Permit CITY OF TIGARD ELECTRICAL PERMIT
1111 COMMUNITY DEVELOPMENT Permit#: ELC2019-00043
TfGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/24/2019
Parcel: 2S103CCO2800
Jurisdiction: Tigard
Site address: 13965 SW AERIE DR
Project: MITRA Subdivision: EAGLE POINTE Lot: 3
Project Description: (4)branch circuits for interior remodel.
Contractor: ERTELL ELECTRIC LLC Owner: MITRA, KEERTHI A
PO BOX 279 SRIKANT,ARCHANA
FOREST GROVE, OR 97116 13965 SW AERIE DR
TIGARD, OR 97223
PHONE: 503-841-4511 PHONE:
FAX: 503-359-5652
FEES
Quantity Description Date Amount
4 crt Branch Circuits wo/Purchase 01/24/2019 $78.44
Specifics: Service or Feeder
1 ea 12%State Surcharge- 01/24/2019 $9.41
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $87.85
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 503.2 .1987 or 1.800.332.2344.
�- -`
Issued By: e�y a��.- �' 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 Ap lication , „....a ,--,. CCrlFOR OFFICE USE ONLY
' ilCity of Tigard .m, Received
Date`Bv: y. CEIMMIMME
n 13125 SW Hall Blvd..Tigard.OR 97223 g 4 ?5\9
II' Phone: 503.718.2439 Fax: 503.598.1960 IAN
Related Permit
Inspection Line: 503.639.4175 + Reade Date'B; ® See Page 2 for
TIGARD p 1M,-',', '
Internet: www.tigard-or.gov ct � ,t btified-Method: Supplemental Information
TYPE OF K [�� tyG 131U��S PLAN REVIEW
❑New construction ®Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w;items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings_
® i-and 2-family dwelling 12 Commercial/industrial ❑Accessory building less to ground,or exceeds 14.000 ❑Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder ❑Other: 0 Fire pump. 0 installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
0 Addition of new motor load of system.
Job#:
Job site address: 13965 SW Aerie Dr I 00111 or more. 0 -r,"1-2-.--1-3-,
City/State/ZIP:Tigard,OR 97223 0 Six or more residential units. occupancy.
0 Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name:Mitra 0 Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site:SW 123`d Terrace FEE SCHEDULE
Description I Qtv. I Each I Total I
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: includes attached garage.
1.000 sq.ft.or less 168.54 4
Tax map/parcel#:2S103CCO2800 Ea.add'I 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
75.00 2
updating exiting outlets,can lights,vanity lights,and vent fans (with above sq.ft.)
Limited energy,multi-family
75.00 2
adding cans and surface mount residential(with above sq.ft.)
Renewable Energy 0 See Page 2
® PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: Keerthi Mitra&Archana Srikant 200 amps or less 100.70 2
Address: 13965 SW Aerie Dr
201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:Tigard,OR 97223 601 amps to 1,000 amps 301.04 2 11
Phone:(503)579-3534 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 1
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
® APPLICANT A CONTACT PERSON Branch circuits—new,alteration,or extension,,er panel
A.Fee for branch circuits with
Business name: Maughan Design above service or feeder fee.
742 ,
each branch circuit
Contact name:Daryl Oberacker B. Fee for branch circuits without
Address: 1910 NW Lovejoy St. service or feeder fee,first 1 56 t 8 56.18 2
branch circuit
City/State/ZIP:Portland,OR 97209 Each add'l branch circuit 3 7.42 22.26 2
Miscellaneous(service or feeder not included)
Phone:(503)241-4059 Fax: :( ) Each manufactured or modular
67.84 2
dwelling.service and/or feeder
Email:orders@maughandesign.com Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name:Ertell Electric Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
.Address: PO 219 ❑ See Page 2
panel.alteration,or extension.
City/State/ZIP:Hillsboro,OR 97123 Each additional inspection over allowable in any of the above
Additional inspection(I hr min) 66.25/hr
Phone:(503)596-2199 Fax:(503)359-5652 Investigation(1 hr min) 90.00/hr
Email:dylan@ertellselectric.com
Industrial ptam(t hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lie.: 180540 Electrical Lie.: c390 Suprv."Lie.: 5420 S specifically listed('1A hr mm)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature.required: i
r, Subtotal: 78.44
Print name: Dylan Wentworth 10ate: Jan 17,2019 0 Plan Review Required(25%of pennit fee):
State surcharge(12%of permit fee): 9.41
Authorized signature ,_ — TOTAL.PERMIT FEE: 87.85 ,..,7
This permit application expires if a permit is not obtained within 180
Print name: Dylan W ent tort' Date: Jan 17,2019 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:Building\Pennits.ELC_.PermitApp_EL'_ERE.doc Rev 06/17/2015 4404615T(I 1;05/EOM'WEB
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
13965 SW AERIE DR, TIGARD, OR, 97223
Record Type: Record ID:
Residential - Electrical ELC2019-00043
Inspection Type: Inspector:
199 Electrical final David Young
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor