Permit CITY OF TIGARD ELECTRICAL PERMIT
ill 11:1%, COMMUNITY DEVELOPMENT Permit#: ELC2019-00503
Date Issued: 10/09/2019
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S115BA00100
Jurisdiction: Tigard
Site address: 16200 SW PACIFIC HWY N
Project: Planet Fitness Subdivision: None Lot: None
Project Description: TI:new electrical panels and branch circuits for new tenant.
Contractor: ERTELL ELECTRIC LLC Owner: TECOLOTE RESOURCES INC
PO BOX 279 KELLY'S LEGACY LLC, ET AL
FOREST GROVE, OR 97116 BY HESSLIN HOLDINGS INC
23421 SOUTH POINTE DR STE 270
LAGUNA HILLS, CA 92653
PHONE: 503-841-4511
PHONE: 503-764-7595
FAX: 503-359-5652
FEES
Quantity Description Date Amount
1 ea Services or Feeders-601 to 09/30/2019 $301.04
Specifics: 1000 amps
125 crt Branch Circuits w/Purchase 09/30/2019 $927.50
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea Sign or Outline Lighting 09/30/2019 $67.84
1 ea Plan Review Electricial 09/30/2019 $324.10
Type of Const:
Occupancy Grp: 1 ea 12%State Surcharge- 09/30/2019 $155.57
Electrical
Total $1,776.05
-
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit ill expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law r.,uires you to foll., the ules adopted by the Oregon Utility Notification Center. Tf e riles are set forth in OAR
952-001-0010 through OAR 952-0* -s.90. You;;r-''•btai, op of e rules or direct questions to OUNC by calling 503.2 2 .'87.r 1.800 32*444.
Issued By: , / Permittee Signature: / L ' jr
aill
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale,lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
as ear,
Electrical Permit Application FOR OFFICE USE ONLY'
City of Tigard jU 2 g 2010 Received
ate/y: \ ` Permit : `g �� 0 (
Date/By: 'moi lA / E 3
e 13125 SW Hall Blvd..Tigard,OR 97223 Plan Review
= Phone: 503.7182439 Fax: 503.595.196p i€(At ir..� Datelly: ' Related Permit# ��
"_v1lY t..i�'
inspection Line: 503.639.4175 i 1 l Heady Date€$yIN See Page 2 for
TIC ARI) N G D ISIO ` ,
Internet: www°.tigard-ar.gov ��'- e )11/A0/"I; .� Supplementallnformttion
TYPE(OF WORK PLAN REVIEW
0 New construction ®Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w'aems checked):
®Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition ❑Other: where the available fault current ❑Marines and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10.000 amps at ISO volts or 0 Floating buildings.
El 1-and 2-family dwelling ®Commercial/industrial 0 Accessory building less to ground.or exceeds 14,000 0 Commercial-use agricultural
amps tar all other installations. buildings.
0 Multi-family ❑Master builder ❑Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
0 Addaion of new trrotor toad of system.
Job#: Job site address/6240 f w �f% . L 10(►HP n more. lel"A"."E"."1-2","I-3".
City/State/ZIP:Tigard/Oregon/97223 K ❑Six or more residential units. occupancy.
y ❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name:Planet Fitness ❑hazardous locations.
❑Supply voltage for more than
0 Service or feeder 600 amps or more. 600 volts nominal
Cross street/directions to job site:Corner of SW Pacific Hwy and Durham Rd FEE SCHEDULE
me..cription i Qt. 1 twee I Total i
New residential single-or multi-family dwelling unit
Subdivision: 1 Lot . Includes attached garage.
1,000 sq.11.or less 168.54 4
Tax map/parcel#: Ea.adds 500 sq.ft.or portion 33.92 1
DESCRIPTION OF;WORK limited energy,residential 75.00 2
New electrical panels and branch circuits for gym (with above sq.IL)
Limited energy,multi-family 75.00 2
residential(with above sq,ft.)
Renewable Energy 0 See Page 2
0 PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation
Name:Town Square Fit LLC 200 amps or less 100.70 2
Address:15171 Bangy Road 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:lake Oswego/OR/97035 601 amps to 1,000 amps 1 301.04 2
Phone:(503)764-7595 Fax:( ) Over 1,000 amps orvolts 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
0 APPLICANT ►t CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
a
A.Fee for branch circuits with
Business name:Town Square Fit LLC above service or feexkcr fee, 99 742 2
each branch circuit
Contact name:Gary Van Drew B.Fee for branch circuits sss hoot
Address: 15171 Bangy Rd service nch � fee,first 5618 2
uit
City/State/ZIP:Lake Oswego/OR/97035 Each add'!branch circuit 26 7.42 2
Miscellaneous(service or feeder not included)
Phone:(503)764-7595 1 Fax::( ) Each manutactured or modular
dwelling,service and/or feeder 67.84 2
Email:gvandrew5(rcrosn.com Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name:Not Determined 6f ll £/eG-ir; , Sign or outline lighting I 67.84 2
Signal elfeult(s)or limited-energy ❑ see Page 2 2
Address: pe is D02, .2./ 9 panel,alteration,or extension.
City/State/ZIP: J)Jv 1/r(S boy 0 0 p fiejQ✓t 9'7/2-3 Each additional inspection over allowable in any of the above
Additional inspection(I hr min) 66.251 hr
Phone:( ) S '6,_ 2.' 7 sly I Fax:( ) / Investigation t 1 hr min) 90.00/hr
Email: b y)41"‘
*s. & elr+r;115 ed eG#Y;G to ( [L L Inspectionsfor which no fee is
90.001 lir
p 5y20 e specifically listed t'/hr min)
CCB Lic.:�$`j�lj►� Electrical Lic.:ie._310 Suprv.Lia: 7 .J
ELECTRICAL PERMIT FEES
trsuprv.Electrician signature,required: a Subtotal:
Print name: 1 /0.Vi ,v��'�i/o f t, Date: /b_9�/ C 0 Plan Review Required(25%of permit fee):
Y I State surcharge(12%of permit fee):
l Authorized signature: TOTAL PERMIT FEE:
�_ This permit application expires if a permit is not obtained within 180
Print name: Dale: 0 ..9-19days after it has been accepted as complete.
* Number of inspections allowed per permit.
IfBuilding'Peratits.ELC_P _ELR_FRE.doc Rev 06'17`2015 440=16157(1105;COMAEB
-ie(, 1‘, i•
Electrical Permit Application 1 , - ,•-.0,- ' '—' FOR OFFICE USE ONLY'
I . . City ofTigard JUL 2 9 2019 , Received.
13125 SW SW Hall Blvd..Tigard,OR 97223 ,..,„ ,r, Plan Review i
• Phone: 503.718.2439 Fax: 503.598.196t1 f y 01- ilUtATI Li Date/By: , a A 41 Related Permit 0.7.9. 6.?,aU Pi_W\
Inspection Line: 503.639.4175 cady Date:By 1 "4 '/c, / . 0 See Page 2 for
TIGARD ..J i- DIVISION-
Internet: www.tigard-or.gov ' e.,ifiediNte„;...1: 111,,, ,/ 4 Supplemental Information
....atri...-...—....- .. _
TYPE OF WORK *-- -
PLAN REVIEW
0 New construction Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w Items checked):
It.Service or feeder 400 amps or more 0 Building over three stories-.
0 Demolition [II Other: i where the availabk fault current 0 Virrinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10.000 amps at 150 volts or 0 Floating buildings.
Ell 1-and 2-family dwelling El Commercial/industrial D Accessory building less 10 ground.or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
0 Multi-family Eil Master builder [1 Other: 0 Fire pinup. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
pe 0 Addition of new motor lewd of yste
s- m.
Job#: - Job site addrts/6,71a0,54) ,0011P or inure.
i ID Six or more units. occupancy.
City/State/ZIP:Tigard/Oregon/97223 residential
0 fleahh-care facilities. 0 Reerc-ational vehicle parks.
Suite/bldg./apt.#: Project name: Planet Fitness 0 Hazardous locations. 0 Supply voltage for more than
0 Service or feeder ono amps or more. 600 volts nominal.
Cross street/directions to job site:Corner of SW Pacific Hwy and Durham Rd FEE SCHEDULE
Description 1 Qtr..
tack Total I •
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1.0(X)sq.Ii or less 168:54 4
Tax map/parcel#:
Ea.add'1500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK , Limited energy,residential
75.00
)
New electrical panels and branch circuits for gym (with above sq.fl.
Limited energy,multi-family 75.00 2
residential(with above sq.11.)
Renewable Energy 0 See Page 2
0 PROPERTY OWNER I 2 TENANT services or feeders installation,alteration,and/or relocation
Name:Town Square Fit LLC 200 amps or less100.70 2
Address:15171 Bangy Road
201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:lake Oswego/Ott/97035 601 amps to 1.000 amps 1 , 301.04 , 2
Phone:(503)764-7595 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 I 59.36 I
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 1 125.08 2
Owner signature: Date: 401 amps to 599 amps
168.54 2
0 APPLICANT ' CONTACT PERSON
Branch circuits-new,alteration,or extension,per panel
Pi.Fee for branch circuits with
Business name:Town Square Fit LLC above service or feeder fee, 99 7.42
2
each branch circuit
Contact name:Gary Van Drew B.Fee for branch circuits without
. . service or feeder fee,Fust
Address: 15171 Bangy Rd branch circuit 56.18
City/State/ZIP:Lake Oswego/OR/97035 Each add'I branch circuit 26 7.42 2
Miscellaneous(servke or feeder not included)
Phone:(503)764-7595 Fax::( I Each manufactured or modular
67.84 2
dwelling,service and'or feeder
Email:gvandrew5qmsn.com Reconnect only 67,84 2
t CONTRACTOR Pump or irrigation circle 67.84 2
Business name:Not Determined Sign or outline lightingI 67.84 2
Signal circuit(s)or limited-enerriv ' 2
Address: panel,alteration,or extension. -- 1 1:1 See Pa"2
Each additional inspection over allowable in any_of the above
City/State/ZIP: ' Additional inspection(1 hr min) —I 66.251 hr
Phone:( I 1 Fax:( ) Investigation(1 brim ) 90.00/hr
Industrial plant(1 hr rain) 78.18/hr
Email: Inspections for which no fee is
90.001 hr
CCB Lie.: Electrical Lie.: Suprv.Lic.: specifically listed(I/.,hr min) .
ELECTRICAL PERMIT FEES
Suprv. Electrician signature,required: Subtotal:
Print name: Date: 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: TOTAL PERMIT FEE:
---1
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
L'Build jog'Perroit,,ELC_PermitApp_EIR_ERE.dot Rev 0617'2015 440-4 I5Tt I I,05;CONINtrEB
Electrical Permit Application-City of Tigard
Page 2-Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Dna'IptitaEzkTOIJI I
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
5 kva or less 10030 2
Check Type of Work Involved:
5.01 to 15 kva 133.56 2
I I Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
n Burglar Alarm 25.01 10 50 kva 301.04
I
50.01 to 100 kva 552.26 2 Garage Door Opener*
>100 kva(l'ee in accordance
55226 2
with OAR 918-309-0040)
I Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System*
Each additional kva over 25 7.42 3
Vacuum Systems* >100 kva-no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
n O• ther - Each additional inspection is
66.25 hr
charged at an hourly(I hr min)
I Inspections for which no fee is
90.00 hr
specifically listed t' nun)
COMMERCIAL WORK ONLY 1 ELECTRICAL PERMIT FEES
Subtotal(Enter on Page II:
Fee for each commercial system: S75.00
Number of inspeerlons allowed r•er pernui.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
Audio and Stereo Systems
1 I Boiler Controls
Clock Systems
Data Telecommunication Installation
Fire Alarm Installation
15 HVAC
n I• nstrumentation
I I Intercom and Paging Systems
n Landscape Irrigation Control*
n M• edical
n Nurse Calls
n O• utdoor Landscape Lighting*
I I Protective Signaling
n Other:
Total number of commercial systems: I
*No licenses are required. Licenses are required for all
other installations
L Buikleng Pennits ELC_Perent.App_CLR_LRE doc Rev 06,17 2015
FOR OFFICE USE ONLY—SITE ADDRESS:
This form is recognized by most building departments in the Tri-County area for transmitting information.
Please complete this form when submitting information for plan review responses and revisions.
This form and the information it provides helps the review process and response to your project.
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
!PI . Transmittal Letter
T G A R C) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • i d-or. m_v_
TO: -)---6 DATE RECEIVED:
DEPT: BUILDING DIVISION RECEIVED
OCT 2820 . '
FROM:
• CITY T ARD
VI
V� nf � BUILDIN '!VISIONCOMPANY: QJO a
PHONE: TO3 ?71 $79 , id
RE: 1n In}j� , } ,n r-
W�0 �W Y- o c( C �` d GSC , v/l FC.e'r C/3
(St ddress) " (P 4. it Number)
t
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS: 4
Copies: Description: ' '?opie•. Description:
Additional set(s) of plans. /� Revisions: r LA l y
Cross section(s) and details. ~ Wall bracing and/or late al analysis.
Floor/roof framing. j� t Basement and retaining walls.
Beam calculations. I! Engineer's calculations.
Other explain): //�
REMARKS: &it_l_,IIJ�!SIFIRMMI /lIR =,
FOR OFFICE USE ONLY
Routed to Permit Technic'.n: Date: _ Initials:
Fees Due: ❑ Yes gl No Fee Description: Amount Due:
4 U1->j.)., ( ?~'lr ',�,-{ - -- $ LST("
$
$
$
Special
Instructi• s:
Repri' Permit(per PE): _ ❑ Yes ❑ No Done ��,��
)4 Applicant Notified: 7•11r-o_. Date: /I /.,-7c,-,, Initial ' fy
I:\Building\Forms\TransmittalLetter-Revisions_061316.doc