Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit#: ELR2013 00235
T L c. q RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/24/2013
Parcel: 25101 DB00100
Jurisdiction: Tigard
Site address: 7320 SW HUNZIKER RD 102
Project: Plaza Home Mortgage Subdivision: VARNS ACRES Lot: 3
Project Description: TI expanding into adjacent space.
Contractor: ERTELL ELECTRIC LLC Owner: HILLTOP BUSINESS CENTER LLC
PO BOX 279 HUNZIKER LLC
FOREST GROVE, OR 97116 9430 NW KAISER RD
PORTLAND,OR 97231
PHONE: 503-841-4511 PHONE: 503-699-5100
FAX: 503-359-5652
FEES
Description Date Amount
Specifics: Restricted Energy Permit 09/24/2013 $75.00
12%State Surcharge-Electrical 09/24/2013 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio&Stereo: 0 Boiler Controls: 0
CCTV: 0 Clock Systems: 0
Data&Telecommunications: 1 Fire Alarm: 0
HVAC: 0 Instrumentation: 0
Intercom/Paging: 0 Landscape/Irrigation: 0
Landscape Lighting: 0 Medical: 0
Nurse Calls: 0 Protective Signal: 0
Security Alarm: 0 Other: 0 Total $84.00
Other Desc: Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued ey Permittee Signature: ,
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale,lease or rent.
OWNER'S SIGNATURE: Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept In a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each Inspection.
Sep 23 13 11:02a Ertell Electric,LLC 5033595652 p.2
Electrical Permit Application FOR OFFICE USE ONLY to....:\k‘fc,c)
City of Tigard
Received
r�rl DateB l
a ]3125 SW Hall Blvd.,Tigard,s.ti,.�r O`J 4 a
liAl
' ' B Phone: 503.718.2439 Fax: 50 ±r':1 ..,c Plan Review
p��� DateB : Oilier Permit: g�P�o/ tit i
TI GA RD Inspection Line: 503.639.4175 }I.`� Y ��® Dale Ready/By: ruris El See Page 2for
Internet: www.tigard-or.aov h` di�\G �`O?1 Notified/Method: . Supplemental Information
PE OF WORr s$ PLAN REVIEW
v v-n Please check all that apply(submit 2 sets of plans w(tems checked below);
❑New construction eldition/alteratio, ��:� � nt
❑Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition ❑Other: •
where the available fault current ❑Marinas and boatyards.
CATEGyRY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
Icssto ground,or exceed,14,000 ❑Commercial-use agricultural
D I-and 2-family dwelling gi Commercial/indtrtrial ❑Accessory building amps for all other installations. buildings.
0 Multi-family 0 Master builder III Other: U Fire pump, ❑Installation ef150KVAor
JOB SITE INFORMATION A LOCATION ❑Emergency system. larger separately derived system_
❑Addition of new motor load of ❑"A","E "I-2",`'I-3
Job no.: 2^ Job site address: �/^^ ` "/I `I' 10014Pormole. occupancy.
C�yf 7�OLQ 5� !•ruh?t7(Li ❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: Gtr ❑Health-care facilities_ 0 Supply voltage for more than
ji
/ _ ❑Hazardous locations. 600 volts nominal.
Suitc/bldg./apt.no.: /42 1D+ Project name:i_ ,/Gy �ote ❑Service or feeder 600 amps or more.
/�j ICC FEE SCHEDULE
Cross streetidirections to job site: nercriptioa
I QT- I Nee_ I Tonal I •
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq.H.orless 168.54 4
Ea add'I 500 sq.R.or portion 33.92 1
Tax map/parcel no.: Limited energy,residential
DESCRIPTION OF WORK i (with above sq.ft.) 75.00 2
� Limited energy,multi-family 75.00 2
(ejc , ,,„,( ()Gi ce i= 44, residential(with above sq.R)
■ / Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
LI PROPERTY OWNER [TENANT 200 amps or less 100.70 2
201 amps to 400 amps 1 33.56 2
Name: k
i r u 401 amps to 600 amps 200.34 2
Address: '?J i T 7 JAI/,— re_ L fi /02 601 amps to 1,000 amps 301.04 ---� 2
r-� If`J
Over I.000 amps or volts 55226 2
City/State/ZIP: r
�,/,.e�e! ,.Q� N13 Temporary services or feeders installation,alteration,and/or
Phone:(03 ) 6e e3_ 670,9 (Fax:d ) relocation •
200 amps or less 59.36 l
Owner installation:This installation is being made oln property that I 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 158.54 I 2
Owner signature: I Date: Branch circuits-new,alteration,or extension,per panel
❑ APPLICANT I I ❑ CONTACT PERSON A.Fee For branch circuits with
above service or feeder Fee, 7 42 2
Business name: each branch circuit
B.Fee for branch circuits without
Contact name: service or feeder fee,first
branch circuit 56.18 2
Address: Each add'I branch circuit 7.42 2
City/State./ZIP: Miscellaneous(service or feeder not included)
Each manufactured or modular
67.84 2
Phone:( ) Fax: :( )
dwelling,service and/or Feeder
Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67.84 ; 2
CONTRACTOR. Sign or outline lighting 67.84 2
Business name •'feel c/ < Signal circuit(s)orlimited-energy I See
re panel,alteration,or extension. Page 2 sm.sdi 2
Address: 22 Each additional inspection over allowable in any of the above
f� AM 4274 Additional inspection(I hr min) I 66.25/hr
City/State/ZIP: („6-/-4,„1j i saA) t9'I it, Investi a[ion(1 g ( )
hr min 66.25/hr
Phone:( -03)4-616-al cin Fax:(53 ) q- 5-e 5.-2_ Industrial plant(I hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.:/y051240 I Electrical Lic.:/e4 3o ' Suprv.Lic.: specifically listed('AA hr min)
i ELECTRICAL PERMIT FEES
Suprv. Electrician signature,required: ./. _.i A Subtotal: : 7�i•.19
v 1���` Plan review(25%of permit fee): 1 -- I
Print name 4,4 4 s ate: /j.i j 3 i3
`�°J State surcharge(12%of permit fee): q:
Authorized signature: TOTAL PERMIT FEE:
This permit application expire if a permit is not obtained within t80
Print name: Date:
days after it has been accepted an complete.
• Number of inspections allowed per permit.
I\BuildingtPcrmiis\ELC_PermitApp_ELR ERE doe Rev 05212017 44o-4615T(11/05/COM/WEB
Sep 23 13 11:02a Ertell Electric,LLC 5033595652 p.3
Electrical Permit Application-City of Tigard
Page 2-Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Fee for all residential systems combined I ... $75.00 nescnplion 1 Qty. I Fee 1 Total I
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems*
1 5.01 to 25 kva 200.34 2
nBurglar Alarm Wind generation systems in excess of 25 kva:
25.01 to 50 kva 301.04 2
n Garage Door Opener* 50.01 to loo kva 552.26 2
>100 kva(fee in accordance with 552.26 2
---- n Heating,-Ventilation and Air Condi i oning OAR 918-309-0040)-
S stem* Solar generation systems in excess of 25 kva:
S'
Each additional kva over 25 7.42 3
n Vacuum Systems* >100 kva—no additional charge 0.0 3
riEach additional inspection over allowable in any of the above:
Other: _ Each additional inspection is 66.251 hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00!hr
specifically listed(iS hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system I $75 Subtotal: ' 7��
(SEE OAR 918-309-0000) .00 Plan review,if required(25%of permit fee):
State surcharge(12%of permit fee):
Check Type of Work Involved: TOTAL PERMIT FEE:
❑ This permit application expires if a permit is not obtained within ISO
Audio and Stereo Systems days after it has been accepted as complete_
• Number of inspections allowed per permit.
n Boiler Controls
❑ Clock Systems
NI Data Telecommunication Installation
❑ Fire Alarm Installation
[� HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
Fl Medical
❑ Nurse Calls
Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems: I
*No licenses are required. Licenses are required
for all other installations
r.ltioilding■'erm Ils1ELC PermitAVD_ELR_ERR doe Rev 05@12013