Permit U CITY OF TIGARD ELECTRICAL PERMIT
11111 g • COMMUNITY DEVELOPMENT Permit #: ELC2013 -00098
T 1GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/13/2013
Parcel: 2S115AB01900
Jurisdiction: Tigard
Site address: 16200 SW PACIFIC HWY A
Project: Anytime Fitness Subdivision: 1994 -028 PARTITION PLAT Lot: 2
Project Description: (1) sign lighting
Contractor: MEYER SIGN CO OF OREGON Owner: SN PROPERTIES PARTNERSHIP
15205 SW 74TH AVE 1121 SW SALMON ST
TIGARD, OR 97224 PORTLAND, OR 97205
PHONE: 503 - 620 -8200 PHONE:
FAX: 503 - 620 -7074
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 02/13/2013 $67.84
Specifics:
1 ea 12% State Surcharge - 02/13/2013 $8.14
Electrical
Type of Use: COM
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $75.98
Required Items and Reports (Conditions)
This pe ' 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 a in accordance with - approve• • ans. This permit will expire if work is not started within 180 days of iss •-, o 1 work is suspended for more the 180
da . ATTENTION: Oregon law - quires you to follow the rules adopted by the Oregon Utility Notificat •n lent• Those rules are set forth in OAR
95 - 001 -0010 th .ugh OAR 952 -• • 1 1 009 Yo ay obtain a copy of the rules or direct questions to OUNC by calling 5 3.23..19 • r 1.800. 2.2344.
I ued By: _ I L�� - Permittee Signature:
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 T , / Date: o
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 Appli R ENFD FOR OFFICE USE ONLY
City of Tigard ar Received permit No 67/09 QQ
Date /B : C
13125 SW Hall Blvd., Tigard, O 2013 ®,��C�
c � L V
g ' t '3 Plan Review Other Permit:
II Phone: 503.718.2439 Fax: 503!5' :' 9 Date /B
'HOARD Inspection Line: 503.639.4175 T IGARD Date Ready/By: Juris: El See Page 2 for
Internet: www.tigard-or.gov CAN IDP! Notifieti/Method: Supplemental Information
TYPBPit -4MNIt P v
t PLAN REVIEW
❑ New construction ❑ Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ® Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling ® Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A", "E ", "I- 2 ", "I -3",
Job no.: Job site address: 16200 SWPacific Highway, Ste A
100H or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: Tigard, Oregon 97224 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Ste. A Project name: Anytime Fitness ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: SW Pacific Highway and Durham Road Description I Qrv. I Fee. I Total I
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add' 1 500 sq. ft. or portion 33.92
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family 75.00 2
Install building sign on storefront wall and connect to existing electrical residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER ® TENANT 201 amps to 400 amps 133.56 2
Name: Greg Gold 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: 12181 Margo Ave. Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and /or
City/State /ZIP: Hastings, MN 55033 relocation
Phone: (651)438 - 5000 Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits — new, alteration, or extension, Qer panel
Owner signature: Date: A. Fee for branch circuits with
® APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: Meyer Sign Co B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: Lyn Davis branch circuit
Each add'I branch circuit 7.42 2
Address: 15205 SW 74 Ave Miscellaneous (service or feeder not included)
City/State/ZIP: Tigard, OR 97224 Each manufactured or modular 67.84 2
Y g dwelling, service and/or feeder
Phone: (503) 620 - 8200 Fax: : (503) 620 - 7074 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail: lyn @meyersignco.com
Sign or outline lighting I 67.84 (07411 2
CONTRACTOR Signal circuit(s) or limited - energy
Business name: Meyer Sign Co panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 15205 SW 74 Additional inspection (I hr min) 66.251 hr
OR 97224 Investigation (I hr min) 66.25/ hr
City /State /ZIP: Tigard, Industrial plant (1 hr min) 78.18/ hr
Phone: ) 620 - 8200 503 620 - 7074 Ins for which no fee is
( Fax: ( 503 ) 90.00 / hr
s pecifically listed (% hr min)
CCB Lic.: 64014 X 4 2 I f Electrical Lic.: 20 -190CL Suprv. Lic.: 524 SIG ELECTRICAL PERMIT FEES
Subtotal: 6 7. g'y
Suprv. Electrician signature, required: Plan review (25% of permit fee):
Print name: Carey Rhoads Date: 2/5/13 State surcharge (12% of permit fee): *It /'f
TOTAL PERMIT FEE: '7 5--. 9'
Authorized signature: This permit application expires if a permit is not obtained within 180
Print name: Lyn Davis Date: 2/5/13 • days after it has been accepted as complete.
Y Number of inspections allowed per permit.
I : lBui !di ng \Permits\ELC- PermitApp.doc 07/01/10 440- 4615T( I I /05 /COM/WEB