Permit rill a CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2022-00285
T i GA RD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 6/30/2022
Parcel: 1 S 136DC04600
Jurisdiction: Tigard
Site address: 7255 SW DARTMOUTH ST
Project: Planet Fitness Subdivision: 1995-013 PARTITION PLAT
Lot: 3
Project Description: Electrical for TI: (1)800 amp service with(3)branch circuits.
Contractor: Owner: COMMERCIAL NET LEASE REALTY, INC
450 S ORANGE AVE, STE 900
ORLANDO, FL 32801
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders-601 to 06/30/2022 $301.04
Specifics: 1000 amps
3 crt Branch Circuits w/Purchase 06/30/2022 $22.26
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea Plan Review Electricial 06/30/2022 $80.83
Type of Const: 4 ea Info Process/Archiving-Sm 06/30/2022 $2.00
Occupancy Grp: $0.50(up to 11x17)
1 ea 12%State Surcharge- 06/30/2022 $38.80
Electrical
Total $444.93
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 ap el,c,�a�ble 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 work is suspended for more the
180 days. ATTENTION. Oregon law requires you to follow the rules adopted by the Oregon Utility Lion Center Those r et forth in OAR
952-001-0010 through O R 2-001-0090. Yo av°rain a ow/of the rules or direct q: ::o ::e:ah0
503.23 . 87 r 1.800. .2344.
t`�/
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'N 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 OFFICF. 1 SF t)yI.l
Received g
City of Tigard Permit#:
• 13125 SW Hall Blvd.,Tigard,OR 97 a i1
g � / - € Plan Review
' 0 Phone: 503.718.2439 Fax: 503.59811960=�. 1 —(-: � �� Related Permit#:
Date/By: _
1 Inspection Line: 503.639.4175 Ready Date/ y. r J Juris: 0 See Page 2 for
11 T T G A R 1) Internet: www.tigard-or.gov fi d/Metho b
.41' � 1 Supplemental Information
1
",,.db v,+'.;`BcBT k4, , a" " e3 1- ".��nPa,,.: ., r`x a °p.r i:,,�: a, .a Ll 1 s
( , i-» ��,�s�aa!n'sr,.�a.Ir.���iPa��fY,�fi+`a't€w� z,+z � � ,.,,a'-- -; ..a-„�. ,� ,arer _ ,,.,. '.-,�` i.'' ;i l' + _ "a-a, �.
�� 0 New construction NI Addition/alters Onf lacerlier Please check all that apply(submit 2 sets of plans w/items checked)
' Service or feeder 400 amps or more ❑Building over three stores.
El Demolition El Other:
where[he available fault current ❑Marinas and boatyards.
oa',m''l''''''''''4,1" ' "11"r�p'�"s"T' 11 ,..,, iaa' .,;; .,� " i r_" r r ' A10#i
, '� ¢?,1'A'� 1 exceeds 10,000 amps at 150 volts or 0 Floating buildings.
El ® El and 2-family dwelling Commercial/industrial Accessory building less to groans,or exceeds Ia,o00 ❑Commercial-use agricultural
i amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other ❑Fire pump. 0 Installation of 150 KVA or
r5 rrl ar,- k,tl
t ; M 1t g t ; g ,. ❑Emergency system. larger separately derived
, ,. �a �
❑Addition of new motor load of system.
Job#: Job site address: 7255 SW Dartmouth St I0OHP or more. ❑"A","E "1-2","l-3
City/State/ZIP: Tigard, OR 97223 ❑Six or more residential units. occupancy.
0 Health-care facilities. ❑Recreational vehicle parks.
fi ❑Hazardous locations.
Suite/bldg./apt.#: I Project name:Planet Fitness, service 0 Supply voltage for more than
❑Service or feeder 890 amps or more. 600 volts nominal.
Cross street/directions to job site: if0.0: l it y'tre e.• s, vemeo tri g
Description Om1 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
fau"1°r a u "a,' . e x a ; ; Ea.add'l 500 sq.ft.or portion 33.92 1
_.. r:.N �,, . s a a> „ ,M:! ,Wvs, 4 Limited energy,residential 75.00 2
Upgrade the existing400 ampservice to 800 amp. only (wedeth negy,mbove sq.ftti
pq p Limited energy,multi-family 75.00 2
Install temp power & light circuits residential(with above sq.ft.)
�/ t Renewable Energy ❑ See Page 2
l oP "�rW i'Ora der/tl( /d1 ' 8 t�' `, o A g" Services or feeders installation,alteration,and/or relocation
e"��aa*t�l�.r . .. g.. . �, w
t 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 1 301.04 301.04 2
Phone:( ) I 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
>e%',+ +r e+"+s a"° �� Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: above service or feeder fee, 3 7 42 22.26 2
each branch circuit
Contact name: B.Fee for branch circuits without
56.18 2
Address: service or feeder fee,first
branch circuit
City/State/ZIP: Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular
dwelling,service and or feeder 67.84 2
Email: lei' Reconnect only 67.84 2
+a4 /I a r r z ..: „„,�'!l pea Zi -1
�a _ ,�e". �1 rt"a e� .� Pump or irrigation circle 67.84 2
Business name: Ertell Electric Sign or outline lighting 67.84 2
Address: Signal circuit(s)or limited-energy 0 See Page 2 2
PO Box 219 panel,alteration,or extension.
City/State/ZIP: Hillsboro OR 97123 Each additional inspection over allowable in any of the above
+ Additional inspection(1 hr min) 66.25/hr
Phone:( ) 503-841-4511 Fax:( ) Investigation(1 hr min) 90.00/hr
Industrial plant(1 hr min) 78.18/hr
Email: Dylan@ertellselectric.com Inspections for which no fee rs
90 00/hr
• .. specifically listed(h hr mm
CCB Lie.: 180540 Electr' ic.: � Suprv.Li ' 5420 � ��; �g�,� a
Suprv.Electrician signature,required: Subtotal: 323.30
Print name: Dylan Wen t • 0 I Da -: May 3rd, 2022 0 Plan Review Required(25%of permit fee): 80.83
State surcharge(12%of permit fee): 38.80
Authorized signature: TOTAL PERMIT FEE: 442.93
�.--r This permit application expires if a permit is not obtained within l80
Print name: Dylan We orth Date: May 3rd, 2022 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR ' .doc Rev 06/17/2015 440-4615T(l 1/05/COM/WEB