Permit Support Document (29) 111 CITY OF TIGARD , 'I r.' ELECTRICAL PERMIT
f COMMUNITY DEVELOPMENT Permit#: ELC2019-00288
GAIL D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/01/2019
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Parcel: 2S102AA00906
Jurisdiction: Tigard
Site address: 12084 SW MAIN ST
Project: ICE-4592 Subdivision: Lot: 4
Project Description: shell work including (1) 100a 480v panel,75kva transformer,200a 120v panel.refeed 2 hvac units,&lighitng from
new tentant panels.set up customer metering pack in rite aid electrical room. 8/12/2019: REPRINT permit to
correct address from 12080 to 12084 for Kimberly Berg's Rebel Fit Club.
Contractor: INDUSTRIAL COMMERCIAL ELECTRIC COMPANY Owner: BSM REALTY LLC
PO BOX 21282 BY RITE AID
KEIZER, OR 97307 PO BOX 3165
HARRISBURG, PA 17105
PHONE: 503-981-2383 PHONE:
FAX: 503-981-0053
FEES
Quantity Description Date Amount
Specifics: 2 ea Services or Feeders-200 05/01/2019 $201.40
amps or less
15 crt Branch Circuits w/Purchase 05/01/2019 $111.30
Type of Use: COM Service or Feeder
Class of Work: ADD 1 ea 12%State Surcharge- 05/01/2019 $37.52
Electrical
Type of Const:
Occupancy Grp:
Total $350.22
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 0 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Ttsued
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Permittee Signature: moi✓ L /\/ .----.
By: ,,, ;4,7_16 __ _
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.
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
12080 SW MAIN ST, TIGARD, OR, 97223 July 3, 2019 at 12:13:49 PM
Record Type: Record ID:
Commercial - Electrical ELC2019-00288
Inspection Type: Inspector:
199 Electrical final Chip Barnett
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor