Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00337
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/05/2012
Parcel: 1 S134CA07700
Jurisdiction: Tigard
Site address: 11000 SW 121ST AVE
Project: Windsor Properties Ltd Subdivision: 1995 -019 PARTITION PLAT Lot: 1
Project Description: (1) 200 amp service
Contractor: BRIDGETOWN ELECTRIC Owner: WINDSOR PROPERTIES, LTD AND
22732 NW GILLIHAN ROAD CHANEY, JOHN R & PATRICIA K
PORTLAND, OR 97231 PO BOX 647
HILLSBORO, OR 97124
PHONE: 503 - 621 -7122 PHONE:
FAX: 503 - 621 -7123
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 06/05/2012 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 06/05/2012 $12.08
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112.78
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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 952 -00 0090. You ay obtain copy of the rules or direct questions to OUNC by calling 503 2 or1. /)
Issued By: Permittee Signature: v^� ' r 1Q L I��"f�l /U4
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.
Jun 01 2012 1:21PM Bridgetown Electric 503 - 621 -7123 page 1 5
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Electrical Permit Application : � , ;, , ;
City of Tigard C v may: le `f , Z- �1 2. ! j(Y -�3�
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13125 5W Han Blvd., Tigard, OR 972
Phone: 303.639.4171 Fax: 503.598.1960 p
Plan Review
g Other permit:
Inspection Line: 503.639.4175 JUN 0 120 _ Ready/fly: ( a for
mttrnet www.tigard orgov Notified 4Q . 1 Sgpm.avl inrbr
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., .�wa,�. �s.7n l�..E ��Yi `i. li�iLLl.:'zl'6„� �wV � . A 7� I. a _ .. YAr �f i � .J a � int_i� , cCcr t n, .1. i!.'f lca�',`I! J �� '
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❑ New construction r! .. ition/alterrai ` I !1 11. ' ` • - Please duck all p a0• Y
(eubmir a oats • pbm warms eiMetted below)
❑ Demolition ❑Other O Service « ' w • amp& or more I] sanding over sires aacrten
p ' w the - , �- Sleek current O Mains and boatyard&
�'`i � J+.. 4��ifd1{�f�LrtZ•s,. =1, F+i� 2 aa,ul H! pin +re. w,. >r�txtcr\,y V , r� , ' �,r' q :, �. et 130 vole « O F
,1 tl W AA�( W,c g exceeds 10, , r � qB
. .d a.� •. V .1 a +:+�5'1i1.5r.•etiY'she I'L.!1nA2 � 4.t'rIF1!,In,�� . 1..:a.i_i c .� R: aalsu�.al iY�` -�� 9k.5i 54 . ��15:' r. r
P and - - farm dwelling agricultural i "� lY g ❑ Comincrciayindnstrtal ❑ Acce buildi .
less to for . . ` exceeds ON. O b o diep.
❑ Mu l tare
amps for r a • • i � ia�aalow. baldtnaa.
Multi in ❑ Master builder ❑ Other: O F6e pump. O lastanetboa of 75 KVA or
hrl; Ji+, -�',' � �.,ax�x� .E+u- a - y 7 n oa 7f +94N�- :� %' r. >iw z. -ve y c, +
.5 °I ry f t cllti4�kiii 1 , r 4 1 . i 5 , � r , f 2 , s r t � au f f . iik . -g - i i 13 Emergency Addition of a larger r. "1- ^, "1- ", eyes
f_c�iiT.ct. �lasr}r i:49una : n,F.i�i�•SnnA�ixv ;: `: + '�' t � !u ' ba.1 . ❑ Additfan or ee • - load load or O,. � „ -Z ., . „�
Job no.: --- / b site address: / f ' /21 sr 1001 «m , - oowpaocy.
O Se. or mono i . -. tint onus. CReereatioanl vehicle pieta.
City/State/ZIP: r / c Olieahb -care fag, Sas* vokage kr mom than
DRaaardnrs • . , P '.. 600 volts nominal.
Suite/bldgJapt. no.: P name: O'Semeo , " ; I•.' . . ampsarmore. rr
NiSit.i�l32'J :.iltt�il ; S xie.`Fi,t ' 1 . fiT �` ,- .
Cross street/directions to job site: l c i s,.. .r` 01 1111
- New readttgntia I M t I . , . or matt 4ainay dWl tlling ant
Iaelndeaa ,, .. garage.
Subdivision: I Tot ao.: 1,000 sq. fi. or 1 168.54
Tax map/parce�ll no. ���}� 1 y ! y�p� t � y '�y� Ea. add'I 500 txl «Pow 33.92
t{S.R I R+rSY 7 .'+. 1 .;,Sat,'S ,.�1�,D air i •� i. i :4:i , 1 , L:�.t;:aC,: �:' ri ,_dI i t ` : " 3 7' lb{ above ; --
') 75.Q0
l . --family 75.00
MLa r S N . , residential (wi i, hove e.9. ft.)
Services re l - z A-/-/ P _cEr C- T in c I aatlationialteretbo ,amlMr relocation lCtC;�� amps or less tai
f ly t . 7 ::7 'eV� s. -' t *,� Rt" y r 5 t 7 }�{ ;,,,}�.r�'w, a4 Z • } Tall 20) amps to 400 . 133 1100.70 .56
. r:. IQ.,�°r. .�, a ,..,.. �..:u..,v,G. ° A.: ti ti` ttCfLt��S! :� :5s. ^1L'.9lG�aCw n�:.ImS.r.[1aiS I _
Name: 401 amps to 600 :1 ... - 200.34
Address: 601 ampa to 1, , s , ' G ps 301.04
Over 1,000 amps • , r 552.26
Ciry /State/ZIP:
� 7 ry . - or feeders Installation, afteatfon aadlor
Phone: ( ) I F ax: (. ) 200 amps or less I 49.36 '
Owner Installation: This installation is bein made oil 401 amps tO 400 )25,08
g Property that I awn which is not
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670. and 701. 401 amps to 599 168 S4
Branch elrealta I ', era, alteration, or extension, panel
Owner signature , Date A Foe tar broach I � . wpk
' •4. il C• ia"{+i;SV e r Yserr {rc+t . np r s'ti T , .y �rf.n �,srervyrnxan,. v 8h0Ye3Qillce •:. fee, 7
;N tii , r, ay 12 der m t , a fi S' 6>+A .42
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•" '4••• •im`u:t.�.t,Ftaiv.�.F, r �lrlu�i �)I §F� P .ta,...r?•.x.w.a�w �.t.y %k.,4 -h sluwaalG.•NC�3 fib[
Business name: B. Fee tar branch ; I its wW .ow
service or r.. •..! '._., fast
Contact name: bro circuit I s6 l e ;
w
tr
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Address: .Fachaddahranch,iy11E : - 7,42 2
INiaeetlaneoea '' ' or feeder not indaded)
City /Srate/ZIP: Parch • modater I
dwelling, service .!.• • f 1 F 67.84 2 •
Phone: ( ) I Fax:: (; ) Reconnectady I a 67.84 2
E-mail: y Pump or cigar I ie 67.84 2
ellll'tV � � 3.?;$. _¢`t` ,$'�? ,lYi i `'` ,..7, , i' cr! , i.'t ls9Npi tl2�3�7i'i�Gud d Sign l dru tie l or 67.84 2
. :;L:�_ ;,b, i'..:�' a`.4L'11. p`tN41mf7ei�i4R11t� + ) _ , •
Business name: 1 11 r e. . VI11 IMIIIIIIIIIIIIIIII lmmd t11te D Or l Paa e. 2 2
" `' Each additional G' neaten over allowable hi any of the above
Address: e£701 N . L_0n'tei' S et A4ditiormlfns
•� (1 lvmtn) 66?3/M
City /StaterilP: j� i.Alvla oR o ,�'93 ' i 3 Irlvestlgatioa (1 hr , ' ) 6625/hr
Mawp (1 , ,1 '',) 78.18/hr
Phone: (So; )141 7 12 Z I Fax: (44 ) 62.1 1123 inspections for , t no fee is
- Meal listed 1 tubs 9000/M
• B Lic.: 107 824 I E ctr;4a1 Lic.: - I S rv. Lic.: ci i 771) `t:1AilWryli 1 �t.f.. "v.._ _ '. ..: ! ; fl . ."S' �' .
Suprv. Electrician signature, required ' Subtotal 4
Lao ,p
' P1.. 1 1' ' (25% of pamlt fix):
Print name:, •y4 4, s1 rhS /.. - I Date: State = I il (12% of /, 05 f
permit foie): �
Authorised signature: TOTAL PERMIT FEE: /12. ?e
Tbb perm t ap . ,+ - a . • eagles: iif. pe elf Y sot obe i bed *ado 180
Print name: I Date: • a it ea„ accepted as complete. stun. _ L 1
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