Permit •
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
°. COMMUNITY DEVELOPMENT Permit #: ELR2009 -00063
T I GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/14/2009
Parcel: 2S 110BA04401
Jurisdiction:
Site address: 14315 SW MCFARLAND BLVD
Subdivision: Lot: 0
Project: GENTRY
Project Description: Limited energy for all encompassing.
Owner: FEES
GENTRY, TODD C & LAURA J Description Date Amount
14315 SW MCFARLAND BLVD Restricted Energy Permit 04/14/2009 $75.00
TIGARD, OR 97224 12% State Surcharge - Restricted Energy 04/14/2009 $9.00
PHONE:
. Contractor:
ERTELL ELECTRIC LLC
PO BOX 279
FOREST GROVE, OR 97116
PHONE: 503 - 841 -4511
FAX: 503- 359 -5652
Type of Use: SF
Class of Work: ALT
Total Number of Systems:
Audio & Stereo:
Security Alarm:
Garage Door Opener:
HVAC: Total $84.00
Vacuum System: Required Items and Reports (Conditions)
Other
Other Desc:
•
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 952 - 001-0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
/��� e,*
Issued By: `y �t Q i l,� i csf `. (J Permittee Signature 9 t +'
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'N Date:
LICENSE NO.
Call 503.839.4175 by 7:00 a.m. for an Inspection that business day.
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 each Inspection.
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RECEIV::- .
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard APR 13 2019 eRr l . ( t ' ,� Permit No.: ' �j 4No , ail
1312.5 SW 11x11 Blvd.. Tigard, OR 47223 Plao view
Oilier Ptstmt. D A • c
C Phone: 503.639.4171 Fax: 503.598.1960 CITY OF TIGA • '•tte•Av.
TiCA Inspection Line: 503.639.4175 1e Ready /By' Jul Supplemental See Wformation
Internet: www.tigard- or.gov BUILDING DIVISIG "' rfied/Method: (�
TYPE OF WORK PLAN REVIEW
Please check all that apply (submit 2 sets of plans w /iterns checked below):
❑ New construction ® Addition/alteration/replacement
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial - use agricultural
E I- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump ❑ Installation of 75 KVA or
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E',' 2 ". "l -3 ",
or more. occupancy.
Job no.: Job site address: 14315 SW M cfarland Blvd Six rm
❑ Six or more residential amts. ❑ Recreational vehicle parks.
Ci • State/ZIP
iy' Tigard, Or 97223 ❑ Health - care facilities. ❑ Supply voltage for mote than
❑Hazardous locations. : Ti ard, G00 volts nominal.
Suite/bldg./apt no.: Project name: Gentry ❑ Service or feeder G00 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qtv. [ Fee. 1 'loud I- •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft or less 145.15 i 1 4
Ea. add't 500 sq. ft or portion 33.40 I 1
Tax map /parcel no.: Limited energy, residential 1 75.00 75 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
Low voltage permit for installing phone and coax in addition residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation •
200 amps or less 80.30 ' 2
❑ PROPERTY OWNER ] ❑ TENANT 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Ci iState/ZIP: Temporary services or feeders installation, alteration, and/or
tY relocation
Phone: ( ) Fax: ( )
200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 snips to 599 amps 133.75 2
Branch circuits — new, alteration, or ex tension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
without service or feeder fee,
46.85 2
Contact name: first branch circuit
Address: Each add', branch circuit 6.65 _ , 2
Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 2
90.90 dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 66.85 • 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Signal cirnvit(sl or limited -
Business name: Ertel) Electric, LLC
energy panel• alteration, or
Address: P.O. Box 279 extension. Describe: Page 2 2
.
City /State /ZIP: Forest Grove, Or 97116 Each additional inspection over allowable in anyof the above
Per inspection 62.50
Phonc: (503) 841 -4511 Fax: (503) 359 -5652 Investigation per hour (I he min) 62.50
CCB Lic.: 180540 I Electrical Lic.: C390 u.rv. Lie.: 54205 Industrial plant pee hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: �� Subtotal: 75
Plan review (25% of permit fee):
Print name: Dylan Wentworth Date: 13 April 09 0
` /� Slate surcharge (12% of permit fee): 9
Authorized signature: r 011111111.r TOTAL PERMIT FEE: 84
' This permit application expires if a permit is not obtained within 180
Print name: Dylan Wentworth Date: 13 April 09 days after it bat been accepted as complete.
• Number of inspections allowed per permit.
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