Permit (8) CITY OF TIGARD ELECTRICAL PERMIT
= COMMUNITY DEVELOPMENTIII
Permit#: ELC2019 00777
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/05/2019
Parcel: 2S115AB01900
Jurisdiction:
Site address: 16200 SW PACIFIC HWY
Project: Tigard Towne Square Subdivision: 1994-028 PARTITION PLAT Lot: 2
Project Description: Landlord work to replace 2000 amp service with 1600 amp service and refeed panel and shell lighting; add(2)200
amp or less service/feeders and(3)branch circuits for exterior lighting for Planet Fitness suite N and Spec Space
suite M.
Contractor: ERTELL ELECTRIC LLC Owner: SN PROPERTIES PARTNERSHIP
PO BOX 279 1121 SW SALMON ST
FOREST GROVE, OR 97116 PORTLAND, OR 97205
PHONE: 503-841-4511 PHONE:
FAX: 503-359-5652
FEES
Quantity Description Date Amount
2 ea Services or Feeders-200 12/05/2019 $201.40
Specifics: amps or less
1 ea Services or Feeders-Over 12/05/2019 $552.26
Type of Use: COM 1000 amps or volts
Class of Work: ALT 3 crt Branch Circuits w/Purchase 12/05/2019 $22.26
Service or Feeder
Type of Const: 1 ea 12%State Surcharge- 12/05/2019 $93.11
Occupancy Grp: Electrical
1 ea Plan Review Electricial 12/05/2019 $193.98
Total $1,063.01
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 O•e 952-001-0090. You ma •btain a copy of i- les or direct questions to OUNC by calling 50 . 32.1987 or 1.800.332.2344.
Issued By: / --, Permittee Signature: �ll Cs L '
,, 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 ONL1�,
City of TigardRECEIVER Dateived/0 3, /y 4,-;, it
. ,,
:71
- 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review;
�/
Phone: 503.718.2439 Fax: 503.598.1960 OCT 3 1 2019 Date/By: !ew`;1 10 i Lii,6 i Related Permit#:
TIGARD Inspection Line: 503.639.4175 Ready Date/By: , /� 't,i uris: H See Page 2 for
Internet: www.tigard-or.gov -�i�� �`� "1"� otifie od:/,/L�/ ���� Su elemental Information
TYPE OF WORK Q ✓ 44,4- t.„ 4., P 1 I
0 New construction E Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
®Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition ❑ Other:
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
0 1-and 2-family dwelling E Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder D Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: I Job site address: 16200 SW Pacific Hwy 100HP or more. ❑"A","E","1-z","1-3",
City/State/ZIP:Tigard,OR 97224 ❑Six or more residential units. occupancy.
0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: I Project name:Tigard Towne Square 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: FEE SCHEDULE
Description I Qty. I Each I Total I '
New residential single-or multi-family dwelling unit.
Subdivision: 1 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 OF WORK Limited energy,residential 75.00 2
Replace 2000 amp service with 1600 amp.Refeed panel and shell lighting (with above sq.ft.)
Limited energy,multi-family 75.00 2
4 r,...„) 2�}� 6-ti.q, P�.� residential(with above sq.ft.)
PROPERTY OWNER I Renewable Energy 0 See Page 2
, ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: 200.amps or less 2 . 100.70 201.40 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:( ) I Fax:( ) Over 1,000 amps or volts 1 552.26 552.26 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
APPLICANT I 0 CONTACT PERSON
0Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: above service or feeder fee, 3 7 42 22.26 2
each branch circuit
Contact name: B.Fee for branch circuits without
Address: service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP: .." Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name:Ertell Electric,LLC Sign or outline lighting 67.84 2
Address:PO Box 219 Signal circuit(s)or limited-energy ❑ See Page 2 2
panel,alteration,or extension.
Each additional inspection over allowable in any of the above
City/State/ZIP:Hillsboro 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 Lic.: 180540 Electric. Lic.: C390 S .rv.Lic.: 5420 S specifically listed(V2 hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required:gii .liiiiiiiiiiIP
Subtotal: 775.92
Print name: Dylan Wentworth Da e: I ct 31,2019 0 Plan Review Required(25%of permit fee): 193.98
State surcharge(12%of permit fee): 93.11
Authorized signature: t TOTAL PERMIT FEE: 1063.0
This permit application expires if a permit is not obtained within 180
Print name: Dylan Wentwort Date: Oct 31,2019 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_EL _ERE.dor Rev 06/17/2015 440-4615T(11/05/COM/WEB