Permit y q CITY OF TIGARD ELECTRICAL PERMIT
1 7 - COMMUNITY DEVELOPMENT Permit#: ELC2015-00346
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/12/2015
Parcel: 1 S135BA00102
Jurisdiction: Tigard
Site address: 10206 SW WASHINGTON SQUARE RD
Project: Ulta Beauty Subdivision: OAKBURG Lot: 9
Project Description: Electrical for TI:(4)200 amp feeders and(125)branch circuits.
Contractor: ERTELL ELECTRIC LLC Owner: PPR SQUARE TOO 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
4 ea Services or Feeders-200 05/12/2015 $402.80
Specifics: amps or less
125 crt Branch Circuits w/Purchase 05/12/2015 $927.50
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 05/12/2015 $159.64
Electrical
Type of Const:
Occupancy Grp:
Total $1,489.94
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 th adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You ma in a copy for direct questions to OUNC by calling 503.232 9877 or 1. 0. .2344.
Issued By: Permittee Signature: /714
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.
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard Received
DateB : 1 7� Permit No `� &—_ e
• 13125 SW Hall Blvd.,Tigard,OR 97223 `f Plan Review
li Phone: 503.718.2439 Fax: 503.5.4'.1t r,E1 V ED Date/By: Other Permit: /f i If Q(S a.o (i
•I i c; }t a Inspection Line: 503.639.4175 / Date Ready/By: Juris: �(�Hi See Page 2 for
Internet: www.tigard-or.gov v 1 q 0'O 7 Notified/Method: Supplemental Information
TYPE OF WORA i D 4,4 ) [��y PLAN REVIEW
;O" Please check all that apply(submit 2 sets of plans w/items checked below):
❑New construction ®Addition/alterat�o r�lA�A11� 1v Pas
❑Demolition ❑Other: 1`D�1`r� ❑Service or feeder 400 amps or more ❑Building over three stories.
where the available fault current ❑Marinas and boatyards.
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 ❑Accessory building amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system.
❑Addition of new motor load of ❑"A","E","1-2","1-3",
Job no.: Job site address: 10206 SW Washington Square Rd
I00HP or more. occupancy.
❑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.
Suite/bldg./apt.no.: Project name:Ulta Mims ( g,.. a4 ❑Service or feeder 600 amps or more.
Cross street/directions to job site:SW Greenburg Rd Description I Qty. I Fee. I Total I
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq.ft.or less 168.54 4
Ea.add'I 500 sq.ft.or portion 33.92 1
Tax map/parcel no.: Limited energy,residential
75.00 2
= DESCRIPTION o ` YORK. (with above sq.ft.)
Limited energy,multi-family 75.00 2
Lighting and power circuits for new tenant improvement.Install four(4)new 200 residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
amp electrical panels from existing service. Services or feeders installation,alteration,and/or relocation
❑ PROPERTY OWNER ❑ TENANT 200 amps or less 4 100.70 ,_511339---2'
201 amps to 400 amps 133.56 Lt)10 2
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/State/ZIP: Temporary services or feeders installation,alteration,and/or
Phone:( ) I Fax:( )
relocation
200 amps or less 59.36 I
Owner installation:This installation is being made on 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 168.54 2
Owner signature: Date: Branch circuits–new,alteration,or extension, 'er panel
" ' a A.Fee for branch circuits with
'� ` p ,', :�.4 above service or feeder fee,
7.42 12
Business name: ? '� L l each branch circuit L
s _ B.Fee for branch circuits without
Contact name: service or feeder fee,first 56.18 2
branch circuit
Address: Each add')branch circuit 1z,b-- 7.42 927.50 2
Miscellaneous(service or feeder not included)
City/State/ZIP: Each manufactured or modular
Phone:( ) I Fax: :( )
dwelling,service and/or feeder 67.84 2
Reconnect only 67.84 2
E-mail:
Pump or irrigation circle 67.84 2
CONTRACTOR . i : R , _ Sign or outline lighting 67.84 2
Business name:Ertel)Electric,LLC Signal circuit(s)or limited-energy See
panel,alteration,or extension. Page 2 2
Address:PO Box 219 Each additional inspection over allowable in any of the above
City/State/ZIP:Hillsboro OR 97123 Additional inspection(1 hr min) 66.25/hr
Investigation(1 hr min) 66.25/hr
Phone:(503)596-2199 I Fax:(503)359-5652 Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is
CCB Lic.: 180540 I Electrical Lic.: C-390 _ 90.00/hr
uprv.Lic specifically listed(Y,hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required. —
Subtotal:
Print name: Dylan Wentworth
'dr _ Date: 5 May,2015 Plan review(25%of permit fee):
State surcharge(12%of permit fee): ...-YII"r
Authorized signature: ( 1 TOTAL PERMIT FEE: ,,.t l.t lti iy
y May,2015 This permit application expires if a permit is not obtained withi 180
Print name: Dylan Wentw r Ma , days after it has been accepted as complete.
• Number of inspections allowed per permit.
1:\Building'Pennits\ELC_PermitApp_E ' .doe Rev 05/21/2013 440-4615T(1 l/05/COM/WEB
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
10206 SW WASHINGTON SQUARE RD,
TIGARD, OR, 97223
Commercial - Electrical
199 Electrical final
PASS - No C of O
ELC2015-00346
Chip Barnett
Violation Summary:
Inspector Contractor