Permit CITY OF TIGARD ELECTRICAL PERMIT
I . COMMUNITY DEVELOPMENT Permit #: ELC2013 -00349
Date Issued: 06/26/2013
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 parcel: 1S135BC00100
Jurisdiction: Tigard
Site address: 10775 SW GREENBURG RD
Project: Tigard 76 Station Subdivision: HILLSBORO Lot: PTS 1 -2
Project Description: (1) 401 -600 amp panel for car wash.
Contractor: ERTELL ELECTRIC LLC Owner: RAJ PETROLEUM
PO BOX 279 ATTN: BATRA, RAY
FOREST GROVE, OR 97116 10775 SW GREENBURG RD
TIGARD, OR 97223
PHONE: 503 - 841 -4511 PHONE:
FAX: 503 - 359-5652
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 401 to 06/26/2013 $200.34
Specifics: 600 amps
1 ea 12% State Surcharge - 06/26/2013 $24.04
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $224.38
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 090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1 800.332.2344.
Issued By: Permittee Signature: dA. e-/ci 41-77 o
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 503.639.4176 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.
Jun 24 13 03:OOp Ertell Electric, LLC 5033595652 p.1
Electrical Permit Applicati E l� JE FOR OFFICE USE ONLY
N � Received City of Tigard 2 �1� (� ®� j PLC- • , "" 003
1,
g � U N 2 Date!B . Permit Vo :
• 13125 SW Hall Blvd., Tigard, OR 97223 IV P1ar. Keview ��
Phone: 503, 7 18.2439 Fax: 503.598 196 Date/By. Other Permit
TIb,ARD Inspection Line: 503.639 4175
CITY ®r DeteReadyBy- tune: // B See Page 2for
Internet. www.tigard-or.gov I Y r TIGARD N ouTiedMethod, � I Supplemental Information
TypE op Alli DIVI SIOI`t
❑ New construction Igl Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below'
❑ Service or feeder 400 amps or more El Building over three stories
I:
Demo I aion ❑Other:
where the available fault current ❑ Marinas and boatyards
• CATEGORY OF CONSTRIICTI3N exceeds 10.000 amps at 150 volts or ❑ Floating buildings
less to ground, or exceeds 14.000 ❑ Commercial -use agricultural
❑ I - and 2 -family dwelling gCommerciallindustrial ] Accessory building amps for all other installations buildings
❑ M ulti- fan_ly ❑ Master builder : Other ❑ Fire pump ❑ Installation of 150 KVA or
❑ Emergency system. larger separ:dely derived sysein.
JOB SITE INFORMAT1ON AND! LOCATION
❑ Addition of new motor load of ❑ "A" "E" "l -2" "l -3"
no. Job site address: t �7 \ 1001 -iP or more occupancy
;�h n
1 O �� S1.) �f l tr ❑ Ste or more residential units ❑ Recreational vehicle parks.
Ci /State./7.IP: I 1 t 1 ( t7 r ❑ Health-care facilities. ❑ Supply voltage for mane than
t t L{ CL ( L G _ ❑ Hazardous locati 600 volts nominal.
Suile;blde. /apt. no.: vJ Project name: ❑ Service or feeder 600amps or more
./�>�u�o �.h • - FEE SCHEDULE , '
Cross street/directions to job site: Description I Qtv Fee I Total I •
New residential single or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq R or less 16854 4
Ea. add'] 500 sq ft or portion , 33 92 1
Tax map/parcel no.: Limited energy, residential 1 75 00 2
with above sq. A.
DESCRIPTION OF w ,lRrr � ( q. )
Limited energy, multi- family '
,��. � � Q' C O3 I" a . 3e residential (with above sq. ft) I 75.00 2
1 `
1 Renewable Energy ❑ See Page 2
Services or feeders installation, alteration, and/or relocation
❑ PROPERTY OWNER 1 ❑ TENANT 200 amps or less 100 70 2
201 amps to 400 amps 133 56 2
Name.
401 amps to 600 amps t 200.34 2/20 3* 2
Address 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552 26 2
City/State/ZIP: Temporary services or feeders installation, alteration, and /or
Phone: ( ) Fax: ( relocation
200 amps or less 59 36 1
Owner instr llation: T> installation is being made on pro erty that I own which is not 201 amps to 400 amps 125.08 2
int.ndcd far sate. least, ; -1 or exchange, according to OR 44 ?, 449. 670, and 701. 401 amps to 599 amps 168 54 2
Owner signature: Date: Branch circuits- new, alteration, or extension, per panel
❑ APPLICANT ❑ . ONTACT PERSON A Fee for branch circuits with
above service or feeder . 7 42 2
Business 'tar; each branch circuit
i - - -- B Fee for branch circuits without
Cm.ltact name: service or feeder fee, first 56 18 2
branch circuit _
Adc. ess: Each add'I branch circuit 1 7.42 2
L
Ciri /State/LI ?: Miscellaneous (service or feeder not included'
�� Each manufactured or modular 67.84 2
?il ;ci e: j Fax: - ( ) dwelling, service and/or feeder
_. Reconnect only 67.84 2
ii : Pump or Irrigation circle 67.84 2
CONTRACTOR - S :gn or outline lighting 1 67 84 2
Bus ness name: r Signal circuit(s) or limited - energy See
Lrl_'T Ct� - - i panel, alteration, or extension. Page 2 2
Address Cp C) p c 2 - 7 c3 Each additional inspection over allowable in any of the above
Additional inspection (I hr min) 66.251 hr
Citl iState'Z
pir '�7�f ' C q�/ f Invcstigation(1 hr mm) 6625l
Phone: ( 8 t'�' „1 _ . •= Fax: or _ Industrial plant (1 hr min) 78.181 hr
so- Inspections for which no fee is
CCB Lie . .a[. Electrical Lie.: , ■ i , I Supry Lie.: speafcalrylisted( % : hr min) 9000 /hr
�� ELECTRICAL PER?1ilT FEES
Subtotal:
Supt v, Elect ician si;natur.;, required: �� Plan review (25% of permit fee): -
� _ ___ _.1 = - = ��.� 2_00 - - f -'��
Pr�nt -- �A� / Date: � [� _
TOTAL PERMIT FEE 7
e ' State surcharge (12°% o f permit fee)- 24
h ithcrize l sip. ta[ur : �� Ai ») .A.-. r ) .
' '�� :..
This permit application expires if permit is not obtained within 180
Print nalnz: 1/e '. ` ` r(� 1 `GI' Date: CO _2 - — i days after it has been accepted as complete.
r`-r ' Number cf inspections allowed per permit.
t sBwldin 5'P errrus\c'_ _Ptrmr4p:_ELI :_EREdoc Rev 0521/3013 .40-4615T(I i /05rCOMAVEB
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
10775 SW GREENBURG RD, TIGARD, OR,
97223
Commercial - Electrical
199 Electrical final
2013-11-21 00:00:00
ELC2013-00349
FAIL
Need added permit fees an contractor will recall. Email todd@ertellselectric.com
Violation Summary:
Inspector Contractor