Permit CITY OF TIGARD ELECTRICAL PERMIT
1111 ,
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00364
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/30/2011
Parcel: 1 S 126CA00100
Jurisdiction: Tigard
Site address: 9225 SW HALL BLVD F
Project: Ideal Image Subdivision: FAIRVIEW PLACE CONDO Lot: 20
Project Description: Electrical for TI.
Contractor: ERTELL ELECTRIC LLC Owner: GREENBURG CORNERS LLC
PO BOX 279 BY MENASHE, R BARRY
FOREST GROVE, OR 97116 621 SW ALDER, SUITE 605
PORTLAND, OR 97205
PHONE: 503 - 841 -4511 PHONE:
FAX: 503 - 359 -5652
FEES
Quantity Description Date Amount
26 crt Branch Circuits wo /Purchase 06/30/2011 $241.68
Specifics: Service or Feeder
1 ea 12% State Surcharge - 06/30/2011 $29.00
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $270.68
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 may obtain a co. o the rue or direct questions to OUNC by calling 503 .1987 or 1.800.332.2344.
Issued By: /i; / Perm ittee Signature: c =5e 4.
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.
Jun 29 11 03:44p Ertel] Electric, LLC 5033595652 p.2
Electrical Permit Applicatio 'E D t oli. USE ON
City of Tigard / Received
/� • 13125 g,y Hall Blvd., T igard, OR 9722 Date/B : / v Permit No::
10 2 9 2011 Plan Review � ��/ r! y
.
Phone: 503 Fax: 503.598 6
Date O /
Dare/By: Other Permit: { r/
T 1 CsA R p Inspection Line: 503 639.4175 C Date R Ready, By: Ott 1 I f A j_.. do t 1 3
Internet www tigard or gov TTY OF TIGARD Notified/Method
r ®pplemcntallnformmtiun
:: E?. � w 7b :: ,p !.f,. 11 4V10
❑ New construction E Addition /alteration/replacement Please check all that apply (submit 2 sets o w /items checked below): '
0 Service or feeder 400 amps or more 12 Building over three stories.
❑ Demolition ❑ Other:
where the available fault current ❑ Marinas and boatyards.
,' aT' 1tt F N', R1.1 ov . exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
❑ 1 - and 2 dwelling less to gr ound, or exceeds 14,000
Y g ® Commercial /industrial ❑ Accessory building ❑Coaunewial -use agricultural
El Multi-family mps for all other installations. buildings.
Y ❑ Master builder ❑ Other: CI pump.
❑ Installation of75KVAor
3 r ,- I.1DS ❑Emergency system, larger separately derived system.
❑ Addition of new motor load of ❑ `A ", ••E•' "I-2", "1 -
Job no,: Job site address: 9225 SW Hall Blvd t so, T, r 1001 or more R c i
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State/ZIP: Tigard Or 97223 ❑ Health - care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suiteibldg'apt. no.: Project name: Ideal Image 0 Service er feeder 600 amps or more.
Cross street/directions to job site: EEE SCHErtfLl -
Description I Qty. i Fee, 1 - Total
New residential single- or multi - family dwelling unit.
includes attached garage.
Subdivision: Lot no -: 1,000 sq. ft. or less b 168.54 4
Tax map/parcel no.: Ea. add'1 sq. ft. or portion 33.92
:: itSt t ](f)PII; - `t7Tt#K - Limited (w th above sq ti
Limited energy, multi-family 7500
2
lti - family
New lighting and power circuits for tenant improvement residential (with above sq. ft.) 75.00 2
I
Services or feeders installation, alteration, and /or relocation
200 amps or less I 100.70 • 2
1''1R(3YEIt't d' ,, '
' 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 2D0.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City /State/ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 l
Owner installation: This installation is being made on property that 1 own which is not 201 amps to 400 amps _ 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 l 2
Owner signature: Branch circuits — new, alteration, or ex_ tension, per panel
t] 'P jc. 1tl" ;; 10.4 T P #RSt)111 A. 4e boveservice h or t feederfze
Cf fit;! � 7.42
_ - each branch circuit 2
Business name: B. Fee for branch circuits without
service or feeder fee, first I 56
Contact name: branch circuit 56.E8 2
Address: Each add' I branch circuit 25 7.42 185.5 2
Miscellaneous (service or feeder not included)
CitylState /ZIP: Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Piscine: ( ) Fax: : ( ) Reconnect only 57.84 2
E Pump or irrigation circle 67.84 2
. 0*178, itgI '. lighting 67.84 2
ten or outline li
Signal circuit(s) or limited- energy
Business name: Ertell Electric, LLC panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: P.Q. Box 279 Additional inspection (1 hr min) 66.25! hr
City:State/ZIP: Forest Grove Or, 97116 Investigation (1 hr min) 66.251 hr -
Industrial plant (1 hr min) 78.18, hr
Phone: (503) 841 - 4511 Fax: (503) 359 - 5652 Inspections for which no fee is
specifically listed (Yx hr min) 9900i hr
CCB Lie.: 180540 Electrical Lie.: C 390 ,Lie.: 5420 S 1 0i _ )yI `i> $ 41/01
Suprv. Electrician signature, required: ( Subtotal: 241.68 '
Plan review (23% of permit fee): :
Print name: Dylan Wentworth ' Date: 29 June 2011 State surcharge (12% of permit fee): 29
Authorized signature: � TOTAL PERMIT FEE: 270.68
This permit application expires if a permit is not obtained within 180
Print name: Dylan Wentwo 10fr Date: 29 June 2011 days after it has been accepted as complete.
' Number of inspections allowed per permit.
BuildingPermitslEL -PermitApp.doc 07 /OI/10 440405Tt11/05/COMWEn