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Permit t CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit #: ELC2011 -00035 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/14/2011 Parcel: 1S135BC00700 Jurisdiction: Tigard Site address: 10831 SW CASCADE AVE Project: Comcast Subdivision: Lot: 0 Project Description: (8) branch circuits for relocated work stations. Contractor: BRIDGETOWN ELECTRIC Owner: CH REALTY III /PORTLAND INDUSTRIA 22732 NW GILLI HAN ROAD BY THOMSON PROFESSIONAL & PORTLAND, OR 97231 REGULATOR CONTROLLING OWNER OF EPROPERTYTA PO BOX 4900 PHONE: 503 - 621 -7122 SCOTTSDALE, AZ 85261 FAX: 503 - 621 -7123 PHONE: FEES Quantity Description Date Amount 8 crt Branch Circuits wo /Purchase 01/13/2011 $108.12 Specifics: Service or Feeder 1 ea 12% State Surcharge - 01/13/2011 $12.97 Type of Use: COM Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $121.09 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 a cordance witty 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. AT , TION: Oregon -w • ui you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -001- 010 through OAR 95 ..1 -00 •d. You may obtain a co y. SOUNC by - ef the rules or direct questions „11iety� 2.1987 or 1.800.33 .2344. I 1 � Issue y: Permittee Srgnatu • 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. can 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. Jan 13 2011 11:33AM Bridgetown Electric 503 - 621 -7123 p,1 Electrical Permit Applic ti roc I F014 OFFICE (xr ON1.1 y I N Cit Dare/B ! PermitNo.: ELC4iat — 00605 13125 SW of H Tigard all Blv Tigard, R 972 2� 13 3 { Date/ Review ' Phone: 503.639.4171 Fax 503.59& K t"'r 2� Date/II Other Penn 1 IL, ;\ 1: 1 c Inspection Line: 503.639.4175 Date Ready/By, IliM Internet www.tigard-or.gov �� 1 tv.'1® Notified/Method: aupplemesra� r/ TYPE C a ion/ replacement \1�S��1t '. y rio,14 gEvti : .. . .... • ❑ New construction Addition Please check all that apply (submit 2 sets of plans w/ttems 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 GOT+13TIt riON exceeds 10,000 amps at ISO volts or 0 Floating buildings. ..:.. ` _ :.: .....,...., .... less to d exceeds 1 d 0 0 Commercial-use agricultural as s o groan , or excee s 0 ❑ ommercial -use agicu ❑ I and 2- family dwelling A 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. 1 • , B Fr Iis(F'QIItiNOC S At ti:OCATIUN.. • • ❑ Addition of new motor load of Job no.: 11-0 Job site address: i (:)?)1) t A p p 100HP or more. occupancy. \` I Q � � �""`� ❑ Six or more residential units. ❑ Recreational vehicle parks. w ry' City /State /ZIP 611006 ❑ Health facilities: ❑Supply voltage for more Man v El Hazardous locations. 600 volts nominal Suite/bldg. /apt. no.: I Project name: lAlkl<� 4 A , , - ❑ Service or feeder 600 amps ore. y f:a' t M >tik�t i t Cross street/directions to job site: Deseription I .oty . ` _.. lee. I 'rea • New residential sirfgle -'Or m ulti family dwetlltig unit. Includes a ttached garage. Subdivision: I Lot no.: 1,000 sq. ft. or less 168.54 4 Ea. add'I 500 sq. ft. or portion 33.92 1 Tax map /parcel no.: Limited energy, residential 75.00 2 • = l I Bs R11P'I'IOI' ?OF %*OI Ti .. (with above sq. ft.) . Limited enu Q gy, multi- family 75.00 2 /'S ShWeg .41s- %'P' e .5 " 6 ce�� !3 ri-,"c 3 residential (with abovesg fl.) Services or feeders installation, alteration, and/or relocation 200 amps or less 100.70 2 20 1 amps to 400 amps 133.56 2 �rP;lr�r#I�FRFY OWNER I:.. '- ..:..; • ti TENANT P P • 401 amps to 600 amps 200.34 2 Name: 601 amps to 1,000 amps 301.04 2 Address: Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation, alteration, and/or ;ity /State /ZIP: relocation Phone: ( ) I 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 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2 Branch circuits - new, alteration, or extension, per panel Owner signature: • Date: A. Fee for branch circuits with r r. above service or feeder fee, 7A2 2 `..:r F4Y k { . it I ., ...1 . 0 A,I,� ,,p0$ , ea ch b circuit Business name: B. Fee for branch circuits withow // service or feeder fee, first / 56.18 .54 n l e 2 Contact name: branch circuit _ Each add'I branch circuit , . 7,42 CA C Clint 2 Address: Miscellaneous (service or feeder not included) ! City/State/ZIP: Each manufactured or modular 67 Sd 2 ty dwelling, service and/or feeder Phone: ( ) Fax: : ( ) Reconnect only 67.84 2 Pump or irrigation circle 67.84 2 E-mail: Sign or outline lighting 67.84 2 . CON'r 00-. „ . Signal circuit(s) or limited- energy Business name: la ip i' E1 - rr— %C, Parcel, alteration, or extension. Page 2 2 Each additional inspection over allowable in any of the above Address: .n7 3 Z },J' 0,1i,ii ANA 174v' Additional inspection (1 hr mm) 66,25/hr + City/State /ZiP: '' ,© e ll Z3 + Investigation (I hr rein} _ 66.251 h r Industrial plant (1 hr min) 78.181 hr Phone: e' Fa t Inspections for which no fee is p ( .r ) „' - 1 Z Lo (�it 1%ij ) �D�. 7 1;13 90.00/ hr specifically listed (14 hr min) CCB Lie.: i0,' B 4 Electrical Lie.: - e5$ .7c, Suprv. Lic.: 4 i 7 7 j„ 'Et $C C4L ;ri tl ' ".irr _ ,.09 �t . . .. ,�l Suprv. Electrician signature, requWc ' 4.-- .e � a� Plan review (25% of perm : ' it. Print name: L ' //--A. — Ci i e - 0.2,s lrc? Date: Stale surcharge (12% of permit fee): it.q TOTAL PERMIT FEE: yZl,Oi T This Y Print Authorized : signature: permit application expires if a permit is not obtained within 180v I ` Print name: Date: a days after it has been accepted as complete. Number of inspections allowed per permit. I:i BuiltlingtPermits \ELC- PermitApp.doc 07/01/10 440- 4615T(11 /OtICOM/WEB i