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Permit C ITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT • ' COM MUNITY DEVELOPMENT Permit #: ELR2013 -00091 T t G A. R O 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/25/2013 Parcel: 1 S 135BA03302 Jurisdiction: Tigard Site address: 10520 SW CASCADE AVE Project: Office Depot Subdivision: OAKBURG Lot: 27 Project Description: (1) low voltage for Data/Telecommunications Contractor: BRIDGETOWN ELECTRIC Owner: MARX, ERNEST L & BARBARA R 5701 N LOMBARD ST TRUST PORTLAND, OR 97203 -4113 2140 VELOZ DR SANTA BARBARA, CA 93108 PHONE: 503 - 621 -7122 PHONE: FAX: 503 - 621 -7123 FEES Description Date Amount Specifics: Restricted Energy Permit 04/25/2013 $75.00 12% State Surcharge - Electrical 04/25/2013 $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 1.800.332.234 Issued By: � du GU Permittee Signature: Qom+ 1 APeLe41'7oM 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 24 2013 1:31PM Bridgetown Electric 503- 621 -7123 page 2 Electrical Permit Application RECEIVEI. gi City R 131 of Ti and SW Hall Blvd., 'Tigard. OR 9722.3 Phone: 503.639.4171 Fax Ilan s � 3 - r7t 111 503.598.1960 A P R 2 4 2013 ,� ° .rt I nepn d : Line: 3 175 I tats R t l e Hy: B 8nn 2 tor www.tigardor.grly CITYOFTIGARD ",n1r .._ G �.. :assr 0 t I r I 1 ,. ❑ New construction ® Addition/alleration/ , lacefneni Plume dwelt ' that • • y (mamma =Wits arlliaas.4111 a • below): 0 Service co fender amps • • amps et more ©mama `g o.ar• novamania, CI Dcmol i110n El Other: whae the a saahin f a u l t c o m m a 0 Marina fwd hosoirds CATIEC91017.4,4001M1000,41 exceeds 10.000 amps as 130 war or 0 Floating tunings. Jew in wound, or oiYaaeda 14.000 0 Com nercal - t.e agricultural ❑ I- and 2- family dwelling J Caamnetlleial/indusbrta+ 0 Accessory building amps for all other Widta ❑ Multi - family ❑ Muster builder 1 ❑ Other: 0 Fin: pump ❑ lastafaioa of 75 KVAei .o $01',.1'i t ' 1 OC1171DN D kmap icy wow, Urges re1�r'Y d sy.rm ❑ Addition of now Aptor Ind d' 0 ' A ". - E", - 1-2 - , - 1-1". Job rut.. 13 - 3. L( lob site address: t S 1001lP to muss eocupsncy. - � -._.._ n� 4� .._-. _. ❑ se ��x Of mow tidarNtal urns. 0 Roaaliaaal vehicle pads City /Statc/ZIP: -,' 0 ., z i/ 4`A ZZ 3' 0 l lr lth -cut raoibt 0 Supply voltasa far more nun _...__._.. __.__...... - .. _.... _......... ___ D Itararr5.a location: 600 volts nominal. Suite/bldg. /apt. no.: P'rojei. name: D ldxvroo or redder 6110 amps or mono • Viriffiiait: Cross street/directions to job site: e••niatiat 1 Oin I to. I l iar 1 • — _ .. New reaidenlial single- or andri- henry dwelling rail. -- _- _.... ._ __ . - •-- -._.._ ` Includes attached _ .... _ .. _...._._. _.._._ —._ prate. Subdivision: • 1.01 no.: t.(100 sq ft or low 168.54 4 --- -.-- ..-- ---_- _. - -._. _ . _ .___.,_. _.,_.. l a add'1500 wt. II or motion 33,92 Tax maplparccl no_: I.imttu rt�s d energy. modern tat 2 - 75.00 (with above - 1 ).imii d energy, mulu -family /� - 75:00 G /�Ws`a:e 40 D.._ la .4awith4.. R. �_n '^' n - - - -- merle .__- 4 -... M' "._...� n nt,.1( Services or feederishurapptioa .sheratioa,asdlarnJaertion , . - �H" Ca �r la le. _ ----T - 200 antpti rx tarn 1I 10070 2 CI , Ia8 1 0 Tgg4AN r 201 amps to 400 amps' i 133.56 3 Name: - 4 anima amps to 600 ani 1 200.34 2 MI I an to 1.000 amps r 301.04 2 Address: Over 1.000 naps or volts ' 552.36 2 - __ _ _._. .___ ..... ......... temporary services or feeders installation. sleration, and/or C ity /State// IP: relocation Phone: ( ) FlL : 1 i ) ?00 amps or less 59.36 1 Owner instaliatita: This installation is being made on p ty that I own which is not - "111 amps to 1125.011 t 2 intended for sale, lease. rent, or exchange, according to'C1RS 447. 449. 670. and 701. 40 mops 1O 599 =pi 161.54 2 firaaelt circuital - vim. alteration, or essemiaa. panel Owner signature: 13m`' A.� fatd above service or C?QMAit'T !'RIidON' each branch circuit ? ;2 Kusiness name: 13 tee for branch circuits without _.. ._ . . service or feeder fop, first Contact name: I branch circuit j ' C - 1-- - Nlisrdtarmtls c servlire or feeder 7+' , Add rims: _ not tad - (sty /Statezip: i Nach manufactured armodular . 67.114 7,-, Duelling, servioo and/or foods Phone: ( ) F ax:: ( '. ) Reconnect only 67.84 2 __.. ._.. _. . _ Pump LW irrigation cink III 67.14 v ,I�Ineii: --; - , outline or tiime i tin 67.64 ?F: ::. I Signal circuittst or binned-energy a - Business name: 1Z1�N E ff ` `r -- pal altetalroa. a elsbaasion. 2 1. t Kota t o ducal inseeedna over a : , heart a ntt#s above Address: S 7 0 ` j , f . ` t a 4ei S Trecer , Additional inspection 1 br mitt) 66.25/ hr City /State/ZIP: i L ?J:a OR I/ 2 0 3- r I i -` - -- Investigation t 1 hr min) b6. Iv ^_ . . _ _._ ...... Industrial plant (1 lr Will ' 78.18/ M Phone: ( 8 )( A j . 7 12 2 J Fax (1ggl ) l -7 i �; Inspections for which io fee is [� }� a " s. 'Lit timed 16 of. 91.00 hr 14 Lac.. 10.3 t� Electrical Lila.. ,. � ,� Supry Lie.: a at 77s , •;:;m - .'� . ��� _ . roquited• . . -. _ 7s Suprv. Electrician signature, ` ��-. r: „t _-_ __ ' _ Plan review (29X9 orpartuit tae); 1 <r . _Sip' ,--,...1; �. c'r Date / </ Jr 3 Safe surc�iarga (}2%orpe nit Pas): 9 Print name: _ -, TarAL, N TFEE: : '1 — Authorized signature: Ilia yenoit'optic.au. ilrlearlwwittwaralwrttawn tau _.._._..____ days shrr allowed slajiil(asallta)Ilrrw Print name: 1 1>rtte: A ether �r r tom allowed 1 SuOdirotkPor sitAlit.C- PookApo.doc 0/01/ In aN• MtxrrllK , ttllflrW I i i