Permit (14) CITY OF TIGARD ELECTRICAL PERMIT
' COMMUNITY DEVELOPMENT Permit#: ELC2023-00569
Date Issued: 9/21/2023
TRGAKD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S136DD01300
Jurisdiction: Tigard
Site address: 6855 SW BAYLOR ST
Project: Kruse Woods Financial Partners Subdivision: WEST PORTLAND HEIGHTS Lot: 18
Project Description: (11)branch circuits and low voltage for data telecommunication installation for TI.
Contractor: ERTELL ELECTRIC LLC Owner: PROJECT 3.0 LLC
PO BOX 279 6855 SW BAYLOR ST
FOREST GROVE,OR 97116 TIGARD,OR 97223
PHONE:
PHONE: 503-841-4511
FAX: 503-359-5652 FEES
Quantity Description Date Amount
11 crt Branch Circuits wo/Purchase 09/21/2023 $130.36
Specifics: Service or Feeder
1 ea 12%State Surcharge- 09/21/2023 $24.65
Type of Use: COM Electrical
Class of Work: ALT 1 ea Signal circuit or Limited 09/21/2023 $75.00
Energy Panel
Type of Const:
Occupancy Grp:
Total $230.03
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes an all other applicable law. •II work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuanc , or if work is suspended f•r more the
180 days. ATTENTION: O law requires you to fo he rules adopted by the Oregon Utility•,.ification Ce er. Those - are set fo h in OAR
952-001-0010 throua R 01-0090. You may c n e rules or direct questions to OUNC by calling .232.198 or 1.81: 4,0
Issued 8y: 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'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 OFFICE USE ONLY
fTigardRECEIVED Received a �� v3 �p �> C�2�'OG5�Q
City o — Permit 4:
natn;B .
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
i Phone: 503.718.2439 Fax: 503.598.19(� Date/By: Related Permit
Inspection Line: 503.639.4175 JEP 21 2023 Ready Date/By: hills: lill Sec Page 2 for
TIGARD Internet: www.tigard-or.gov Notified/Method: (Mc hills:
Information
f
TY OF TIGARD
TYPE OF WQ „ G^ :-;t _,,•.. PLAN REVIEW
❑New construction ®Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w items checked):
❑Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition ❑Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
0 1-and 2-family dwelling E Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
snips for all other installations. buildings.
❑Multi-family ❑Master builder 0 Other: ❑Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system larger separately derived
❑Addition of new motor load of system.
Job#: Job site address: 6855 SW Baylor St 100HPormom. ❑`A',"e".'l2 "1.3
City/State/ZIP: ❑Six or more residential units. occupancy.
Tigard, OR 97223 ❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name: KWFP tenant im rov. ['Hazardous locations. 0 Supply voltage lbr more than
❑Service or feeder 600 snips or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description l Qty. I Each I Total I *
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 i
DESCRIPTION OF WORK l ,, „ -ern
Limited energy,residential 75.00 2
Power and lighting circuits for tenant improvement (wed energy sq.,
multi
g p Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Renewable Energy ❑ See Page 2
D PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: `�Y)\�tjl 3 4 LLL 200 amps or less 100.70 2
Address: la SS %\. . , r .- 201 amps to 400 amps 133.56 2
q 401 amps to 600 amps 200.34 2
City/State/ZIP: ✓, /�J, /'I t O' 11'L1` 601 amps to 1,000 amps 301,04 2
Phone:( ) t�j) v� ,JI 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
- - - - - A.Fee for branch circuits with
Business name: � n� al u bu above service or feeder fcc, 7.42 2
each branch circuit
Contact name: B.Fee for branch circuits without
service or Address: branch circuitdcr fee,first 1 56 18 56.18 2
City/State/ZIP: Each add'I branch circuit 10 7.42 74.20 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax: : ( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: Reconnect only 67.84 2
''. CONTRACTOR Pump or irrigation circle 67.84 2
Business name: Ertel) Electric, LLC Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energyIX See Page 2 75.00 2
Address: PO Box 219 panel,alteration,or extension.
Each additional inspection over allowable in any of the above
City/State/ZIP: Hillsboro, OR 97123 Additional inspection(Ihrmin) 66.25/hr
Phone:( ) 503-841-451 1 Fax:( ) Investigation(1 hr min) 90.00/hr
Email: dylan a erteliselectric.com Inspectionsl fnrt(I whichhr no) 78.18/hr
Inspections for no fee is 90 007 hr
CCB Lie.: 180540 Electrical Lie.: C 390 Suprv.Lie.: 5420 S specifically listed(i hr min)
W,..
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Dylan Wentworth-4.--N—
... 1 -"' Subtotal: 205.38
Print name: Dylan Wentworth Date:September 21,2023 0 Plan Review Required(25%of permit fec):
State surcharge(12%of permit fee): 24.65
Dylan Wentworth 4.`" '""`u` 'a"" TOTAL PERMIT FEE: �775
Authorized signature: „„
This permit application expires if a permit is not obtained within 180
Print name: Dylan Wentworth Date:September 21,2023 days after it has been accepted as complete. zt
* Number of inspections allowed per permit.
I:Building Pumas\ELC PermitApp ELR_F:RE.doc Rev06/17/2015 440-4615T(I103 Mr 5/COWEB 2,^/'y,03