Permit (35) CITY OF TIGARD ELECTRICAL PERMIT
F 1w COMMUNITY DEVELOPMENT Permit#: ELC2019 00059
T IG.q.R L3 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/05/2019
Parcel: 2S112DC00701
Jurisdiction: Tigard
Site address: 15965 SW 72ND AVE
Project: Gym Habit Subdivision: FANNO CREEK ACRE TRACTS Lot: 39
Project Description: (3)branch circuits in additional rooms for TI.
Contractor: ACE ELECTRIC&CONSTRUCTION LLC Owner: PACIFIC REALTY ASSOCIATES
9210 SW 28TH AVE ATTN: N PIVEN
PORTLAND, OR 97219 15350 SE SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-244-0078 PHONE:
FAX:
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo/Purchase 02/05/2019 $71.02
Specifics: Service or Feeder
1 ea 12%State Surcharge- 02/05/2019 $8.52
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $79.54
Required Items and Reports(Conditions)
AIL
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Spe.alty Co.es and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 :: s .f issua ce, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the ..o•ted by the Oregon Utili Noti icati•. enter. T e rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a copy• e rules or•iryct questions to OUNC. calling.�'Agg ot11 .332.2344.
Issued By: A • Per ignatur •
l
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale,lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Application FOR OFFICE 1 SE O\L\
City of Tigard RECEIVE
III a 13125 SW Hall Blvd.,Tigard,OR 97223 •lan Review
i Phone: 503.718.2439 Fax: 503.598.1960 n Date/ : Related Permit#:
- Inspection Line: 503.639.4175 FEB 5 2019 Ready Date/By: B See Page 2 for
TIGARD Internet: www.tigard-or.gov Notified/Method: IIMI. Supplemental Information
. . TYPE OF WORK.24.1-171511$F1
�ITYOF TGRON PLAN REVIEW
❑New construction TAddition/alteration/> "emenL Please check all that apply(submit 2 sets of plans w/items checked):
:
0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition ❑Other: where the available fault current 0 Marinas and boatyards.
ATEGORY;"OF CONSTRUCTION " exceeds 10,000 amps at 150 volts or 0 Floating buildings.
1-and 2-familydwellingCommercial/industrialless to ground,or exceeds 14,000 0 Commercial-use agricultural
❑ ® 0 Accessory building amps for all other installations. buildings.
❑Multi-family 0 Master builder 0 Other. 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
Job#: Job site address: 15965 SW 72nd Ave ❑100HP or more motor load of System.
❑Six or more residential units. occupancy.
City/State/ZIP: Tigard,OR 97224 ❑ ❑Recreational vehicle
Health-care facilities. p rks.
Supy voltage for
Suite/bldg./apt.#: Project name: Gym Habit ❑Hazardous locations. 0
6 0vlolts nom al.more than
❑Service or feeder 600 amps or more.
Cross street/directions to job site:Carmen/72nd , FEE SCHEDULE
Description I Qty. I Each I Total 1 *
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot#: 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
(with above sq.ft.)
Place four outlets in room additions Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Switch lights already contained in additional rooms Renewable Energy 0 See Page 2
Q PROPERTY OWNER' , TENANT Services or feeders installation,alteration,and/or relocation
200 amps or less 100.70 2
Name:Lisa Rhoades&Jordon Hice
201 amps to 400 amps 133.56 2
Address: 1185 SW Stephenson Court 401 amps to 600 amps 200.34 2
City/State/ZIP:Portland,OR 97219 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
Phone:(503)908-3290 Fax:( ) Temporary services or feeders installation,alteration,and/or
Email: relocation
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 125.08 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 599 amps 168.54 2
Owner signature: Date: Branch circuits—new,alteration,or extension, 1 r panel
Z APPLICANT ' 1' Cl CONTACT PST N A.Fee for branch circuits with
`` above service or feeder fee,
Business name:Gym Habit each branch circuit 42 <,:. 2
B.Fee for branch circuits without
Contact name:Lisa Rhoades beanih oirrfuder fee,first 1
56.18 5J. 41 f 4 2
Address: 1185 SW Stephenson Court Each add'l branch circuit a 7.42 /y IA_ 2
City/State/ZIP:Portland,OR 97219 Miscellaneous(service or feeder not included)
Each manufactured or modular
Phone:(503)908-3290 Fax: :( ) dwelling,service and/or feeder 67.84 2
Email:gymhabit365@gmaiLcom Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
CONTRACTOR,
Sign or outline lighting 67.84 2
Business name: e c, Signal circuit(s)or limited-energy
G� 9 coms �' panel,alteration,or extension. ❑ See Page 2 2
Address: ((41 S w 5 e to,,,s Ov, C r Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
City/State/ZIP: P,,_+-(,„,„) Oros o c(7 2..1
Investigation(1 hr min) 90.00/hr
Phone:(5,6 y) 3 i e, 5 q 5 .� Fax:( ) Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is
c5 c co a r o br.- 0 9 itn c.v.( ( , C.a i.,, specifically listed('/,.hr min) 90.00!hr
Email:
CCB Lie.: Electrical Lic.: Su rv.Lie.:
,ELECTRICAL-PERMIT TEES
I `I 4 Z L I 6 8g-"7 p 7i 5 '7.
Suprv.Electrician signature,required: !"../(4_,.......,.... t c 4It`) Subtotal: '�j.(�
�''�•''�
0 Plan Review Required(25%of permit fee): --
Print name: Robert McGowan Date: 1/17/19 State surcharge(12%of permit fee): i —2.-.
TOTAL PERMIT FEE: (, i...)
Authorized signature: CZ" 7_,,/J, This permit application expires if a permit is not i i m 180
days after it has been accepted as complete.
Print name: Robert McGowan Date: 1/17/19 * Number of inspections allowed per permit.
I:\Building\Permits\ELC_PenmitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
15965 SW 72ND AVE, TIGARD, OR, 97224
Record Type: Record ID:
Commercial - Electrical ELC2019-00059
Inspection Type: Inspector:
199 Electrical final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor