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Permit CITY OF TIGARD ELECTRICAL PERMIT III II " COMMUNITY DEVELOPMENT Permit #: ELC2013 00259 Date Issued: 05/06/2013 TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503.718.2439 Parcel: 2S115AB01900 Jurisdiction: Tigard Site address: 16200 SW PACIFIC HWY A Project: Anytime Fitness Subdivision: 1994 -028 PARTITION PLAT Lot: 2 Project Description: (4) branch circuits to reconnect A/C and heat pump Contractor: BEAR ELECTRIC Owner: SN PROPERTIES PARTNERSHIP PO BOX 389 1121 SW SALMON ST DONALD, OR 97020 PORTLAND, OR 97205 PHONE: 503 - 678 -1355 PHONE FAX: 503 - 678 -1108 FEES Quantity Description Date Amount 4 crt Branch Circuits wo /Purchase 05/06/2013 $78 44 Specifics: Service or Feeder 1 ea 12% State Surcharge - 05/06/2013 $9 41 Type of Use: COM 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 001 -0 0 You may obtain a copy of the rules or direct questions to OUNC by calling 503 232,1987 or 1 800 33 Issued By: �f'l -C /.0 Permittee Signature: O Af PrPPtt e 4PQ ILI 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. MRy- 06- 2013(MON) 11:40 Bear Electric (FAX)5036781108 P. 001 /002 x........1.a ma* .a Got MIL P1.1 /11Ls1LIOf1 FOR OFFICE USE ONLY • City of Tigard � , heisted ( / 1 I IIIII 11i,C'N s.. 13 Vomit Nn ag- I:l'StiN ll.allll,tl 1,r•ala In: ,;�;; o�Al3' � 1 MA 0 6 20 13 I'I.,n((i•tyt, — _.._.._ _... Name sir, 718.243 I as �n 3 �r13 14nn 11.UC Itt I tdn - , Pc 111 noun 1 Inc 5 b 31. 17 TIGARD 1 ,t� U.n•u.•.i� U, -- - -- t.r - — CITY OFTIGARD ! 1 'a . rage 2 far I nlctuel nwaa Iteard•or.l'O1 Noodled �kda.'t 6 e l Se e mrnlsl Inforraatiun TYPE OF 44/14DINGDIVISION PLAN REVIEW ❑Nc�tcoii-.iIuction AddiliO11 /allc raliull /ICrIat:ClnCli _ I' Ica.. t: abacialldratappll(suhmn •t•uertraacre.l.CdIMlnu) ❑ s<n,(C Iii feeder 400 nm ❑ Demolition ❑ Other. u amp.. or mote ❑ moiling ntcl t m heie Ow at faoh crt ❑ Manilla sent boom. mob. CATEGORY OF CONSTRUCTION . ^ccc.ls 10.000 imps al 110 tnh. m -- I ❑ fln�itrn hud I • 011d 2- Inmily dwellin t X..om nercial /industrtul ❑ Accessory buildin le >, II, I: n M Csttcds 14,1100 O lrnttlttCl Cl01 -row afut uhural - - f :unpr. nu all calm a,xrallatinn Imddu ❑ IVllilli-1anii ly ❑ Muster builder ❑ Other: 0 rote pump 0 In <lullanan of 75 K VA Of JOB SITE INFORMATION AND LOCATION ❑ I.tncrUCncv s■slan Lupo aclrvetcla derived aystcm Q Addtuou of iww motor load at ❑ A' - °I. I .. I -1 Job no.' Job site address :'�'O J O i I carke L 11 w t A 11 a It nr mote. nccupnncl T /'� `—�/ t,V` 0 t/� ❑ l SIN or mute rcat units 0 Reece mm.d vehicle parks. Oily /Slate /"LIP: 1 �� t V Cli a0) © I leatm -care facilities Q Supply tnllape for m rul e dear 1 1 ` "1 �/ ❑ 1!amnions locations 600 vnh• ■ I Suite/bldg./apt. n0.: Project name :` c + _ E - 0 Service or feeder 000 amps al more Cross street/directions to site: („L �� FEE SCHEDULE Desenptlnu I Qt., j Pre. .1 Turd I • New residential single- or multi - family dwelling unit. Includes attached caracc. Subdivision: Lot no.: (.000 sq. ri tor less 1 168 54 4 fax pulp /parcel n0.: — - - -' 1i:,. add'1500 sq fl, ul portion 33.92 Limited energy, restdennol 1 DF,SCRIPTION OF WORK twill) above sq. RI 75.00 ���^_; Limucd energy, mulct- Iantlly 2 `�•[ /� /y ±l a 75 00 i �1� restdcmiat (with above 9. R ) Services or feeders installation, alteration, and/or relocation 200 amps or less 100 70 2 0 PROPERTY OWNER 0 TENANT 201 amps to 400 amps 133.56 2 Name: 401 amps to 600 amps 200 34 2 —• Address: 001 amps to 1,000 amps 301 04 _ 2 Over 1,000 amps or volts 552 26 2 City /Stale/ZIP: Temporary services or feeders installation, alteration, and/or relocation Phone: ( ) Fax: ( ) 200 amps or less 59.36 1 Owner installation: This installation is being made on property that 1 own which is not 2 amps to 400 am 125.08 2 intended for salmi lease. rent, or exchange. according to ORS 447, 449. 670, an 701, 40) amps to 599 amp 168 54 2 Owner signature: Branch circuits - new, alteration, or extension, per panel Date: A. Fee for brunch circuits u'n/r CI APPLICANT r- 0 CONTACT PERSON above service or feeder fee, 7 Qa 2 _ each branch circuit Business name: B Fcc for tunnels circuits without "'— """ - service or feeder fee, first Contact name: branch circuit 5b 18 ' 2 - -- Each add'I branch circuit 7 7 42 19. 2 Address: Miscellaneous (service or feeder not included) City /Slate/ZIP: B ac h manufactured or modular 67.84 2 dwelhnr service and/or feeder Phone; ( ) Fllx :: ( ) Reconnect only h7 $4 2 E Pump or ofigation circle 67.84 2 CONTRACTOR • S ign or outline ligltlinp h7 84 2 v .� _panel, circuit(s) or Iitlnled energy Business nam alteration, or extenSu Page 2 2 1 e `) k� •.•- Each additional inspection over allowable In any of the above Address: 1 1 Additional inspection (1 hr min) 66.25/ hr ,_ !$latC /LIP: t"1a1 I �I 0 20 Investig, (1 hr min) 66 251 hr - ` Industrial plant (1 hr min) 78.18/ hr Phone: 1 t ` � ' .. 1 'a•f ^ e • ' .' I Inspections for which no fee is /'�� speeifiudlylistedcishrmm) 9000 / hr CCA Licr; 1 l � Electrical Lic.:2 l �� ELECTRICAL PE R M IT FEES t� — i Suprv Lie � ��(� Suprv. Electrician signature, required %cy r - /O r p W Subtotal I v.. O,lr4'L - ce Plat review (25 % ofper,nit fee): Print name: P 1 - I D ate• State surcharge (12% of permit fcc): � —. 1 5� IA l- 1 Authol ized signature: TOTAL PERMIT FF.F: —' In - `• Thb permit applicadou elpirat if a permit is not obtained within 180 Print name: .S ` i Date: I b days after it has been accepted as complete. ,•. ' Numbci of inxpections allowed I ci poen! I utuudmaiJ'ermua0 1•C- rermunppdee 07/01/10 410•4015 ,l11/05,COpt/tvCD .