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Permit ;, CITY OF TIGARD ELECTRICAL PERMIT • COMMUNITY DEVELOPMENT Permit #: ELC2012 -00493 Date Issued: 08/21 /2012 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 parcel: 2S110DCO2300 Jurisdiction: Tigard Site address: 11515 SW DURHAM RD E -9 Project: Naturo Medicine Center Subdivision: 1998 -128 PARTITION PLAT Lot: 1 Project Description: (3) branch circuits for (1) dryer and (2) water heaters Contractor: NICE ELECTRIC CO Owner: HIP WILLOWBROOK LLC PO BOX 636 BY HARSCH INVESTMENT CORP MCMINNVILLE, OR 97128 PO BOX 2708 PORTLAND, OR 97208 PHONE: 503 -434 -5802 PHONE: FAX: 503- 472 -1628 FEES • Quantity Description Date Amount 3 crt Branch Circuits wo /Purchase 08/21/2012 $71.02 Specifics: Service or Feeder 1 ea 12% State Surcharge - 08/21/2012 $8.52 Type of Use: COM Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $79.54 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 OA 2- 001 -0090 You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. / Issued By: Permittee Signature: � L/ /979P �'� 7ON 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 503.639.4176 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. 2012 /AUG /20 /MON 09:18 Nice El P. 003 FAX No, 503 472 1628 • eI V - . trical Permit Application ■ Fort OFFICE USE ON ii i City of Tigard . AUG 2 0 2012 Received �® �:.: I: _ r/ DetdB 1--:' 3125 SW Hall Blvd., Tigard, OR 97223 Plan Review 1 hone: 503.718.2439 Fax: 503.598.1960 f (� Dale/By: Other Permit: Inspection Line: 503.639.4175 ■ .v 1 DateReady /By: iris: ® Sec Page 2 lbr Internet 'www•tigard-or•gov BUILDING D `f„ .'r0!l otifie�d,/Method: s _ 17 ( ,,� �. , Supplemental Information .J °4 r' r••.' ^ i '..' " ,,:5t i Gf tt � • r)::',7°.::?' W... �., ,: W .4' 1 t^ . .'. Yhti' �::. 1 : „. !•:t •''{9d'? lial.IL P : l Yt u`'. r r S ac ^Ji i 1C „Zr, ` A�i - IA 0 New construction D • Addition/alteration/replacemcnt Please check all that apply (submit 2 eels of plans wiles= checked below): ['Service or feeder 400 amps or more 0 13uilding over three stories. ❑ Demolition ❑ Other: whore the available fault current 0 Marinas and boatyards. �� ) , . , ' . D 'ly, ' `y" . -. ' ks..,7 4 ; >Sl:70:0 :6 r "' 1 exceeds 10,000 snips at 150 volts or ❑ Floating buildings. > t ""• less to ground, or exceeds 14,000 ❑ Commercial-use ogricultmal 0 l - and 2- family dwelling 0 Commercial /industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi - family ❑ Master builder ❑ Other ❑Fire pump. ❑ Installation or75 KVA or c „ . . r. , x ❑ Emergency system. larger separately derived ayeton. '. ih f'e` . 0. 7>R4 ;10 1� .'•,.0;4. .,, 1 *� ft. i �' ❑ Addition of new motor load of ❑ "A" "2", .,1 -Z„ .,1 -3„ l lob no.: lob site address: 1 I S lc C , f k,,, I or or more • occupancy. ❑ Six xrtn residential units. ❑ReeteStlorWl vehicle Parka. City /State/ZIP: • I _,,,_ _ , ,J, ` Q C 7 �,aI ❑ Healthcarefacilities. O Supply voltage for more titan �" U � ['Hazardous locations. 600 volts nominal. Suite/bldg. /apt. n — • Project name: /1/4 /`f( /e/A/6" > r . .. :7 " vice or feeder 6 00 amps or ore. . pa j, .i ..+ ; :1 : r' 40 m i/y a 31D L 9 , w NZ q ,t g "ol; • Cross street/directions to, lob site: • aacriniioe _ .11'_ Pea Total • New residential single- or multi - family dwelling unit. includes attached garage. Subdivision: • Lot no.: - • 1.000 sq. tl Tax map/parcel no.: ,Q � 7�7k 7,,P' .' �'r6;.s \ - t } '.n. ! !4+'° �... G,.... rJC"•".ti,*,O'. 1 a41 ~ Ki.. -..w�' ' energy, „ J p Limited energy, multifamily 75.00' �© w / F i n J d r( a y- • g- Ll e l -r- t,� 11 .t- residential (with above s.. ft. / 1 Services or feeders installation, alteration, and/or relocation • 200 amps or less II 100.70 H Exitwat -264-000044 201 amps to 400 amps 133,56. .. Name: p .� f 401 amps to 600 amps MI 200.34 � 601 amps to 1,000 amps — 301.04 MIIIII© Address: Over 1,000 amps or volts - 552.26 — Temporary services or feeders installation, alteration, and/or City /State/ZIP: relocation Phone: ( ) Fax: ( ) 200 amps or less 59.36 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 25 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670; and 701. 401 amps to 599 amps 168.54 2 Branch circuits –new, alteration, or extension, ■ er panel Owner signature: Date: A. Fee for branch circuits with . - � � { t' g3 . 'v; : . a3� i ; 'c. ' © bk►�gr' - , • •^ :, above service or feeder fee. 7A2 2 /,� w:' `t ,i, :I�� �. � ' �r each branch circuit Business name: l etfiiLv AL A, v � C riwt: Ii .c ., B. Fee for branch circuits without II service or feeder fee, first Contact name: t \ ' (y 5 56.18 k,1$ Each add'I branch circuit . L 7.42 Emma Address: 6 \- 1k 4 yaj Miscellaneous service or feeder not included City/State/ZIP: II Each manufactured or modular . �12 vy e ' �” dwellingg, , service and/or feeder Phone: (5 p3 )s '�S y- 5- ' Fax:: ( ) Reconnect only E -mail: 1 ■ 67,84 1121 Sign or outline lighting 67.84 Witag410•Nha i liteig.0*;.atiltMalg i katitSgal Signal circuit(s) or limited-energy EMINEIN Business name: A L,e. Z_(oct,� ° ' .. ei alteration or Each add Inspection over allowable In any of the above Address: pa �j 634. Additional inspection (1 hr min) 66.25/ hr VVI� VLi Or 17/ Investigation 66.25/ hr City/State/zip: r Industrial plant (I hr min) 78.18/ hr Phone: (5b3 ) Li 3 Li- -- S g/b,p...... Fax: (9)3 ) 1/72._ - L t ?, by Inspections for which no fee is II 90.00/ I 'lice// listed 04 hr min / ; CCB Lie,: A 6 1 / Electrical Lie.: 3 ( —q Suprv. Lie.: 32� �, '- *at:;;j s' ) ,1CpA '! I�3Id,S ;: 'i' .;: Suprv. Electrician sigha , quired: '.7 ' 77�_� / /1 - Subtotal: 1)?.. Plan review (25% of permit fee): Print name: t2 £ A I c_ Date: �'t'7 y State surcharge (12% of permit fee): g, 5'?' • /r T OT AL PERMIT FEE: - q 5 L Authorized signature: ,D,-)1,.„...,_, This permit application expires If a permit Is not obtained within 1 0 4.� Prig[ name: Ante: days after it has been accepted as complete. = Number of inspections allowed per permit. Ulu ild'i WermSi C,PermitAagdoc 07/0t /to 440.4615711 1/OS /COM/WEl 2012 /AUG /20 /MON 09:18 Nice Electric FAX No.503 472 1628 P. 001 NICE ELECTRIC COMPANY CBB #2061 • Company Lic. #36-9C Commercial -- Industrial Residential Wiring Facsimile Transmittal Sheet Address DATE: ?tZO ) • 1605 NE Riverside Dr PO Box 636 To: _ McMinnville OR 97128 COMPANY: AAA •1 _ A • Contact ,[� Phone 503.434.5802 FAx #: 3V_2 • • • Fax 503.472.1628 p- r� A , Email niceelectric @integra.net PHONE #: 5'•71 o • //�-' 6 1 PAGES (INCLUDING COVER SHEET): S FROM: , AM Notes /Comments ek/VkalL____tyr (- R- 0 ` rr ►\•U,wk t 1+ I s/ stt - Ceti ►.L. CCA "Ease the Day - The Electrical Way"