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Permit CITY OF TIGARD • ELECTRICAL PERMIT q $ COMMUNITY DEVELOPMENT Permit#: ELC2013 00637 Date Issued: 10/24/2013 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 2S 110DC00700 Jurisdiction: Tigard Site address: 11205 SW SUMMERFIELD DR Project: Summerfield Club House Subdivision: WILLOW-BROOK-FARM Lot: 17 Project Description: Disconnecting and reconnecting HVAC units. 2/27/14,REPRINTED to correct address from 10650 to 11205 SW Summerfield Dr. Contractor: ERTELL ELECTRIC LLC Owner: TIGARD RETIREMENT RESIDENCE LLC PO BOX 279 PO BOX 847 FOREST GROVE,OR 97116 CARLSBAD,CA 92018 PHONE: 503-841-4511 PHONE: FAX: 503-359-5652 FEES Quantity Description Date Amount 11 crt Branch Circuits wo/Purchase 10/24/2013 $130.38 Specifics: Service or Feeder 1 ea 12%State Surcharge- 10/24/2013 $15.65 Type of Use: MF Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $146.03 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. ATTENTIO : law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 rough OAR 952- 11-00sp. Yo may obtain a copy of the rules or direct questions to OUNC by callin .1987 or 1.800.392.2344. Q4 li Issued B • / ( � i 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. CITY OF TIGARD ELECTRICAL PERMIT g : COMMUNITY DEVELOPMENT Permit#: ELC2013 00637 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503 718.2439 Date Issued: 10/24/2013 Parcel: 2S110DD14000 Jurisdiction: Tigard Site address: 10650 SW SUMMERFIELD DR Project: Summerfield Club House Subdivision: SUMMERFIELD Lot: B Project Description: Disconnecting and reconnecting HVAC units Contractor: ERTELL ELECTRIC LLC Owner: SUMMERFIELD CIVIC PO BOX 279 ASSOCIATION FOREST GROVE,OR 97116 10650 SW SUMMERFIELD DR TIGARD,OR 97224 PHONE. 503-841-4511 PHONE FAX. 503-359-5652 FEES Quantity Description Date Amount 11 crt Branch Circuits wo/Purchase 10/24/2013 $130 38 Specifics: Service or Feeder 1 ea 12%State Surcharge- 10/24/2013 $15 65 Type of Use: MF Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $146 03 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 ma ••.- -•• • the -s or direct questions to OUNC by calling 503 232.1987 or 1 800 332.2344 Issued By: � _ i Permi ee Signature: 41/1.!...n• 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. Oct 23 13 04:15p Ertell Electric, LLC 5033595652 p.2 Electrical Permit A t u.6,.::,L�t i'WED FOR OFFICE USE ONLY ( e r Received IIIII . City of Tigard Date/13 ' — - V 13125 SW Hall Blvd.,Tigard,OR 57223 Plan Review �� .M11111= Phone, 503.718.2439 Fax' OW 198 102013 Date/ • Other Permit TIGARD D Inspection Line: 503.639.417 x+ Date Ready/By El See Page t for Internet www tigard-or gov ��dry pp Notified:Method Supplemental Information I� Ty IDIFgl i. II'IV ISION . - : PLAN REVIEW. .' ❑New construction &IaJ�lt�r`a on/replacement Please check all bust apply(submit 2 sets of plans w/items checked below) ❑Service or feeder 400 amps or more ❑Building over three stories. ❑Demolition ❑ Other: where:he 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 ❑ 1-and 2-family dwelling ❑ Commercial/industrial El Accessory building an for all other instatlattor15. buildings 'Multi-family ❑Master builder ❑Other. ❑Fire pump ❑Installation of 150 KVA or El B SITE INFORMATIOII AND LOCATION Emergency tioof o system. larger 2" system s}ste JO ❑Addition new motor load of ❑`A^,"E","l-2","I.3", Job no: Job site address. i e(1,50 `�m�.��l a b� Six or more ore. occupancy t� ❑Six or more residenrial units ❑Recreational vehicle parks. City/State/ZIP:—79 Ay� ' / '7 L f ❑Health-care facilities ❑Supply voltage for more than ❑Hazardous locations 600 volts nominal Suite:bldg./apt.no.: Project name:�u rn� � C`�}� / � ❑Service or feeder 600 amps or more. �-t _• ..L.14.SC DULE: '. . Cross streeudirections to job site: Description I Qn. I Pee. I Total [ • New residential single-or multi-family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1:000 sq ft.or less 168 54 4 Ea.acd'l 500 sq ft or portion 33 92 1 Tar map/parcel n0.: Limited ener gy,residential 75 00 2 DESCRIPTION OF WORT{ (with above sq ft.) _ Limited energy,multi-family 75 00 2 (. n y G„- fli at !2 n i vn y rJ /-!' s4 G residential(with above sq ft 1 1� �Cl- f `� Renewable Enert y ❑ See Page 2 ,'JiY1,it3 Services or feeders installation,alteration,and/or relocation ❑ PROPERTY OWNER i ❑ TENANT 200 amps or less 100 70 2 201 amps to 400 snips 133 56 '_ Name: _ 401 amps to 600 amps 200 34 '_ • Address: 601 amps to 1,000 amps 301 04 2 Over 1,000 amps or volts 552 26 ■ City/State/Z[P• Temporary services or feeders installation,alteration,and/or relocation Phone:( ) Fax:( 200 amps or less 59 36 1 Owner installation:This installation is being made on properly that I own whic`1 is not j 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 2 Owner signature Date: Branch circuits-new,alteration,or extension,per panel ❑ APPLICANT ❑ CONTACT PERSON.. ' ' A.Fee for branch circuits with above service or feeder fee, 7.42 Business name: each branch circuit B.Fee for branch circuits without Q Contact name: service or feeder fee,first 56 18 (�/ ( D 2 branch circuit �! Address: Each add'I branch circuit 10 _ 7 42 _ 181.20 2 City/State/ZIP./State/Z1P. Miscellaneous(service or feeder not included) Y Each manufactured or modular dwelling,service and/or feeder 6 84 2 Phone:( ) Fax. :( ) Reconnect only 67,84 . 2 E-mail: t l/a(.c..e 7 'i e•C� Pump or irrigation circle 67 84 2 CON1'ILACTO Sign or outline lighting 67.84 2 Business name: . 'r-+' _I( -f t_G" l c , Signal circuit(s)or limited-energy See Farrel alteration,or extension Page 2 2 Address: 1 Q Ir �U Se ,21 -l Each additional inspection over allowable in any of the above i _ /� Additional inspection(I hrmtn) 66.25/hr City/State/ZIP: `1 S1DC)rim , Q� (97 1.23 Investigation(1 hr mm) 66.25/hr Phone:( ) 3Lf1 -X51 y Fax:(S,) !!69 _ 5-co 5,, Industrial plant(I hr min) 78.18/hr Inspections for which no fee is 90.00/hr CCB Lie.: f$b5/..I0 I Electrical Lie.: ( 3i e Suprv.Lic.:,q. Q S specifically listed(''/_hr min) ELECTRICAL PERMIT F.S Suprv.Electrician signature,required: � _ — o 1O/t/ill Subtotal: 1gtp-,3p Print name. Date: to, 13 Plan review(25%of permit fee): _ Bk. • l '.!�rl State surcharge(12%ofpennit fee): 15-.(125 Authorized signatur-` . L f r+, fif/ TOTAL PERMIT FEE- // This permit application expires if a permit is not obtained within I name:L�O I5 4.pi Ai-n f o 72:7-74 Date. /o/n/�/f 3 days after it has been accepted as comp e. { �� / P t� • Number of inspections allowed per permit 016-03 -03 1 Itui dirgWermns'ELC PermnApp_ELR_ERE doe Re-05,21r:oil 44046151-11 l/O5iCOM WEB lY