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Permit III p CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT s , COMMUNITY DEVELOPMENT Permit #: ELR2012 00237 T TGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/15/2012 Parcel: 2S113AB00500 Jurisdiction: TIGARD Site address: 16083 SW UPPER BOONES FERRY RD 120 Project: Spec Space Subdivision: FANNO CREEK ACRE TRACTS Lot: PT 37 Project Description: (1) low voltage for Data/Telecommunications for TI Contractor: BRIDGETOWN ELECTRIC Owner: G &S FC LLC 5701 N LOMBARD ST 16083 SW UPPER BOONES FERRY RD, PORTLAND, OR 97203 -4113 STE • TIGARD, OR 97224 PHONE: 503 - 621 -7122 PHONE: FAX: 503 - 621 -7123 FEES Description Date Amount Specifics: Restricted Energy Permit 10/15/2012 $75.00 12% State Surcharge - Electrical 10/15/2012 $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 $84.00 Other Desc: Required Items and Reports (Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952- 001 -0090. You may obt copy �A opy of the rules or direct questions to OUNC by calling 503.232.1987 or / 1.8 / 0 � 0.332.233 / 4 � 4. t ' Issued By: J f L&Ct f Permittee Signature: Dkl I'f PPL/64�d/&L OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale, lease or rent. OWNER'S SIGNATURE: Date: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC' Date: LICENSE NO. Call 503.639.4175 by 7:00 a.m. for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project Approved plans are required on the job site at the time of each inspection. Oct 11 2012 3:55PM Bridgetown Electric 503 - 621 -7123 page 1 Ele Permit APDhicationRE ;;'t:: : ,1 :: , ; " Received City of Tigard . i 3' 5 ll m No.: . - o o L3 ty R�. 0� / I c L.� � 7 _ Phone: o3 9 Blvd. '' °' SO . 11 20 12 "°" Other Penult: Plan Rev Inspection line: 503.639.4175 CITY Dare Ready/By: furl : See ' -- 2 for Internet: www.tigand- or.gov s ' r OF T • r Notified/Method: Ti 4 1 Sap • . Information ? , • • , , r � ,� 4: - 1FT2 El'1(I jltt, j s, ? yl b.��:, i �• W , I j ,' �. y r - O� ,c �. : F y :..�i :: Ai ' tiCff' ', - . , i• , ,-..... � , ,Nr_ cN n { fY" ! ^ ; ' rWi y "ALL '' d /�,� ,�.� 3:'�, � i i _, 'pi',1 .t il i lk ,1 ,,,., I � l._ '4, t,C 1 [1 , 1 , sL , , ,'' ,..4. ' n , n , . 'Y°''r�' : „ ' iz' .. i - c.•i.. `a - 1 .1w!$.r3G�aamir.is� @ ,il IFl":7 �: i rc..1. :: ., ' - ; ..1 P I. 1- Y'_. � ><..i;..:{wet- : Ji... - !{ 1L7!.7 rr.I C[F S , . . 1. .,... ❑ Ner construction Pleaseaedr all :' , '(euu •if 'sof':' {}Isis wditey,sr -: -.: ,- • ldelow): ❑ Addition/alteration/replacement �, a � . Q Service or feeder' 00 mope or more a Building • three stories. ❑ De� .1 lition ❑ Other where the availab fault commit • Marinas and . • , vas. ' r':) 1, f All' "& ii - r L _'' lay h 3 • , ''' -' i ' , : . �y ` } .l. - l , ,loll : ' I• + ' -4 - 1 ss wN .. . 1.- .. :0∎0 e. i a , PVKk ,;,wd3µf WC 1 , ',e rosekl''Ite.4tcb, ' I , . '4a.' , F LP ;' t ' - ', 1 - ° - ' _I.::, less to g 16,000 r pnet s 14,000 ,000 me or III Commercial bu• ' - a a :, d 2- family dwelling ❑ Commercial/industrial ❑ Accessory building am for all o' er - e eels t ns. a com agricultural ❑ 1- t'Y B snaps for •11 ottra : ostall•bons. buildings. ❑ Mufti ❑ Master builder ❑ Other: 0 Fire pump. 1 Installation • 75 KVA or 3�� {ryry, �1 l ? ,` Na r3 a :. 1 . 7"s t ` , y r .�; t f'.:d 4, -- � ❑ Emergency syste Large - y derived system 7J� •M!, atr,ITIL Z1 iintu V nii'iLl t a•' °; 5- ' :NF 0 Addition ofnety load of III °A ", ••g , •,••1 , ••1 - 3• Job no:: `'1, - 51 tj Job site address: ( le Q 3 SW 10OHP or morn. occupancy. utp (1Rld` [7atSKRA FsNrtrt , ❑ s;a or more i•t unite. IN Recreational ,. - !o pinks City/S(ate/ZIP: � ' t ctl 1.Z.�( O ❑HoaltlJCano ,: la Suppiyw for more than {{ ❑ Hazardous 600 volts ' •' ' nil. Suite/1:1dg, /apt.no.: / Project name: warn,,, 0 r , 0 styli"!artaoder 11 e um••• ,� Cross e treet/directions to job site: ,:j 4 � � � � ;'1 �,,1 l 11 {I 4 • • New residential ogle or multi i:: , dwelling unit. 4 Indicter a - -' garage. Subdiviision: I Lot no.: 1.000 sq. ft. oricas 168.54 4 Ea. add'l SOO.sq_ ft or portion 33.92 I Tax . : cel no.: N• ry i (�F p tu- C. ,� ■ rAar ( :: : . y r , s :: - Lu(wIt shove B(1. ) L'CS i vok J e C United t family 75.00 2 , A.0.iC0. tANYtL. (�tl4w�'t`C � residential(wdh • ' •e sq. R) `t Services or 1 al ' don., and/or relocation I •f - - • - 200 amps or lass 100.70 2 y ,,,� .. : r� . 1 E r ! T1. I ' ! Z .1, r� . ! . .� ri' E r �i'a i ., , li r;i�s?k`4 amps to 400 ' Pa 133.56 2. Fi .t�'i.�� ( 4�'i� �:/r.,sr�..sl, , fk sln I.. t d<+�i r ., :tus�'aniir:t_ieti'�� '�.• „ .. " 201 a 401 amps to 600 ' .. 200,34 2 Name :l 4 601 amps to 1,000 4 301.04 2 Address: Over 1,000 amps o' vOtts 552.26 2 City/St}ate/ZIP: Temp my se a or feeders la - Maws, alteration, and/or i Phone , ( ) I Fax: ( ) 200 amps or lest 59.36 I 1 Owne* installation: This installation is being made on property that I own which is not 201 m400 401 to 599 125.08 2 intend d for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 168'54 Branch circuits , t alteratioa, . extension, pertianel 2 Owner{ signature: Date: A. Fee for bti ich - with �r I 9f LRl d7 p u r MO WW�,�iYll rnil ir i r f: "1i24t F a ouesavice e t, - - fee, ;' � ' ^'1: 4i"dt`�'aa " fin , e b , 7.42 2 - 1(. C.. i:.:' .,,,,to. 8,.11:.. - --:A.. 11,..it...hs, :1, ,Y.t. .xL1,1....a.e.. a 21...er ai,:r ' �. ' each.braaneh elm Busin name: B. Fee for bran h . without i service or - ■ - -, fern 56.18 2 Contact name: branchcitwit Each add') branch • , coif 7.42 2 Address: Miscellaneous (: . or feeder • • atadaded) Eachmanuthcltsed modular City/Sfate/ZIP: &alibis, feeder 67.84 2 Phone:I ( ) I Fax: : ( ) Reconnect only 67.84 I 2 E-mail l p.1 n' , e _ r l t Pump or irrigation • irek 67.84 I 2 I,r. lirlll`�liK It arl�'tl #jt �.'��!.1,.'.. ,. u 1rati antnai aril ' ! � tAi:II Signor l circu as 67.84 I 2 '' f ' ,a, .,`k..l¢ Sigoateincuitjs)or:mitedtnetgy Busine • name: Si1 ELsel'R1Cr panel, alteratim4or 1' -' -inns. _ Page2 1 15. 2 t '*'q'" Each additioad. I » pecdott over ell , able in an , of the above Address: S 7 Of P.j 'L ©/Y' 172:D3 6 f 2. /) S 717' Additional iniixe i'. (1 hr min) 66.25/ I City/State/ IP: ' ► WD OR 3 1 3 Investigation (1 hr in) 66,25/ • Industrial plant (1 min) ' 78.18/ Phone: NOS Val l - 712/ I Fah: (50 3) toil, l 712 3 Inspection for • . no fee is 90.00/ COB L(ic.: 10382.4 I Eirtilcai Lie.: (i Suprv. Lic.: 4 1 7'1 g ;,rah; l �' - . 1 i i M ; • *biota : — 5, Mo Suprv. ;Electrician signature, requ . e—/ P : (25 % of • I lice): Print name : a 4, 'yG/�, .5-'e +s 5 ■"c? Date: State , (12%of , fee): q , ob - Authorized signature: T O't''Ai. . : d, . 84. This p•ralt a • ..I . 11on esput*if'a , : ail obta wfNiai lt0 days . • it Ina tread' : _ Print name: I Date: allrnyed per , , is , 1:10oadias\4aroimnc- rmmaAppeoa 07/D1n0 44046157f11a5/aohvWEH , I , Oct 11 2012 3:55PM Bridgetown Electric 503- 621 -7123 page 2 Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: REST W 0 ; .X :; Fee for all residential systems combined........ $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems' ❑ Burglar Alarm ❑' Garage Door Opener* ❑ = Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ = Other • Fee for each commercial $75.00 system ( s03, OAR 918 - 309 - 0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ . Boiler Controls ❑ : Clock Systems Data Telecommunication Installation ❑ : Fire Alarm Installation ❑ : HVAC ❑ ' Instrumentation ❑ :Intercom and Paging Systems ❑ :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 ):\Build egl',ertni1 ELC•PermiIApp.doc CW01110 • • •