Loading...
Permit Ili q CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT COMMUNITY DEVELOPMENT Permit #: ELR2012 -00157 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/25/2012 Parcel: 2S102CB03200 Jurisdiction: Tigard Site address: 9975 SW FREWING ST 140 Project: Adeo Home Care Subdivision: FREWING'S ORCHARD TRACTS Lot: 21 Project Description: Data telecommunications for TI Contractor: BRIDGETOWN ELECTRIC Owner: BY PICOCO 5701 N LOMBARD ST MASSIH LLC PORTLAND, OR 97203 -4113 4343 VON KARMAN AVE 3RD FL NEWPORT BEACH, CA 92660 PHONE: 503 - 621 -7122 PHONE: FAX: 503 - 621 -7123 FEES Description Date Amount Specifics: Restricted Energy Permit 07/25/2012 $75.00 12% State Surcharge - Electrical 07/25/2012 $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 calling5 or 1.800.3332.2344. Issued By: 4 / Permittee Signature: 1. 19 �7 770 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 603.639.4176 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. Jul 24 2012 3:59PM Bridgetown Electric 503 - 621 -7123 page 1 Electrical Permit A Gca K EIVED 1: , , . 1 ; ; . , Si City. of Tigard �� , �� /�I ► , %I . 13125 SW Hall Blvd,, Tigard, OR 9 ' ' 1- © -: r � " N° ��° 2 0 /- �O/SJ Pilot= 503.639.4171 Fax: 503.5911 1 6� 2 4 Z 2 RIM Review I . Omer term P�/�'Oa/ y nate/By: Internet: www ttgard- r � gov CITY OFTIGARD xa: ,So t�wd: (J Supplemental td..m.non � t4 +h,!1 '' �, i ,1 S.i,r,.,,� 1'K !. fkv t:'� dA � � "� � �1� tc7 !1'� rrt 7 •: ,•y j':i• 1:.r d '� t.'.is.. 'r ;. �3'eitf •+y L,1 :1; 1 n ,—,. 9nS` b s:,t� ,, ...r-f 1 � ' a,��g � + � t Z ` 1, i1 . .1_�4nY b�.l¢rbr LL: .H . . > 3 1-1 ' J .. 1 �.I• wL Y�i` 1't: �,.: ?'< _ ,)1...,'.' ❑ New construction ►: Addition/alteration/replacement Please k all ^ is apply (whelk jean v� w/uems ch eck e d wow) ❑ Demolition °Service or ;- . 1 1 '..mpeCrWM 0 B°Oding °verthree stories. ❑ Odter cL �� where t h e I i e melt ammo 0 Marinas end boatyards. t1 Ll v 1"P!';.= i)., JL R: 3',:ri'u 1 1f 1 1 ;s.' : #.,,. •, �t y l M ' a'pr, ti'o> +7' {8 1 k r) ' , 0,1a'1� volts or O Floating hm'Iding'. 11n '' T tii:yl r T;'<< - e ...r_:..4.a:..x�a . r! k '.�Sec.r,./,,d- Ri_tm:t.6.1,titl i.. -.. A. n �� ..5 ': t _ 1 I, 1 meads 1 000 a �j Utndustrla) ❑ Accessory building amps ea !,1 Installations. O Commercial -use °°nnral ❑ 1- and 2- family dwelling 'A Commercia o pomp. � t� D kalall � ❑ Multi - family 0 Master builder ❑ Other: Or n f 7 d '•k' ° ' r n in:a �: rs la a:.; x O RVA Or ;yp``y ti �ri,1• ;, � , r n(•:� 0 r .P,�ny:.: , rdrN'f t�.", 1 D elyderivedeyes. b7 o 1 hW lr to uti e0.1.. i`la.S a t tt �' ,,: ,,,1 }• '!> 1 0' " 2 " . u i _ 3 " r; y a li.rl,. c � 1lixic.3a ;fiut R x aaa:,G ai,�.� ''; ;'<t � +•. `'..�',.n .. f b � �i QAddition of -. ,. me bad of Job no.: %1/l j 4 ) q lob site address: f lqt5 sw F9ta»wm, 144 1oo1•tP or mond 11 anarpeacy, D Six « more .! !la teem D Recreattoael vehicle palm. City /State/ZIP: 6,A,Ro 0.'122' D Health-care D SapPly voltage f« moro than 0 no.: ` Project l � D Hazardous O servtt set I s . 600 wits nominal. Suite/bld Suite/bldg/apt name: aor . ��i ' z �Y or a i r. , . •. Cross Streetldtrecttons to job site: !!: It, ,. 7` ! 3 i1 1 :,r i:v+.I�I '".•5`vr:+ New redden. IR tandly dWellnig ank. ladudes setae , garage. Subdivision: Lot no.: 1.000 sq. R or 1- ; . 168.54 Tax map/par el no.: 13a edd9 500 sq. ;or portion 33.92 s "r, P ; F.'�'fM1fi' + l P y,'1 . S�,se. mi,nr.�e a usy r 9 '19i t U Limited enemy, ' N''04. r. %. E l > > {p fi 's ' �, , yu�r 1r{ 'r.:. 1 \ �'�6'� y ��»G .. .,•, :, tar,„.I,,Ih.,. .'�tl��,.1. G9 »,i Tie ' .Y.:k {�ij7'Yk�, �. if; 41P (with above • I ) 7300 e�V �1I G9 � 1<19 �� ily sAA ., el s � 1 1 A / ( .1 - at 8.) 73.00 � "� Servlees or ! , las>tallation and/or rdneadoo i ' s ^N 4 1 r n �x F fit?" a;k w, 200 amps or Imo II — 100.70 .,' ,, : t . : .1.. al i� ,,,...�j `, ..i•h . r :.W .1ii »:1, •r U A , n . T ? ' � p r 201 B7f to 400 1 L 13356 .n.r1t ^..�.� . #1 Name: ' l ` n �� e 401 amps to 600 , t , 200.34 Address: �� to I�►�L 601 amps to 1 1 11 / 301.04 ig Over 1,000 amps ; i ohs 55226 City/State/ZIP: Temporary • i -. or feeders lasfallatloo, alteration, and/or relocation Phone: ( ) I Fax: ( ) 200 amps or teas I f 5936 mops Owner Installation: This installation is being made on property that I own which is not 2D1 tD 400 • ; j ' 125.08 intended for sale. lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 4 01 amps to 599 ` 1�,� Brandt divulge ; l' . alts do , or extension, perpanei Owner signature: ;p� (� Date: A Fee for brand, . with J !1L ^ u'k "•''', 1, ., knc.'•ts_ns i i r a ► h. t ' t i-41, �. . . , eadi 8QrV10 1 : L7 fee. 742 Business name: B. Fee for branch ' its without service or - -... tree, first 56.18 Contact name: branch circuit I . — .Eachadd'.l�branch I , =MEM .. .. 7.42 Address: Mlseellaneooa a or feeder not Included) J City /Stgte/ZIP: Each month • ... modular I dwdlina. service '.. • feeder 67.84 , Phone: ( ) I Fax:: ( ) Reconnect only I 67.84 5 E-mail: Pump or irrigation I 1 ' fb 67.84 : Sign t • d ,tt t ! �y � �+ G Or outline11 .,1 , i:A 4, 4 ; ,ON r r-' 7: c a �5'h 7t • 'Y ''tin .ra,,.:k :), :u.. signal ' - 67.84 ...r, t..i,.,.... J..r..,d;1.��!'�Rw ,: �' .,p,, i,..� H3?�i:�1�.,, n. •��'�' � ^_;�r• Signal drwft(e) or i.,. .11� Business name: lad s E L.E.ti{ 1 C. panel, alteration, • I J i .. siert, I . Page 2 1 rJ 4) 2 Each add doaal I . section over allowable in any of the above Address: S 7 0 i N , i...0 /1A-6/1420 S T12ELT additional iaspedi (1 hr min) 6625/ hr City/State/ZIP: ep (R 112 03 i 3 tyeeanecc g (1 hr . 6625/ hr Industrial (1 Q' ID) 78,18/1r hone (90 ;) ' 712 Fax: (60 ) . # . 1i I t 2.3 for wh d :' 90.001 hr _ , 1 9 ecc (dal Lic.: Su . Lic. 4 Ins:, , CCB Lie.: O .7 e� .1c G {m 14 1 7 7� M.�}wla �'IiNS.ol:r!'L,i '"'P Y 1 t �{y`° a y 1 . 1ti` R Electrical r..t. , ::,f .'�. a !�� .17i �.:�ln6. 7 v! (�i Suprv. Electrician signature, regiil -, Subtotal: -�- �-`-� P : ! - • (25% of permit fee): Print name: . ,'jG� Sriee. ,,s / -d Date: State . ;' hargo (12% of Permit ice): Authorized signature: TOTAL PERMIT FEE: IY This permits ,., , •-• 1 1 • a expires If a strudels cot obtained within 1g0 Print theme: Date: ' - It has be.eeepaed.. a.m tt.ts • Number of . - « m `., : allowed per permit. 1; 18 .11®rlgWamils 07/01l10 OIW6tSrytU06lcOMlW® r i Jul 24 2012 4:00PM Bridgetown Electric 503- 621 -7123 page 2 Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: 108,10014.11* c Fee for all residential systems combined $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* El Burglar Alarm El Garage Door Opener* El Heating, Ventilation and Air Conditioning System* E l Vacuum Systems* El Other: Fee for sack commercial $75.00 system (SEE OAR 918 -309 -0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls El Clock Systems A , Data Telecommunication Installation El Fire Alarm Installation ❑ HVAC • • ❑ Instrumentation ❑ Intercom and Paging Systems El Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling • ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations 1ieuIdieMPermiu\nc- PermiNPp.aoo 07m1no