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Permit (9) CITY OF TIGARD' , I.. 'Ili ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit#: ELC2019 00745 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/31/2019 TIGARD Parcel: 1S134BC00300 Jurisdiction: Tigard Site address: 12264 SW SCHOLLS FERRY RD Project: Restore Cryotherapy Tigard Subdivision: None Lot: None Project Description: Electrical for TI:(1)panel replacement,(42)branch circuits for lighting,and low voltage for instrumentation. Contractor: ERTELL ELECTRIC LLC Owner: FW OR-GREENWAY TOWN CENTER LLC PO BOX 279 PO BOX 790830 FOREST GROVE, OR 97116 SAN ANTONIO,TX 78279 PHONE: 360-823-7223 503-841-4511 FAX: 503-359-5652 FEES Quantity Description Date Amount 1 ea Limited Energy 10/31/2019 $75.00 Specifics: 1 ea Services or Feeders-200 10/31/2019 $100.70 amps or less Type of Use: COM 42 crt Branch Circuits w/Purchase 10/31/2019 $311.64 Class of Work: ALT Service or Feeder Type of Const: 1 ea 12%State Surcharge- 10/31/2019 $58.48 Electrical Occupancy Grp: 1 ea Plan Review Electricial 10/31/2019 $121.84 Total $667.66 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--s forth in OAR 952-001-0010 through, AR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1. .332.2344. Issued By: AiPermittee Signature: .et-if/. /Gjal���~ 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 Application FOR OFFICE USE ONLY Received �/� CityofTigard �y "'� DateBy: �(��ip 1��1 r � Permit l���y—c�v7y� INv 13125 SW Hall Blvd.,Tigard,OR 97223 r 2 2 2 t9 Plan Review t �� ��11 Related Permit#: P,�1 —dtJ -Oc9 C Phone: 503.718.2439 Fax: 503.598.196®C DateBy: / e( Inspection Line: 503.639.4175 -t'k(°��� Ready Date/By: / Jun,: H See Page 2 for T I G A R D C i 4 o-. Notified/Method: 040/ rrji f�'(p Supplemental Information Internet: www.tigard-or.gov VS Please check all that apply(submit 2 sets of plans w/items checked): ❑New construction ®Addition/alteration/replacement ❑Service or feeder 400 amps or more ❑Building over three stories. ❑Demolition 0 Other: where the available fault current 0 Marinas and boatyards. q A exceeds 10,000 amps at 150 volts or 0 Floating buildings. less to ground,or exceeds 14,000 ❑Commercial-use agricultural ❑ 1-and 2-family dwelling ®Commercial/industrial 0 Accessory building amps for all other installations. buildings. ❑Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or 2� - ; I . i 4 I:Emergency system. larger separately derived ' f ❑Addition of new motor load of system. Job#: Job site address:12264 SW Scholls Ferry Rd 100HP or more. ❑"A">"E">"1-2">"1-3"> ❑Six or more residential units. occupancy. City/State/ZIP:Tigard,OR 97223 El Health-care facilities. ❑Recreational vehicle parks. Suite/bldg./apt.#: I Project name:Restore Crytotherapy El Hazardous 0 Supply voltage for more than locations. 600 volts nominal. ❑Service or feeder 600 amps or more. v , a �vk Cross street/directions to job site: .. .. ,... ! ,.�.. . im» r _. Description Qty. Each 1 Total 1 " New residential single-or multi-family dwelling unit. Subdivision: I Lot#: Includes attached garage. 1,000 sq.ft.or less 168.54 4 Tax map/parcel#: Ea.add'l 500 sq.ft.or portion 33.92 1 , B 'fi t,s._ 4 6 ;.•:!!-3:';(-;:',;,• _ Limited energy,residential 75.00 2 Replace 200 amp panel,branch circuits for power&lighting of a TI (with above sq.ft.) Limited energy,multi-family 75.00 2 residential(with above sq.ft.) �r,,. Renewable Energy 0 See Page 2 OPERTY OWNER 0 TENANT; .,� ❑i `'`t Services or feeders installation,alteration,and/or relocation Name: 200 amps or less 1 100.70 100.70 2 201 amps to 400 amps 133.56 2 Address: 401 amps to 600 amps 200.34 2 City/State/ZIP: 601 amps to 1,000 amps 301.04 2 Phone:( ) 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 Branch circuits—new,alteration,or extension,per panel A.Fee for branch circuits with Business name: above service or feeder fee, 42 7 42 311.64 2 each branch circuit Contact name: B.Fee for branch circuits without service or feeder fee,first 56.18 2 Address: branch circuit Each add'I branch circuit 7.42 2 City/State/ZIP: Miscellaneous(service or feeder not included) Phone:( ) I Fax: :( ) Each manufactured or modular 67.84 2 dwelling,service and/or feeder Email: Reconnect only 67.84 2 d - l f ' Pump or irrigation circle 67.84 2 Business name:Ertel)Electric,LLC Sign or outline lighting 67.84 2 Signal circuit(s)or limited-energy ® See Page 2 75 2 Address:PO Box 219 panel,alteration,or extension. Each additional inspection over allowable in any of the above City/State/ZIP:Hillsboro Additional inspection(1 hr min) 66.25/hr Phone:(503)841-4511 I 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 is 90.00/hr CCB Lic.: 180540 I Electrical Lic.: C390 Aiiii uprv.Lic.: . s i-cificall listed h hr min Suprv.Electrician signature,required: `��" Subtotal: 487.34 Print name: Dylan Wentworth ���^I• e: Oct 21,2019 _ 0 Plan Review Required(25%of permit fee): _ 121.84 State surcharge(12%of permit fee): 58.48 TOTAL PERMIT FEE: 667.66 Authorized signature: This permit application expires if a permit is not obtained within 180 L- Print name: Dylan Wentwort a ate: Oct 21,2019 days after it has been accepted as complete. * Number of inspections allowed per permit. I:\Building\Permits\ELC_PermitApp_ELR_E .doc Rev 06/17/2015 440-4615T(I1/05/COM/WEB Electrical Permit Application—City of Tigard Page 2—Supplemental Information Permit Fees: Limited EnergyPermit Fees: Renewable Energy --gg 044:41441:7-140,i- 1: Fee for all residential systems combined: $75.00 3' Renewable electrical energy systems: Check Type of Work Involved: 5 kva or less 100.70 _© 5.01 to 15 kva MI 133.56 _© ❑ Audio and Stereo Systems* 15.01 to 25 kva - 200.34 _© Wind eneration s stems in excess of 25 kva: ❑ Burglar Alarm 25.01 to 50 kva - 301.04 _© 50.01 to 100 kva 552.26 _© ❑ Garage Door Opener* >100 kva(fee in accordance with OAR 918-309-0040 ■ 552.26 -© ❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva: System* Each additional kva over 25 El 7.42 111 ❑ Vacuum Systems* >100 kva—no additional charge - 0.0 _© Each additional ins ection over allowable in an of the above: ❑ Other: Each additional inspection is ■ 66.25/hr —� char t ed at an hourl 1 hr min Inspections for which no fee is 1. 90.00/hr —. s.-cificall listed '/2 hr min Fee for each commercial system: $75.00 Subtotal(Enteron Page 1): y • Number of inspections allowed per permit. (SEE OAR 918-309-0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC Z)Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I:\Building\Pem its\ELC_PermitApp_ELR_ERE.doc Rev 10/26/2017