Permit (151) ICITY OF TIGARD ELECTRICAL PERMIT
114
COMMUNITY DEVELOPMENT Permit#: ELC2019-00308
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/16/2019
T I ''�I`ng Parcel: 25101 DA00104
Jurisdiction: Tigard
Site address: 13333 SW 68TH PKWY, STE#10
Project: Oregon Academy of General Dentistry Subdivision: VARNS ACRES Lot: 9
Project Description: Replacing existing panels.New power and lighting circuits for TI.
Contractor: ERTELL ELECTRIC LLC Owner: TRIANGLE POINTE TWO LLC
PO BOX 279 901 NE GLISAN ST, STE 100
FOREST GROVE, OR 97116 PORTLAND, OR 97232
PHONE: 503-841-4511 PHONE:
FAX: 503-359-5652
FEES
Quantity Description Date Amount
2 ea Services or Feeders-200 05/16/2019 $201.40
Specifics: amps or less
54 crt Branch Circuits w/Purchase 05/16/2019 $400.68
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 05/16/2019 $72.25
Electrical
Type of Const:
Occupancy Grp:
Total $674.33
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: Ore.•• law requires y. to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through 2-001-.0:a. Yo/r ay obtain a- .y of th� -s or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: /�s/ I.. Permittee Signature: "12,/,t/� -7
/ 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 Applicatl FOR OFFICE USE ONLY
_s Received C
City of Tigard Date/By: Permit#
III 'I 13125 SW Hall Blvd.,Tigard,OR 97223
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g M I Q (11(1 Plan Review= 0 . 4 Related Permit ?>\G
Phone: 503.718.2439 Fax: 503.598.19 8 u 1 J Date/By: 5
Inspection Line: 503.639.4175 'y` �q R-.dy Date/B . (,, �V o Jur's. a See Page 2 for
TIGARD g g CITYOF I IGl'tR i�ified/ d: ii�M Supplemental Information
Internet: www.ti ard-or. ov _ /� PP
. �: t a. a . mart/ice— �.mi�fl►/CiaL�
TYPE OF 4 0'7f 'w 'e R x 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 ❑Building over three stories.
❑Demolition ❑Other: where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or El Floating buildings.
❑ 1-and 2-family dwelling ®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: El Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATIONElEmergency system. larger separately derived
❑Addition of new motor load of system.
Job#: Job site address: 13333 SW 68TH Pkwy 100HP or more. ❑"A "E "t-2","I-3",
occupancy.
City/State/ZIP:Tigard,OR 97223 ❑Six or more residential units. ❑Recreational vehicle arks.
0 Health-care facilities. P
Suite/bldg./apt.#:010 Project name:Academy of General Dentis ❑Hazardous locations. ❑Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. I Each I Total
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#:
Ea.add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OFWORD', " `b va `': ` Limited energy,residential
Remove&replace existing panels with new.Power and lighting circuits for TI
(with above sq.ft.) 75.00 2
Limited energy,multi-family
75.00 2
residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
0 PROPERTY OWNER ' ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 2 100.70 201.40 2
201 amps to 400 amps 133.56 2
Address: .
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 I 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
c PPLICANT 0 CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with I
Business name: 1 r1'e,j , (e (..:_-I-"r., Cabove service or feeder fee, 54
7.42 400.68 2
each branch circuit
Contact name: D i 0, ry j,')e „x �c�.i B.Fee for branch circuits without
Address: t�-� N service or feeder fee,first
1 56.18 2
j � L( � -' 3 £ , .'1.:.1,.txn joy'u r ) branch circuit
City/State/ZIP: `! osbn(-Q/ (J�', q f 2... ✓ Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(So" ) e' -f - 4J ii Fax: :( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: Reconnect only 67.84 2
CONTRATQ>} Pump or irrigation circle 67.84 2
Business name:Ertel)Electric,LLC Sign or outline lighting 67.84 2
Address:PO Box 219 Signal circuit(s)or limited-energy EI See Page 2 2
panel,alteration,or extension.
City/State/ZIP:Hillsboro Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(503)841-4511 Fax:( ) Investigation(1 hr min) 90.00/hr
Email:dylan@ertellselectric.com Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lie.: 180540 Electrical Lie.: C391 _ ..rv.Lie.: 5420 S specifically listed(/z hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature, 'red: WSubtotal 602.08
Print name: Dylan Wentworth , Date: May 6,2019 ❑Plan Review Required(25%of permit fee): 150.52
State surcharge(12%of permit fee): 72.25
Authorized signature: ' TOTAL PERMIT FEE: 824.85
This permit application expires if a permit is not obtained within 180
Print haute. Dylan Wentworth dr. / �- Date May 6,2019 — daya aftt.:t has be.,a*...epted.3 eomptctt.
* Number of inspections allowed per permit.
1\Building\Permits\ELC_PermitApp_ELR_ERE.doe '- t.17/2015 440-4615T(11/05/COM/WEB