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Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT COMMUNITY DEVELOPMENT Permit #: ELR2013 -00072 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/02/2013 Parcel: 2S112DD00400 Jurisdiction: Tigard Site address: 15946 SW 72ND AVE B17 Project: Snow Brand Seed Subdivision: 1994 -006 PARTITION PLAT Lot: 2 Project Description: Low voltage prewire from demark to tenant space for Comcast cable Contractor: BRIDGETOWN ELECTRIC Owner: KAUFMAN, LOTTIE L & 5701 N LOMBARD ST SUBOTNICK, RUTH ET AL PORTLAND, OR 97203 -4113 BY PACIFIC REALTY ASSOCIATES 15350 SW SEQUOIA PKWY #300 -WMI PORTLAND, OR 97224 PHONE: 503 - 621 -7122 PHONE: FAX: 503 - 621 -7123 FEES Description Date Amount Specifics: Restricted Energy Permit 04 /02/2013 $75.00 Type of Use: COM 12% State Surcharge - Electrical 04 /02/2013 $9.00 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. ATTENT • • • • > :on law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -00 • through OA • 52 -0' 8090 You may obtain a copy of the rules or direct questions to OUNC by . t- • 2.1987 or 1.800.332.2344. o _ / Issue. By: ■ . I • / ../41.11.....—...i..' ` Permittee Signatu " ' (ei( r G�---. 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. Apr 01 2013 3:31 PM Bridgetown Electric 503- 621 - 7123 pace 2 Electrical Permit Application kEC gi City of Tigard ' y Permit No.: £� 2 of o/ 3 - DOD Z� 13125 SW Hall Blvd., Tigard, OR 97223 APR O 2 013 Plan Review ' Phone: 503.639.4171 Fax: 503.599.1460 DatclBy: Other Permit Inspection Line: 503.639.4175 � / D ^ ` a Date Roady/9y: ` tee. See Paa. err Suppla Internet: tvvvw tigttrd or.gm R � t � , jNl l nN[ ' i ' ` f, od: ..Mal fa6r..Y.s .at �� �sruq X is - t h w., hV v'C5 ��tit , 'f �, y c �y � � yy,,�,. 1�Q�jp ¢ . :.•.S'` •c} i� r fi{.r, << � '�{n9a., 1 � k a �:d � r,`' l.['v '� ti - hFY yS Y�`T':n•.�. 1. f . ltl 1. 1• i. 1 !� kf'. ❑ Newconstruction g Addition/alteration/replacement Plcraoch.elcaurn • ( aabrthrtj rata ofPlowwiteresdreotaea ,door): ❑ Service a feeder , . news a sera ❑ Budding over three stories ❑ Demolition ❑ Other: where the avai • fault current 0 Marines and boatyards • r er : 14 exceeds I0,000 amps at 150 volts or ❑Flouting build .‘,1 - less to ginned, or exceeds 14,000 ❑ Couaaeial -use egric neural ❑ 1- and 2-family dwelling ® Commerciallindustriltl ❑ Accessory building amps for all other instapdions. bonding. ❑ Multi - family ❑ Master builder 0 Other: O Fire pump 0 lestallatiosof75KVAor ❑ E Addition new system larger separately derived system lZxlh,. :kk, tF '%'..,!4..'„104400 .�'l R [�Additionofrrwirotw load of ❑" ^ " t _2. ..1_3.. Job no.: 13 _2 3/:/ Job site address: J5 ? c/ 6 ? Z p / 4 tooltP or "'or°. °oaup.°cy. 8 q . parka Six a m ore residential units ❑ Recreational vahiole City/State/ZIP: 'r'y ` Q Hearaore facilities. ❑ Supply voltage for more than l ��v t ~ a L d 0 Harardous locations. 600 volts nominal Suite/bldg./apt. ct apt. no.: Proje name: 5 j,, 0,4 2 ra d . f £ D O service 6e e eea 1 r soya err name Cross street/directions to job site: ''''''I'-'''...1': 4..I J . -, I _ N w residential s ask- or mold -family dwdling unit. I lodes attached garage. Subdivision: Lot no.: 1-' h h sq. n. or km 168.54 4 • Fax map/parcel no.' - . ad.d'I 500 sq. es or po 33.92 I L . .energy, residential ark a„Tr 4, 75.00 2 ..I an� aiO4 ..-'r Y • "e q :t ,. J., (9A7Ih above SQ. ft) - L , ited energy, multi-family 75.00 2 l "Pre 1_ residential (with above sq. fl. ) 0 U U r) ``'rA�/• rrG ,,,,; `f-/� M7 MO 4 7�ww.. ea or feeders inrtallation s1terstioa. and/or relocation $� 4,- f`o..�t.1- t u4 . i l I amps orlon 100.70 2 *x ` e 4 4: s : • �1t :.f ;1., u M 4,61 l : r Y ..., s w • •, 2ql ttshps to 400 amps 13336 2 Name: 401 snips to 600 amps 20014 601I amps to 1,000 amps 301.04 2 Address: O 1,000 amps or volts 552.26 2 Temporary servida or feeders installation, alteration, aatl/or City /State /ZIP: Location 4 Phone: ( ) Fan: ( ) 200 amps or less 5936. 1 201 amps to 400 I 125.08 _ 2 Owner installation: This installation is being made onipr+operty that I own which is not I strips amps to 599 s 168.54 2 intended for sale, kase, rent, or exchange, according lo;ORS 447, 449. 670, and 701. ncb circuits - ern, alteration, or extension, per panel _ Owner signature:__ — , I _ Date __� A. Fee for branch circuits with ^t i ' above service or feeder fee, Q r !� ©: AEST?II)�' V 7.42 2 l hired+ circuit Business name: s.'Fee for branch circuits wphoau service or feeder fee, first 56.18 2 Contact name: brooch circuit I h add'l branch circuit 7 42 2 Address: alliscellaneous (service or feeder sot indoded) _ Each manufactured or modular City/State/ZIP: 67.84 tY _ dv/elliryt, service and/or feeder Phone: ( ) Fax: : ( ) R connect only 67.84 2 or inn peon circle 67.84 2 E Si or outline lighting 67.84 2 ,..'14.r , . .:• r •!:;• Gtki '.' ,j,.. ._ . Si' circuiis)orlimited-energy 1x � t : 5. Business name: t E G el, alteration, or extension. Paget 2 �w�� Lf � ELECT RAC., 8 h additional inspection over allowable to any at the above Address: 5 7 01 i f, L o ok 6I I 1 C 7 ;boatel inspection (1 hr min) 6625/ hr - 2 ' In 'gation 0 hr rain) 6625/ hr City /State/ZIP: A41ti1 Al2 tC1 '-‘11 1 In ,dal plant (1 hr min) ' 78.18/hr Phone (sap; )[4l - 1 121 Fa x: (44 ) !a2 � 7 i 23 -- — hutpeclions for which no fee is 90.00/hr listed ' hrmin CCB Lie.: IO BZ4 Electrical Lic.: 149-14 Suprv. Lie.: a i 7 7 •i ,4',. Y ; r Suprv. Electrician signature, require -.. Subtotal: Plan . �� ��' Plan review (25% of permit fee) Print name: yG-.A, .5-,d . -,.s /..' Dater / / //3 - State surcharge (12% of permit fee): 9 - Authorized signature: TOTAL PERMIT FEE $ — tug permit application 'aphis ids persit is sat obtained within 180 days abler it has been accepted as compteae. GP"[ Print name: I Date: • ;Number of in ons allowed per permit. 1. 1BaiidirePamiteN1C- PemilApp.doc ■7/01/!0 44C.451ST(IInSICOMAVIA •