receiv �y`a��� '. •- it#�CG e '1�,, �� 7/_. Date/By: , 47�� i 13125 SW .. 1 Blvd.,Tigard,OR 97223 Plan Revie _ Phone: 5� j�:.2439 AUG 2 9 2018 Date/By: V/j�3 fir t I Related Pend/00;w/��f� yo Email: '�Fa BuildingPermits@Tigard-- v /� xii �y Ready Date/By: Jure B1 See Page 2 for T I G A R D Inspection ine: 503.639.4175 Int ej t i cv kattii trip Notified/Metho��7 l�r f' I Supplemental Information TYPE OF DING DIVISION gel /04/. / PLAN REVIEW New construction 0 Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked): 0 Service or feeder 400 amps or more 0 Building over three stories. 0 Demolition 0 Other: 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 VI Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural am❑Multi-family ❑Master builder 0 Other: Firem all other installations. buildings. 0 for 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. Job#: I Job site address: 6 0c, $'w) �RQTM®um S r, 100HP or more. ❑"A","E","l-z","l-3", City/State/ZIP: 0 Six or more residential units. occupancy. Recreational vehicle parks. 0 Health-care facilities. 0 Suite/bldg./apt.#: I Project name: 6(_ c.T&..I F`! 4 Hew.i c...1- ❑Hazardous locations. ❑Supply voltage for more than ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: A 7 (l E 6mlati✓iv2.1 FEE SCHEDULE Description I Qty. I Each I Total I * New residential single-or multi-family dwelling unit. Subdivision: I Lot#: Includes attached garage. 1,000 sq.ft.or less 168.54 4 Tax map/parcel#: Z S/ /BAT(,. ,-01/5-,../606 Ea.add'I 500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential 75.00 2 ft !-O os72w 4, CLE.c lie 1 L U Cf1(Gtr a( i.le4/ (with above sq.mt) Limited energy,mullti-family 75.00 2 5 TA'T-(C LA residential(with above sq.ft.) 0 PROPERTY OWNER 0 TENANT Renewable Energy 0 See Page 2 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:(. ) Over 1,000 amps or volts 1 552.26 537 . 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 ratAPPLICANT CONTACT PERSON Branch circuits-new,alteration,or extension,per panel A.Fee for branch circuits with Business name: 6Leo-R 1 p Y 414 6.,Q1 to above service or feeder fee, 7.42 2 each branch circuit Contact name: / 'V I A )4 A RT!n1) i3 LA c K 4-V EA I c:14 B.Fee for branch circuits without service or feeder fee,first Address: S.gg51-lMpo t--5 £o/1-t branch circuit 56.18 2 City/State/ZIP: Each add'l branch circuit 7.42 2 Lam& 0st.vc 40 c,r2 97 c35 f Miscellaneous(service or feeder not included) Phone:(56,3 ) 4.43_ 4-414- Each manufactured or modular 67.84 2 dwelling,service and/or feeder Email: k1*h,/L rf pJ K.0 b J, -L)It1 Reconnect only 67.84 2 / ,.i , . _ CQ '> CT4, .s.. _ _ Pump or irrigation circle 67.84 2 Business name: •T 2 Sign or outline lighting 67.84 2 �i� B� iJETF2�+-►�nl�D tL FI1 " IL' - 1 Signal circuit(s)or limited-energy Address: c re. � �,''t,/l& ,�� �(�� panel,alteration,or extension. 0 See Page 2 2 City/State/ZIP: ` /J /, / Each additional inspection over allowable in any of the above K i 4 6�j CGkGC �Gn'1G✓/Z rU Additional inspection(1 hr min) 66.25/hr Phone:( )S)h,,,,k I"T Investigation(1 hr min) 90.00/hr Industrial plant(1 hr min) 78.18/hr Email: Inspections for which no fee is 90.00/hr CCB Lic.: I Electrical Lic.: I Suprv.Lic.: specifically listed('%hr min) ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: Subtotal: Print name: Date: Plan Review Required(25%of permit fee): State surcharge T L Epermit ft Authorized signature:''P7/4.Y1 TOTAL PERMS _ This permit application expires if a permit % Print name: /rev t IQ 14,14.1-0 Date: o.s atr_2c I $ days after it has been accepted: 4 * Number of inspections allowed per permit. p. I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 10/26/2017 440-4615T(11/05/COM/WEB Electrical Permit Application—City of Tigard Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: RESIIJENTIAL WORK oNI.Y; „ ,::,: ::A'1,6,,,,,,_,, 4i,,,, Fee for all residential systems combined: $75.00 Description Qty I Each 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 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 1 charged at an hourly(1 hr min) Inspections for which no fee is 90.00/hr s.ecifically listed('/hr min) Go ',. a.RC: W. i EL 4,'-PE T, ` S 7., Y: „w' r 3 x SubtotalEnteron 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 n 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: o licenses are required. Licenses are required for all r installations \Permits\ELC_PermitAppELR_ERE.doc Rev 10/26/2017 Electrical Permit ApplicationRECtitri I OR 01 1 1( I lar ON 1 City of Tigard Received �� 111 all 13125 SW .. Blvd.,Tigard,OR 97223 q Date/By: meq//, 146, !,' "it el ea19/,'/ ('4S"7a ' I Phone: 5 1:.2439 AUG 2 9 2 018 Plan Revie c, ' Date/By: llf J b r t i Related Per (,��/C,.Dpc2 YO Email:(L.. .BuildingPertnits@Tigard- v Readygi See Page 2 for l U,'.111 Date/By: JurLa: Inspection '.e: 503.639.4175 Int {gat � U Notified/Method9/`1t J Supplemental Information a r es w t ' t96 i)s }4:< ttr na} P kaa %o" A- ! 4 New construction 0 Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked): 0 Service or feeder 400 amps or more ❑Building over three stories. 0 Demolition 0 Other: .. where the available fault current 0 Marinas and boatyards. '`'� ' ''`' ',; ,;'l . - - �` it. :13:e.'1. a,011, , . .. exceeds 10,000 amps at 150 volts or 0 Floating buildings. ❑1-and 2-family dwelling Commercial/industrialless to ground,or exceeds 14,000j 0 Accessory building �� 0Commercial-use agricultural ❑Multi-famil amps for all other installations. buildings. y ❑Master builder ❑Other 0Fire um ,,,�,. .,����, � �� al,� � � � pump. Installation of 150 KVA or i�. . x .L r it r•[r/1 v-,... r 1 f Iq _ .„ �� � � _: 0 Emergency system. larger separately derived Job#• 1 Job site address: 7 p p s� ❑Addition of new motor load of system. �� ^"tO I.ITN s T. 100HP or more. ❑"A","E","1-2","l-3", City/State/ZIP: ❑Six or more residential units. occupancy. 0 Health-care facilities. 0 Recreational vehicle parks. Suite/bldg./apt.#: Project name: eteC k i,'y t-i&-�I C ❑Hazardous locations. 0 Supply voltage for more than i 7 ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: L ' -= t Description Qty, Each Total I +: New residential single-or multi-family dwelling unit. Subdivision: Lot#: Includes attached garage. Tax map/parcel#: e e 1,000 sq.ft.or less 168.54 4 r'G 5J / . L /O/, >'00 boa Ea.add'1500 s ft.or onion PlikEZr 7; t' x 1. 4 _ P 11111 33.92 MID£ Limited energy,residential III with above s..ft. 75.00 —© G01t).ST&.tk 1 4/J gC C rtt I C. (,)( /1(e.(�.- 4ktit e4,r,.1G, Limited energy,multi-family 61:477 0 h residential(with above sq.ft.) 75.00 IIIIII . s ' s a z. .�" a, ram , Renewable Ener 0 See Pa:e 2 Services or feeders installationZalteration,and/or relocation Name: 200 amps or less 100.70 2 Address: 201 amps to 400 amps 133.56 2 City/State/ZIP: 401 amps to 600 amps 200.34 2 601 amps to 1,000 amps 301.04 2 Phone:(_ ) Over 1,000 amps or volts j 552.262 Email: Temporary services or feeders installation,alteration,�a r relocation Owner installation:This installation is being made on property that I own which is not 200 amps or less59.36 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 I 168.54 1 I 2 .5.ie . -fa' E Branch circuits-new alteration or extension .er .anel 7. a � _� $' A.Fee for branch circuits with Business name: eigo-leiF•Y 414E/214/y above service or feeder fee, 81 Contact name: �/ r� �- 5zi 3, each branch circuit 7.42 + h iA J,AAT I iJ� f.7 L/tc 14 4-if ett} 1 e h-} B.Fee for branch circuits without " Address: service or feeder fee,first 1745 Mweit o tas 4.04i) branch circuit 56.18 City/State/ZIP: L+9 E bSt c3E4(�/ O 2 9 7 ajs Each add'l branch circuit -�_© Miscellaneous(service or feeder not included) Phone: J 4 43_ 4 41 q Each manufactured or modular dwellin•,service and/or feeder 67.84 2 t (SOj ) Email: /I A,R.TI N i 0 b V.4:151-1 Reconnect only II 67.84 CONTRACTOR '''F ', Pump or irrigation circle 67.84 Business name: 7 $l- b t-7-E-k -i f N is l> Apt,"t,i(..( "-j(", (p c, Sign or outline lighting 67.84 Address: (700 ZJ - 0 {� 1 i Signal circuit(s)or limited-energy ! ( panel,alteration,or extension. 0 See Page 2 2 City/State/ZIP: Van {�,�J 2---- Each additional ins.ection over allowable in an of the above / s1�t? Additional inspection(1 hr min) II 66.25/hr Phone:(�'1))0). t V) ' S( `,'-) _3 Investigation(1 hr min) 90.00/hr 11111 Email: `'.er� i ( ()f ( rj Lk_ J i c ( Industrial plant(1 hr min) MI78.18/hr min , Inspe tions for which no fee is 1 CCB Lic.: ( I Electrical Lic.: 39 L+ p nel , --- A& listed('%hr min 90.00/hr Suprv.Electrician signature,required: I, / ELECTRICAL.i I rI!EES ;� Subtotal: Print name: ( ar, l� Kek. / %Date: L.-Irl—i • _t Plan Review Required(25%of permit fee): Mill� State surcharge(12%of permit fee): �g.�V111 Authorized signature: �� �, TOTAL PERMIT FEE: MEM a ., This permit application expires if a permit is not obtained within 1:0 I Print name: A"Ev it,., J, l iffier/N Date:e a 21_2Q( $ days after it has been accepted as complete. I * Number of inspections allowed per permit. I:\BuildinglPermits\ELC PermitApp ELR_ERE,doc Rev t0/26/2517 440.4615T(11/0S/COM/WEB Julie Drinkwater From: Remi Johnston <remij@adkelectricinc.com> Sent: Thursday,January 17, 2019 10:01 AM To: #Building Permit Technicians Subject: Electrical Permit#ELC20118-00576 Attachments: Electrical Permit.pdf See attached signed permit. Let me know if you need anything else. Thank you! Remi Johnston ADK [PEL EC TRIC 9000 NE 90th St Vancouver,WA 98662 0:360-546-5155 I C:360-984-13981 F:360-576-6975 1