Permit (253) U CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
"� COMMUNITY DEVELOPMENT Permit #: ELR2013 -00047
T IGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/06/2013
Parcel: 2S115AB01900
Jurisdiction: Tigard
Site address: 16200 SW PACIFIC HWY A
Project: Anytime Fitness Subdivision: 1994 -028 PARTITION PLAT Lot: 2
Project Description: (1) low voltage pre -wire for, demarl to tenant space for comcast cable
Contractor: BRIDGETOWN ELECTRIC Owner: SN PROPERTIES PARTNERSHIP
5701 N LOMBARD ST 1121 SW SALMON ST
PORTLAND, OR 97203 -4113 PORTLAND, OR 97205
PHONE: 503 - 621 -7122 PHONE:
FAX: 503 - 621 -7123
FEES
Description Date Amount
Specifics: Restricted Energy Permit 03/06/2013 $75.00
12% State Surcharge - Electrical 03/06/2013 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: Y Fire Alarm: N
HVAC: N Instrumentation: N
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N Total $84.00
Other Desc: Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.23444.
Issued By: U.Ch � �� Permittee Signature: D 4.," p_164 o iq
/ OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE: Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mar 05 2013 10:24RM Bridgetown Electric 503 - 621 -7123 page 2
Electrical Permit Application' : LIVED '
City of Ti , rd Reoei ed . :
IN
, . 131 SW x ., Tigard, OR 97223 M ► R 5 2013 • f CO 1 3 3 -aX)5�7
Ir. Phone: 503.639.4171 Fax 503.598.1960 n g 1 omw Permit 1, ,41 JO -0(4
I
Inspection Line: 503.639.4175 D TIGARD �" Ready s.: wp: he
Internet: www.tigard- or.gov C . �. \ \ 1. N - 4 moral InfOrMagen •
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t , •r:$ 1 A'. (' rte ' d ,,,, 1 r; G f 1 1 N a" s 1' n ;J* 7_ CY . i • f '' s " ! I ..d . k
�� >.• 1;, L " �' S � .i.IJ��N�A �ps�.41�t' X11.: 1.. a. d_ 1�d., 1:. .�et� 4 ln. ._ . �� 5,:'_l1�:i� ; fl. S fSl.+�1�w.�- � y 1N 1.A :, tl 2 � � ?4i
❑ New construction 53 Addition/alteration/ • lacement ' - lee an lial m ' { 7 c
O 'as or feeder 4 t or Q tOnni'fbtte garbs-
El Demolition ❑ Other: where to evadable • olr comma Cl Merino had boatyard'.
a n7+ I4e yEx , r ,u '1� r . ';'!'''''''''j J: ^+ *tom frf A6 pY
!� •, ;J , �M.�"i �+ ��'h t� "�8 r r ( � J er
_ 1 !� t u f }� ��' �t34 exceeds 10,000. •• • a.1 SO -volts or O ploatug bmld?egz,
qi! Y �u� i 1' ..u t u t , cwt_•1:.:ad_. I_ O'll , 11.d.u 1 .. I .J �,F. .,.P :.s to ground, - . : 14,E a egri6Ylterat
❑ 1- and 2- family dwelling IN Commereial/indu - : Q Accessory building amps for all other „, • ttloos. bnAdiees.
❑ Multi- family ❑ Master builder , ❑ Other: O ire Pump. O Iidlation KVAor
`' r o f Nl lTri - ,,T;', :.-:--•,,f1,1.,,,.`,:', } . .c
a Y t/ • A1P r ), 3 iii' } 1 4J�4W1 '(: a �� me'roeeoYSYttent lar®msepar�ly derived syame.
', _ t y .AN ea..,.• — .utu S. .. e 1! . .� ,.t. • i_ d.L r3 a, S,..-..,..i_t -
._._.Ju . htn • -i, o`� ,u 1)J..,:'•a.1.hL 1 .. 0 , .:Al arrow ,, . ' teed of O "A ^, "E ", "I- a'. "1-3 ",
Job no.: f 3 . f 3 Job site address: / °r IDO1D; ., °CEUpBOOy'
a ix or more .. eoim. ❑ Reew.iortel vehicle parks
City/State/ZIP: 7 ' , op MZEIIIIIIIIIIIII O th c.e ::..'.. a supply voltage au more than
O deRS location , 600 volts nominal.
Suite/bldg. /apt. no.: S A Project name: 4 ,},;, ../,,,,,, 5 O or Deader • , ;I amps or mom:
Cross street/directions to job site•'"' I�Il ' I, '‘,11'Y t '' J Y _ : 1„ t ..t
r '°^ n :. �„ or atulti-ibrmillq`dwe4Utg unit
F' odes attached ... e.
Subdivision: Lot no.: 1,090 sq. ft. alma 1 II 168.54 4
Tax map/parcel no.: En. add'l 500 sq. R. - portion 3392 I
:1 t 'z�� �rw t jnJ x.ta :z t ,� :.to„ °T3nr. J ^ t n or . alt; ' te� ,: • - 75,00. 2
q
1.•.1 ,J. $f y t� n! rc 5 N � s
-N , p 1'HI r ltp J N x ( 1 ''.1121; jl'
�; act 9r'! �, 14�v.� L.uu ,.�_.:mtu.4 ,... :e ._. . t.. Jn !.... . r.twl i4.i Jl6f!iiJa 1F, .: ..a , h .,
r Ited eaemy, 1IY 7500 2
J .J. Vo 14w - + ......„4, - 1c 4-erg aetb a : , . R
/�� ..,. 0 or , - .. - I lo=hllatton smdlor relocates
S 4/ C,.oiatp f C0' 6 ' i a• : , .. or less I 100.70 2
,, , , ; ,,, 1 _ F F *;- .1aptaop 1.1?Aia a, . ,1 al 7 ti i 1 try i s ,i - IT n, i '
133.56 2
2l1 t0400am •
s 'a: : :" . Ig samek.t;...4" fY'•,.^_tor.h4..-0:4•F2. .
",dttftt3 "lei•A� ifu6 1 1.111(. . , , i
'.irrt,,1 .,9� ,i'�, mi.9 ' g %' l' ,..
40 amps to 600 am 200.34 2
Name:
1601 amps to 1,000 a . . 301.04 2
Address: 1,000 amps or ' , its 55226 2
City/State/ZIP: T slot . -. ' - l or feeders lnsttl0rsloe, altcrattoe: asd#or
•
Phone: ( ) ] Fax: ( ) amps 01 1615 1 59.36 1
• Owner Installation: This installation is being made o property that [ own which is n zo! '.nape to 400 125.0E 2
40 amps to 599 : , :: 168.54 2
intended for sale, lease, rent, or exchange, according t ORS 447, 449, 670, and 701. E attsrrtlo 1eltteratoat;tieer-.
Owner signature: Date: A. Foe ihr brands with
, a vivo:- - rs . i rt,.T t J , s 1 ,.. A 1 ' i w I t v - t m s I , i 4, „ :z 71 Y r ;i f a serv or r - feet
4 0 t }� a ti� �.1 "TT 14e ' ' t 3415' .'"' l .J t i ( , A..- 7.42 2
, t tom' '.rmwL'A . r .r_ .L , ,,, ,...,i 1 E ti,l J+ . ,•9'._,. sdtdf� . J.. _ _ .edi t .t
Business name: B. es for brsnch ci ! •_ without
service or feeder >- , fiat 56.1E 2
Contact name: 1 circuit
Eachedd'I - - .t _ j_42 2
Address: Mhcelhrreaua tae • or feeder not Included/
Bath manuraciured City /State/ZIP: modular or feeder 6784 2
swel�ling. service . , ;
Phone: ( ) I Fax:: Recoinlect only 67.84 2
I P or irrigation le 67.84 2
E-mail: Sign orouttineb, 67.84 2
'f� ? It. d74 'h' 1 t�, ! fi t ' �,J . . - 5 ._ ! ,_ h i l 't , ,,,, . �, , 'A 7 ci c u t(
: �! sY_u$.rt �4:L '• .�Y+. 1 ,. .] ]. _ .c n .. - ri „t•;L t -� tm r ., ._l °k: 1 OF t._• -
Business name: Sat Yr Y !�q ” al - or 111
Mil S - 2
" I. ' pis 1 'b4 ■ • • dos over allowable r of the above
Address: ' ,5 7 0 f I.., O IA-6 ° . r, /0 S - L7ts`T II A. ditional i . , . . . (1 hr ado) 66.25/ hr
City /State/ZIP: Aga Z� . ►,3 -At 3 , — satire 'sa4ao p br ',',,) 66,251 hr
OR "1� 1 • „ , .:.Planta nabs) ' /8.18/hr
Phone: (90 3 Veil - 7122. Fax: I '; ) eq,i 1113 , .; oasfor • •• ?, no.fe6 it
, ued hr ,� 90OQIht
�o� ��4 I E al Li e.: Suprv. r 77 ! tr
:, .,
CCB Lic.. .. t l, . Lie.: Oit . , h: t! , er.' t,
Suprv. Electrician signature, requited'; - SnN4ota1 S—
•• / I P ,: •' Review (2S % oft gas):
Print name: ,/ 4 SN-fe Fos / ./4� I Date: 3/.5-/!3 State I (i2%ofpeaitfee):
Authorized signature:
'l'7'AAte'3!$, 0drr, >r74v ` ' g N —
7Al,Pesmtt m ift t 6 rrltbialls0
days , P nt name: Date: • Number of ;.. • :_ ions allowed pm permit
L• eikrinePee .GParoaJvpp.sec 07/O1no 446.4615T(1 1/0 ••s • . .
1 •
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
16200 SW PACIFIC HWY A, TIGARD, OR, 97224
Commercial - Electricial Limited Energy
199 Electrical final
04/12/2013 00:00
ELR2013-00047
PASS - No C of O
Violation Summary:
Inspector Contractor