Permit v CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00242
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/10/2011
Parcel: 2S109AB08500
Jurisdiction: Tigard
Site address: 14255 SW 131ST PL
Project: BLOMMAERTS Subdivision: RAVEN RIDGE Lot: 14
Project Description: Installing transfer switch and generator at residence.
Contractor: ERTELL ELECTRIC LLC Owner: BLOMMAERTS, FRANK J
PO BOX 279 14255 SW 131ST PL
FOREST GROVE, OR 97116 TIGARD, OR 97224
PHONE: 503 - 841 -4511 PHONE:
FAX: 503 - 359 -5652
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 05/10/2011 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 05/10/2011 $12.08
Type of Use: MF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112.78
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 OA' • 2- 001 -0090. You ma • - _. ,:• he rules or .' ect questions to OUNC by calling 503.232.1987 or 1.800.332.2344
/ n
Issued By: /�� .�G -�—r c - 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 Applicat
'°' .CE
TVED ..
.. FOR OFFICF.. USE ONLY
Received iffi p" enn No.
Date/l3 •: Oral ___-. -AA I f
lig • 1 City of Tigard 3125 SW Hail Blvd., Tigard, OR 94OIV
II 1 0 2011 Plan Review
2 . * - Phone: 503.718.2439 Fax: 503,598.1 60 Datc/Bv: Other Permit:
TIGARD Inspection Line: 503.639.4175 CITY OF Date Ready!By: RI See Page 2 for
Internet: cvww.t Try igard-or.gov %,-- oF TIGARD Notified/h4ethod: hMilar SUPPICMCIlla I I nfo rmation
;1- :- ... ...;., .;:::- A :: ''-: :-- - i: r: r••••t.tr.t - tifiviiPtingilk MINION::: :;;• •tt E:, .7.. 7? iF. : := - - . 7 .i:J ':;.• .'' .• .: ' •• 77 . PLAN littVIEW , • • ' :: '
,:',. ..-,, q:.. ,,,.:., .,-, -;-: ;',: -:, ---:::.:-:-,,,:: -,.'"F..: ,:: . ':, ..._: : :: .., - - --. 7.: li;- - - ,1 ; •', "' '• ' ;" ;:i ;, ::' ' - ' ' 7 - '''''' ":' ;•: • - • ;• • • • - - • . •• - - • - ' •
D New construction Addition/alteration/replacement
Please check all that apply (submit 2 sets of plans uditeirs checked below):
z
Er3 Service or feeder 400 amps or more 0 Building over throe stories.
0 Demolition 0 Other: where the mailable fault current 0 Marinas and boatyards.
i 't •• - it- '7 . i7. 7 7 f -:-:: :tCATEGORYT=OF - ..CONSTRPPOON ii: , - ; 1 . - - ,':',:: ",' - l" - • - , - '' exceeds 10,000 amps at 150 volts or Floating buildings
less to ground, cr exceeds 14,000 [ICommercial-use agricultural
El I - and 2-family dwelling 0 Commercial/industrial D Accessory building amps for all other installations. buildings.
0 Multi-family 0 Master builder 0 Other: El Fire pump. 0 Installation of 75 KVA or
' t ,• 7 .,,. , , = ,', : ' • - . ,- - - - - ' • .. . - - .- - -- • : ,- , , . 2- -- ., ['Emergency system larger separately derived system.
1 t .. ';......- ,.. ';' ;`, •: , L•t. 40 -Slit; PNt'Ciii.Mkili*.E:ANII ''. .0•1 -- : '•t• I ':I -1: ''-- '' -: s • " 0 Addition of new motor load of
Job no.: Job site address: 14255 SW 131 Place 1001 or mote.
12 Six or mare residenti occupancy.
al mils. 0 Recreational vehicle parks.
City/State/ZIP: Tigard OR 97224 U Health facilities. 0 Simply voltage for more Man
0 Hazardous locations. 800 volts nominal.
Suite/bIdgJapt. no.: Project name: 0 Service or feeder 600 amps or more
H.;t t iI ii ft t. : . II:;• i: ' . -
FEE SCHEDULE
Cross street/directions to job site: Description I Om I Fer. I Total I .
New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54
. , 4
Ea. add' I 500 sq. ti_ or portion 33.92 I
Tax map/parcel no.: Limited energy, residential
75 00 2
,-. i l : - . ...!„i F _ : , . ..1 ?.: ,. . .. 6 s 414 . 61 0 144 *ow 1 ,!; II.; ,. il: ii t,1•:.; it (with above sq. ft.)
" ' - ' ' 1 ' ' . - . - - Limited energy, multi-family 0
75 0. /
Install transfer switch and generator at residence residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation •
200 amps or less 1 100.70 100.70 2
'• - • t, ,..,: . 0 • - -
A -,- i : ._..: .;; !: A . ,_ .. 0 : :: ;.; ;A .:.-, .-. -. 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
Temporary services or feeders installation, alteration, a ndfor
CityiState/ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps i 25.08 2
Owner installation: This installation is being made on property that I own which is not
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps 10 599 amps 168.54 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A Fee for branch circuits with
. :: .1; . :a , . above service or feeder fee,
ElA.P.OLiCkift ' ';:' .'' - • -: ;:-' 1 i -' tE d NTT a iktikili I: t : z ' ' ' ' I : - ' 7.42
_ . . each branch circuit ,
Business name: B. Fee for branch circuits without
service or feeder fee, first
56.18 2
Contact name: branch circuit
Each add'I branch circuit. 7.42 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular
City/State/ZIP: 67.84 2
dwelling. service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.54 2
Pump or irrigation circle 67.84 2
E-mail:
Sign OT outline lighting 67.84 2 ,
r -: :,. .i.,•1--, ;' . ,-E: :: ! ;1 .'?' ,_-_. :091S71.1.XCIOR,f i 1 ;!:' :: .;- it, :II Ei ;it ' F- ':..'l . I i; Signal circuit(s) or limited -energy
Business name: Ertell Electric, LLC panel, alteration, or =tension. Page 2 2
Each additional inspection over allowable in any of the above
Address: P.O. Box 279 Additional inspection (1 hr min) 66.25/ lit .
,
Investigation (1 hr min) 66.25i hr
CitylState/ZIP: Forest Grove, OR 97116
Industrial plant (I hr min) 78.18/ hr
Phone: (503) 841-4511 Fax: (503) 359-56-52 Inspections for which no fee is 90 hr
specifically listed (A hr min)
CCB Lie.: 180540 Electrical Lie.: 5,190 a ' ' . • ':;';': :: .V
. ,..,- . LEC 1
TRICAX-RMIT FEES :
Suprv. Electrician signature, required: / / 1110 - W OS
Subtotal: r 100.70
Plan review (25% of permit Ice):
,
Print name: Dylan We orth .
•
i Date: 9 May, 2011 State surcharge (12% of permit fee): 12.08
--"------.............„, TOTAL PERMIT FEE: 112.78
/-
Authorized signature: , This permit application expires if a permit is not obtained within 190
_....---------------,_ , _
da,s after it has been accepted as complete.
Print name: Dylan Wentwott Date: 9 May, 2011 • Number of inspeckons allowed per permit.
. .
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