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Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT II Ai s COMMUNITY DEVELOPMENT Permit #: ELR2012 -00124 • T [ G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/18/2012 Parcel: 1 S135BD00100 Jurisdiction: Tigard Site address: 9600 SW OAK ST 335 Project: Donovan/Comcast Subdivision: ASHBROOK FARM Lot: PTS 5 & Project Description: (1) Data Communications Contractor: BRIDGETOWN ELECTRIC Owner: SUN LIFE ASSURANCE CO OF CANADA 22732 NW GILLIHAN ROAD BY NORRIS BEGGS & SIMPSON PORTLAND, OR 97231 121 SW MORRISON ST #200 PORTLAND, OR 97204 PHONE: 503 - 621 -7122 PHONE: FAX: 503 - 621 -7123 FEES Description Date Amount Specifics: Restricted Energy Permit 06/18/2012 $75.00 12% State Surcharge - Electrical 06/18/2012 $9.00 Type of Use: COM Class of Work: ALT Total Number of Systems: 1 Audio & Stereo: N Boiler Controls: N CCTV: N Clock Systems: N Data & Telecommunications: Y Fire Alarm: N HVAC: N Instrumentation: N Intercom/Paging: N Landscape /Irrigation: N Landscape Lighting: N Medical: N Nurse Calls: N Protective Signal: N Security Alarm: N Other: N Total $84.00 • Other Desc: 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 OAR 952- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800 Issued By: Permittee Signature: Q 1 �-iC Tf 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. Jun 18 2012 9:34RM Bridgetown Electric 503 - 621 -7123 page 1 Electrical Permit Avidicati CEIVED City of Tigard Q Review Datefisy: le ' f.2- ,r Pallet No.: 4 _ a ©bL L L IS a Phone:.- 503.639.41171 Tigard, Fax: 503.598.1 '61 1 8 2 012 � ° DOWDY: � Other Permit: � , , Inspection lino: 503.639.4175 r�+ n ' Date xcaar/sy. 0 a 8 P.= far Internet: www.tigaad.orgov �� R1� E ���°" Nalfi0dMetbod 11 LI d tafartoetlon `7� :tN! �, ' •,;' �' 7.. � yy "l ,s tv t[ r wke, n uw t c ^'+ 4;r 4i . ty '�, °F ! J 0 • � 1 1 .� y .4.� - '' E 9 FC t •s ,7 rrncux mow. � J n 4:�i�'`� {.. e'� Jn '� i !s. 1 : J t }4:i y ri.'�q� 1�.. ��4T T '!tl' r t 7r �yyflT;t���'' d } ,�a. � .ca +w . •r� �rutn.4s.. lY.: itzn�ut�i!• -. s `±v},. 4 ' ;Wy 'i, �� a` .. :'!dl'i�d�J. i�';1.. ikn -.. ..�.._. ..,.w..,.[sr::ll�t!ai� ,II Si� ❑ New construction Addition/alteration/replacement Please chock 55 I.. :: ant (ecemli I sets of plane write=, checked below) 13 Demolition ❑Other. O service or -. R 000 amps or mom O Bulldm8 over three atones. � to K1'1 ;f O t ism 75. N4[ fi lWr. �a awn \64lom the avm ' ash current 0 Marinas and boatyards. x'• s�d''_'-k� a iiik t� ; i 1 , '. e 1 y f ! w u , '; ` , a':, P,,a, ,, exceeds 10. t't [ r,.. at 1 S0 volts or Cl Flatting buildings. 4? �u.clo .rte.: .aa:aloap[2c�.,ita usrriaita ., fi ' •' ,. . : 3P. t .7, AS • El 1 - and 2- family dwelling '4 Con � encindustrial ❑ Accessory building .m kes to ground. - mows 14,000 O emmouclal oso agricultural ID Multi ❑ Master builder i laaaoe in buildings. , �t� � i ❑Other 0 F ie pump. t O insist Isaias oF75 KVA or "+ �# qq � t �1 Ik7"N tau pn t z. n J a �� x rl �,,, �� t4� ii" as v �: t4 tk ' .' {:: , 0 Froei>�oc7 a larger separately derived met 4.'i a � l ng 'tcdi:iaw.vm `: f: ..:l ∎ s :.�;!':: ❑Additiaoof S . load of Cl A ","5" "1 � Q -2 ". 9 3 Job no.: i1 - W4 Job site address: R/900 jebW OA( loot>po*ewae, aoeopaeoy. 0 Sir or mom < . -, del 'mks. 0 Recreational vehicle parks. City/Stete/ZIP: 0 M/�.1.'i� °Healthcare fat O Saapply voltage EDT mmeWan t no.: "l [ O Fr�ardous l • �°e 600 who nominal. Su ite/bid g•%p ' ZjS I Project , 1:1 #CI / ` 1 p a psesvk eor - ampsar Cross street/directions to job site: �+ •~T l•�*_�+�� I . ' _ . �r l); i ,[< � l Y i �rJE! . t ens y IJr r w n . - NS $1dC1'f }'. :;5''`{ ° tom m t+�''"_4ii iiiil 'n m 'so New wresl eniial' , Oa or madtWhrntlydeveIIhiguuiL Includes attae garage, Subdivision: . I Lot no.: 1,000 sq. A. or le ` 168.54 1 _ 'fax map/parcel no.: Fa. «dd'I S00 sq. ; Iar portion 33.92 4 N 1 ,. 1tA. ry. g [ Y ^rs r qry • .,pia n f d 'fn yro-n }� #'+ l.united Ca2l�. ir; ,_ r 2 :77 1RtVI .«_ r a w ". i l "' ari':: ,Y65El (with ; 75.00 ' . �a.9,s.w0u n. t ti r.'.r. r�r.t' . ..;k +ate' aq ) Limited energy, • -Amity 75.00 Low Veit ASE V'R 0,4.2,LF, Q.M.I NsA.R., V'to residential (wi; ;:Bovesq.it) - �p Services or f M installation and/or relocation ,t,:• ? tai "["I.Yl:ec!! -aatc .e.prav�aq 'k •':ladr� �P":'.1a ,r 24300111 or less .,` 100.70 { 6 " r . rw6 sir B t k y7, x r ar2$4:• $ AV t '� r i ..i ±'i K' . r. k�x .� ` � ' � : , ! � � %�'`, ry 201 amps to400 •. � .. 13336 a, ,+; Name: 401 amps to 600 ,! .: 200.34 . Address: 601 amps to 1, • • • r • • 301.04 Over 1,000 amps • 55226 City /State/ZIP: Temporary • - or feeders installation, alteration, and/or relocation Phone: ( ) I Fax: (; ) 200 amps or less I 59.36 Owner Installation: This installation is being made on property that I own which is not 201 amen to 400 _' "• _ 125.08 intended for sale, lease, rent, or exchange, according tb ORS 447. 449. 670, and 701. 401 amps to 899 : �.: }68,44 Branch circuits , alteration, or extension, per panel Owner signature: Dale A. Fee lbr branch • is win - µ,: ;� 'fir u. � yy 9Y rdi Pal }grin:J t c n �1;... ; r t. ;'. !i� ,i ?ifP`.• l ilt,a 1 1 j �i 4 ?1:11 h9$1 1.4�G 11107 1 � a S. Yd � 8b0V8 3Cl{7CC f ee' rod ` y t>n n a:•l a.a vise evr ::r S$ ,•;.. r sac a leasrfi ci •r 7.42 . Business name: B. Fee for branch • I F.. ' • MN/ooett Contact name: source or feeds - . that 56.18 , brand] circuit . ! Each tldd'l bawds - 't . ... ... 7.43 Address: Miscdianeous (, - or feeder not laduded) City/State/ZIP: Each menu is • , :.'r, modular 67.84 dwelling, service : ",,. or feeder Phone: ( ) I Fax: : (: ) Reconnect only 67.84 E Pump or Irrigation i le 67.84 ; !' %r u [4t P, r 'trtx''r'.�.:':Sriixd,.cy, i , � F ^. 43 a�''y} `i':.i. r�, Sign oroudean'a 67.84 2 ' IU L:.a.�.i..,::.,.., ll..�k �itls•. �4 °. .. fi:.,t Signal circuit(s) Business name: ' e fl E4 tC ' panel, alteration, . , • - I Page 2 75,°O 2 .rte Each additional 1 • ' - • on over allowable in .any of the above S Address: y 7 01 IV , L.O 6 0 S T1 7' Additional tnspem .1" (1 hr awl) 66.2/ hr City/State/ZIP: , JDD OR Co Z ce " . 1 3 Investigation (1 n) 66.28/ In Industrial plant (t ` 1 .) 78,18/ hr Phone: (5°5 )� 7 I - 1 12 2. I Fax: (e ) ( l 'j 123 Inspections for wh' no fee is a: 43 2 s listed 3 mi CB Li 90.00/ h< ` B prv. Lic.: g ad : ; * , ;y� i • r s. 1 jDt ICltl Lie 1 77 b +E kdRiAli kSJ'';{ ..- .ia,1._. .1 '. . a ,4; , s iid'� J :r :. t, Suprv. Electrician signature, raegulred�f ',� ( �_ , Subtotal: '7r< CO w�c P :. 1 iow(25 %of permit See): Print noun:,, )4t 4 Ste' ,S / /cat' ` I Date: State : 1 huge (12% of permit fee): - l Authorized signature: TOTAL PERMIT FEE: 4 , 170 Print name: 1 This permit a da ay ys • 1 it t been seoepeed as within 180 • I Date: • Number of "., ... • ; , s allowed ter permit 1: lauuding1PamunetC -Pe[mitApp.doc Moine 414`/61ST( iliOS/COMNIEB ii I Jun 18 2012 9:34RM Bridgetown Electric 503-621-7123 page 2 Electrical Permit Application - City of Tigard Page 2- Supplemental Information LIMITED ENERGY PERMIT FEES: Fee for all residential systems combined $75.00 Check Type of Work Involved: O Audio and Stereo Systems* • Burglar Alarm • Garage Door Opener* 1:1 • Heat ng, Ventilation and Air Conditioning System* O Vacuum Systems* O Other: r itI Fee for each commercial $75.00 system (SEE OAR 918-309-0000) Check Type of Work Involved • Audio and Stereo Systems O Boiler Controls O Clock Systems Data Telecommunication Installation El Fire Alarm Installation • HVAC D Instrumentation El Intercom and Paging Systems 1=1 Landscape Irrigation Control* O Medical O Nurse Calls O Outdoor Landscape Lighting* El Protective Signaling O Other Total number of commercial systems: 'No licenses are required. Licenses are required for all other installations LIkoldioePermits\ELC•Po dot 07/01/10