Permit CITY OF TIGARD ELECTRICAL PERMIT
I •p COMMUNITY DEVELOPMENT Permit#: ELC2016-00238
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/28/2016
Parcel: 151260000300
Jurisdiction: Tigard
Site address: 9779 WASHINGTON SQUARE RD D11
Project: Champs Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: S
Project Description: Electrical for TI: (2)200 amp feeders and(52)branch circuits.
Contractor: ERTELL ELECTRIC LLC Owner: PPR WASHINGTON SQUARE 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
2 ea Services or Feeders-200 03/28/2016 $201.40
Specifics: amps or less
52 crt Branch Circuits w/Purchase 03/28/2016 $385.84
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 03/28/2016 $70.47
Electrical
Type of Const:
Occupancy Grp:
Total $657.71
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 dare 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. . r a obtai• . ... . . rules or direct questions to OUNC by calling 503.23 1,487 or 1.80 .33 2344.
Issued 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.
Electrical Permit Application
City eceived ‘`
C125 Tigard 8f Date/By: 3 � , 1....
]' Permit#: % y if
111 il 13125 SW Hall Blvd.,Tigard,OR 97223 P Review Related Permit#: l
_ Phone: 503.718.2439 Fax: 503.598.1960 a c20)(p—( j,-j
Y
Inspection Line: 503.639.4175 :14 Ready a;:t:y: Suns: ,� Supplemental See Page 2 for
TI G A R D Internet: www.tigard-or.gov N 'ik+ h. -�y Information
, s," "? ..' .. , �j� - !,', �. qtr
0 New construction yl Addition/alteration/replacement �A ,,����j m Please check all that apply(submit 2 sets of plans w/items checked):
` +`y ❑Service or feeder 400 amps or more ❑Building over three stories.
0 Demolition ❑Other: . where the available fault current 0 Marinas and boatyards.
�� ' � ' y ' ''''''Ve
exceeds 10,000 amps at 150 volts or Floating buildings.
' s O 9 .-.. b ' �' '` t. :1, ..7 .. :f. ,' ..s,• S e'-- P ❑ g g
❑ 1-and 2-f amily dwelling gi Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. 0 Installation of 150 KVA or
„t S !1 0" P = g Y Y largerseparately
y ❑Emer enc system
se aratel derived
Job#: I Job site address: 77 \&/ ❑Addition of now motor load of system
w a,40,1)-„,,�� � 100IIP or more. ❑••A,> <•E„ x•1.2„ ••l „
City/State/ZIP: "rq r.,�� ❑Six or more residential units. occupancy.
y i D 0 Health-care facilities. 0Recreational vehicle pazks.
Suite/bldg./apt.#: rJ I Project name: C'� ^
0 Hazardous locations. 0 Supply voltage for more than
J ❑Service or feeder 600 amps or more 600 volts nominal.
Cross street/directions to job site: t' ., FEE SCHEDULE
Description Qty. Each Total *
_
New residential single-or multi-family dwelling unit.
Subdivision: I Lot#: Includes attached garage.
Tax map/parcel# 1,000 sq.ft.or less 168.54 4
Ea.add'I 500 sq.ft.or portion 33.92 1
�. �, ir. § „.�. t 4` . -"� .". _ :r M�-,,,,o,...-:;:n� Limited energy,residential
(with above sq.ft.) 75.00 2
Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Renewable Energy 0 See Page 2
- " ' R 1h I A,14 '. - -. is 1 Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 2, 100.70 2000 2
Address:
201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 l
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
,�x � �, Branch circuits-new,alteration,or extension,per panel
` e" 1 - ti Kt4i - ' V A.Fee for branch circuits with
Business name: cite//5 -jet f above service or feeder fee, 5� 3AC
��'c
each branch circuit 7'42 2
Contact name: B.Fee for branch circuits without
Address: 1 D 2./GJ service or feeder fee,first
O / branch circuit 56.18 2
City/State/ZIP: }7t'`/5 60 re A 9 7/Z3 Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(6773) 6.-F0 Z 99 I Fax: :(5-°3)35y-Ss
G Z Each manufactured or modular
p dwelling,service and/or feeder 67.84 2
Email: /coot # G r `!t G r L co Reconnect only 67.84 2
z� 'f24.14:1''''' rP0 a' w T
�.; ,,, F,ae, 1 Y:' - s..,t r 1,' 4 ; S ='1'41°4'
1t -A_z Pump or irrigation circle 67.84 2
Business name: �1r 7 /�S ;/C G f y i-� Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
0 See Page 2 2
Address: 19t Q e0X 2./ ? panel,alteration,or extension. g
Each additional inspection over allowable in any of the above
City/State/ZIP: /f,./4SbClr0 0 91/2----
Additional inspection(1 hr min) 66.25/hr
Phone:( ) Fax:( ) Investigation(1 hr min) 90.00/hr
Email: Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: Electrical Lic.: c 390 Su. .Li lr j S' specifically listed E('/hr min)
� ,''a'' �'W_ -' RMIT'.FEES
Suprv. Electrician signature,required: Subtotal: -139.2y
Print name: ' . r Date: 0
Plan Review Required(25%of permit fee):
`"�-� �� /� State surcharge(12%of permit fee): 7 , y 7
�_ TOTAL PERMIT FEE: 65, 7/
Authorized signature: r
This permit application expires if a permit is not obtained within 180
Print name ( _s , '-/_ Date: f9 I( days after it has been accepted as complete.
w! v" • Number of inspections allowed per permit.
I:\Building\Permits\ELC_P itApp_ELR_ERE.doe Rev 06/17/2015 440-4615T(11/05/COM/WEB