Permit CITY OF TIGARD ELECTRICAL PERMIT
11 • COMMUNITY DEVELOPMENT Permit #: ELC2010 -00537
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09!29!2010
Parcel: 2S112DB00200
Jurisdiction: TIGARD
Site address: 15255 SW 72ND AVE
Subdivision: FANNO CREEK ACRE TRACTS Lot: 45
Project: Pittman & Brooks
Project Description: Electrical for second floor TI.
Owner: FEES
BROOKS & PITTMAN RENTALS Quantity Description Date Amount
15255 SW 72ND AVE
PORTLAND, OR 97224 6 crt Branch Circuits 09/29/2010 $93.28
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 09/29/2010 $11.19
Electrical
Contractor:
ERTELL ELECTRIC LLC
PO BOX 279
FOREST GROVE, OR 97116
PHONE: 503 -841 -4511
FAX: 503 - 359 -5652
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $104.47
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 9 2- 001 -0100. You may obtain a copy of the direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By — _ ittee Signature: r �_. // �� — 4411 �, 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 an inspection that business day.
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.
CC VD
Electrical Permit Application gtCL FOR OFFICE USE ONLY
City of Tigard S E P 2 a 20 0 Received
Date/F3v: elt 0 P ermit No. ,L la —
r
111 =
13125 SW Hall Blvd.. Tigard, OR 97223 k �QQ 1
Phone: 503.639.4171 Fax: 503.598.1960 � r1l jt'►s i e Other Permit: i (.4 ' I 0015 TIG, RD Inspection Line: 503.639.4175 C IN'ta s
rite Ready' Other
L3 See Page for
Internet: www.tigard - or.gov a " �, ^1N�� Notified/Method: �i Supplemen Information
TYPE OF WORK V PLAN REVIEW
❑ New construction a Addition /alterationrreplacement Please check all that apply (submit 2 sets of plans w /itetns checked below•):
❑ Service or teeccr 400 amps or more ❑ Building over three storie .
❑ Demolition ❑ Other: whctc the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10.000 amps at 150 volts or ❑ Floating buildings.
less to mound, or exceeds 14,000 ❑ Commercial -t .e agricultural
❑ 1- and 2- family dwelling ® Commercial/industrial ❑ Accessory building amps for all other i :rstallations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA ur
['Emergency sstem. larger separately cerived system
JOB SITE INFORMATION AND LOCATION Q Addition of new motor load of ❑ "A" `G" ' 1 -'_" I -1"
Job no.: Job site address: 7 1001-IP or more. occupancy.
�5 SW l 7 ❑ Six or mom residential units. ❑ Recreational vehicle parks.
Cil)'iStatc/ZiP: --7-76 t / -Q �'J 726 ❑ Feahh - cnrefacilities. ❑ Supply voltage for more than
a� / ❑ I aaardotts locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: 4) Ai n . 1614 o k J ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 Qt`. I Fee. 1 Total 1 '
New residential single- or multi - family dwelling unit.
includes attached garage.
Subdivision: Lot no.: 1,000 sq. R. o less 168.54 4
Tax map/parcel no.: Ea. add'I 500 sq. R. or portion 33.92 1
Limited energy. residential 75.00 2
DESCRIPTION OF WORK (with above sq. lt.) .
Limited energy. multi - family 75.00 2
-� .A1 ( / ((o i >p��j JZL
ea ej •� �. p residential (wild above sq. ft.) _
I Services or feeders installation, alteration, and/or relocation
L.,07..L.41. Fe.c04— A Db 200 amps or less 100.70 2
0 PROPERTY OWNER - I ❑ 'TENANT 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200 34 , 2
601 amps to 1.000 amps 301 04 2
Address: Over 1,000 amps or volts 552.26 2
CitvlStatl /ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) 1 Fax: ( ) 200 amps or less 59.36 I
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that 1 own which is not
401 amps to 595 amps 168.54 2
intended for sale- lease, rent- or exchange, according to ORS 447. 449, 670, and 701. Branch circuits - new, alteration, or extensioe, per panel
Owner signature: Date: A. Fee for branch circuits with
- • ❑ APPLICANT . ' .I " ❑: CONTACT PERSON above service or feeder fee, 7.42 2
each branch circuit
Business name: f z L .G.Tie _cc:. Gz B. Fur for branch circuis without
1 service or seeder fee. first 1 56.18 5: 03
Contact name: / y �� branch circuit
(i4rt l Gt � i r..- r `� Each add branch circuit ;j , 7.42 37.
Address: o ( g 42)4 Z Miscellaneous (service or feeder not included) _
Each Cit)!State:ZIP: T 20 , t. .n 17 3 ' 7 �c, dwelling. service or modular 67 84 2
• -- t/Y� C�JC. ! dwcll:n servicce and/or fucder
Phone: (s•y ) vT yg-i f Fax: : (555 ). Sloes Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail:
Sign or outline lighting 67.84 2
• . CONTRACTOR . • : : - Signal circuit(s) or limited - energy
Business name: panel. alteration, or extension. Page 2
/ 2 lLzz. a .C�G�l.l� �[� Each additional inspection over allowable in any of the above
Address: ��... .4� 1tR'nt t,� Additional inspection (1 hr min) 66.25/ hr
City /Stag /Z]P: investigation (1 hr In in) 66.25/ hr
Industrial plant (I hr min) 78.18/ hr
Phone: ( ) Fax: ( ) Inspections for which no fee is 90.0C/ hr •
specifically listed (Ar lir min)
CCB Lic.: /9 Electrical Lic.:G 3c . Suprv. Lic.: . . ELECTRICAL PERMIT FEES
Subtotal: q 3 .z g
Suprv. Electrician signature. required: / T . _`..... Plan review (25% fee):
Print name: / ` `. Date: State surcharge (12% of permit fee): 1/..,--z75 / , / R
j - TOTAL PERM' FEE: sZJ[ &Il fl f1
Authorized sig azure: / _- This permit application expires if a permit is not obta ithin loo
days after it has been accepted as complete.
Print name: er Date: Z ; S .. • Number of inspections allowed per permit.
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