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Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT COMMUNITY DEVELOPMENT Permit #: ELR2011 -00177 .TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/28/2011 Parcel: 1 S126CA00100 Jurisdiction: Tigard Site address: 9225 SW HALL BLVD F Project: Ideal Image Subdivision: FAIRVIEW PLACE CONDO Lot: 20 Project Description: Data telecommunication 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 Description Date Amount Specifics: Restricted Energy Permit 07/28/2011 $75.00 12% State Surcharge - Electrical 07/28/2011 $9.00 Type of Use: COM Class of Work: ALT • Total Number of Systems: 1 Audio & Stereo: N Boiler Controls: N CCTV: N Clock Systems: N Data & Telecommunications: y Fire Alarm: N HVAC: N Instrumentation: N Intercom /Paging: N Landscape /Irrigation: N Landscape Lighting: N Medical: N Nurse Calls: N Protective Signal: N Security Alarm: N Other: N Total $84.00 Other Desc: 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 95 -I 41-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Pr Issued By: ' - Permittee Signature: 6/(/ Lip �L/ 6�f /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 503.639.4175 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. Jul 26 11 12:35p Ertell Electric, LLC , 5033595652 p.2 Electrical Permit Applicati - 1 7 L) FOR OFFICE USE ONLY • Ci of Tigard I Received • 13125 SW Hal] Blvd. Tigazd, OR 971.1 U0 L 2 6 2011 ClateBy: 2/71"17/1 Permit No.:�G��� 7 Phone: 503.718,2439 Fax: 503. 598.1960 n ; Plan Review �/ ` TIGARI] Internet: www tigard - oInspection Line: 503.639.4175 CITY OF�iS�tiflU Date/By: tens ermi p� ��� h� Date Ready /By; p i gov ��I OrI, Nolr I Su Sa ©8/ e et od: _,. - .. .,. _ _ mental[nforma uon I� DING d/Nl 1 d• R i D. l Sn !e pp ew construction 0 Addition /alteration /replacement Please apply check all that a (submit 2 sets ofplans wittcins checked below): ❑ Demolition Other: ❑ Service or feeder 400 amps or more 0 Building over three •• - - --�� - _ _ where the available fault current ❑ Marinas , nd boatyards. - - [CS - ���: >� �`.. .. ; : -q ,,_:, exceeds 10, amps at 15C volts or ❑ Floating buildings. ❑ 1- and 2- family dwelling IZ Commercial /industrial building ❑ Multi-family - l ees to moun d 000 e r excee t4,000 ❑ C ornme cia -n a giculturat ❑ Accessory bui mily amps for other installations. building . all ❑ Master builder ❑ Other: ❑ Fire puma• ❑ Installation of 75 KVA or - _ - . JQ8_ It'E-# b TIS), - - - _ .. ❑E ' ._(ATO - '. .:: ;.:. : _. " -: ( : "':, largerseparatelyde;ived system. ❑Addit of new moor load of El '•A" "E "1 -2•' "1.3" Job no.: I Job site address: 9225 SW Hall Blvd 1GOHp or more. xcupancy. City /State /ZIP: Tigard OR 97223 ❑ H ❑Six or more residential traits ❑ Recreational vehicle parks. eah Supply facEities. ❑ Supply voltalta ge for more than Suite/bldg./apt. no.: F ❑ Hazardous locations. 600 volts nominal. Project name: Ideal Image — ID Service or feeder 600 amps or more. Cross street/directions to job site: — Description I Qtv. I Fee. 1 Totd I New residential single- or multi - family dwelling unit. Subdivision: Includes attached garage. Lot no.: 1,000 sq. R. or less I 168.54 14 Tax map,'parcel no.: Ea. add'I 500 sq. ft. or portion 33 1 Limited ::' 1� R.UaTIO?11=' I# >1%OR1 :,_:- : i =,_ ' :.', :- .: �- energy, residential 7' .:. .. _ _ . (with above sq. Iti 75 00 Install data wiring for TI Limited energy, multi- family residential (with above sq. ft) I 75.00 2 — feeders installation, alteration, relocation c = _ '- � : _ . _: - - _ - d .�:'- .:.: _ _ 200 v amps or r ess • n, al ration, and/or ; Q`>,TYt1i _ a _':''',:`:,.. _.:° - .,_._ ; , 100 7D 2 .. .. , - ;.- : ;''f�YA}�]T °.:_ :._`i'` -: ; ' 201 amps to 400 amps 133,56 Name: 401 amps to 600 amps 200.34 2 Address: 601 amps to 1,000 amps 301.04 2 Over 1,000 amps or volts 552.26 2 City /Siate/ZIP: Temporary services or feeders installation, alteration, and /or relocation Phone: ( ) I Fax: ( ) 200 amps or less 59.36 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 12; Og 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.541 2 Owner signature: Branch circuits — new, alteration, or extension, . cr panel - ::: :_ = -- - - - - -, � A. Fee for branch circuits with _ , Date: • , . • a tw0j�`� -' � above service or feeder fee, ' : :. each branch circuit 7.42 2 Business name: B. Fee for branch circuits without Contact name: service or feeder fee, first branch circuit 5 6, i 8 2 Address: Each add'I branch circuit 742 2 I Miscellaneous (service or feeder not included) City/State/ZIP: Each manufactured or modular I Phone: ( ) dwelling, service and/or feeder I 67.84 2 2 Fax :: ( ) Reconnect only 67.84 E -mail: or circle _° 1 i:' _;:.;_ .:- : ::_ "z: -,- ,::_-. _._: _. Pump irrigation 678 2 C] 67 84 wCONfiItiC"IE Sign or outline lighting 4 Business name: Ertel) Electric, LLC Signal circuit(s) or limited-energy Janet, alteration, or extension. I 75 Page 2 2 Address: P.O. Box 279 _ Each additional inspection over allowable in any of the above Additional inspection (1 hr min) I 66.25/hr I City /State/ZIP: Forest Grove OR, 97116 Investigation (1 hr min) 66.25/ hr Phone: (503) 841 - 4511 — Industrial plant (1 hr min) 78.18 / hr V F ax: (503)35' - 5652 Inspections for which no fee is • CB LiC.: 180540 / specifically listed (4 hr min) 90.007 hr 1 Electrical Lie.: C3' Suprv. Lic.: 5420 S ' kJ ixi7GAclx 9' .: ': Suprv. Electrician signature, required: ,,��' Subtotal: 75 � 1i=/ Plan review (25% of permit fee): Print name: Dylan Wentworth Date: 7/25/2011 Stale surcharge (22% of permit fee): 9 Authorized signature: / / TOTAL PERMIT FEE: 84 1 � This permit application expires if a permit is not obtained within ISO Print name: Dylan 1 en we' Date: 7/25/2011 days after has bd as complete. • Number of inspections ailo wcd per een p t; t. BuiIdi nit \ Perm itstELC- PermitArp,de 07/01/10 44o-4 615T(1 I /05.'COAL WE3