Permit CITY OF TIGAR® ELECTRICAL PERMIT
2 ,; COMMUNITY DEVELOPMENT Permit #: ELC2010 -00246
13125 S W Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/20/2010
TIGARD:. Parcel: 1 S135BC00700
Jurisdiction: Tigard
Site address: 10831 SW CASCADE AVE
Subdivision: Lot: 0
Project: Comcast
Project Description: (5) branch circuits for new machines and general use.
Owner: FEES
CH REALTY III /PORTLAND INDUSTRIA Quantity Description Date Amount
BY THOMSON PROFESSIONAL &
REGULATOR, CONTROLLING OWNER OF 5 crt Branch Circuits 05/20/2010 $85.86
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 05/20/2010 $10.30
Electrical
Contractor:
BRIDGETOWN ELECTRIC
22732 NW GILLIHAN ROAD
PORTLAND, OR 97231
PHONE: 503 - 621 -7122
FAX: 503 - 621 -7123
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $96.16
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 -601 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: l � � � -� Permittee Signature:
,,ziC ✓id
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 an inspection that business day.
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.
May 13 2010 2 :06PM Bridgetown , ,uri 503 6 7123 p.l
Electrical Permit A • • lica ''l , , ' f v �' c � a! ,, ' M 2
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" ` CI of Tigard ! + , - 0 1 s t ew '' 17a1 No1 / — 'a 2 SHalTigad, OR 92 7 9 z0 ll Phone: 503.639.4171 Fax: 503.598 1 Plan
T r� Inspection 503.639.4175 Date/B Other Permit.
g FI .7:7-,,,11 I� Date Ready /By:
� wu fii*cmet www ngard or gov I , r -Y OF YIGARD Notifiad/Mnhod: S See page 7 for
t - v Supplemental Information
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.e...r s•..iir ..r._.. AtV.Z' ? i .&.'1...:ix, s lZ4. :65 a ' f Ma �J r :.'! 3 ',L:- ,ieet-.4I'EcNe .N,.� } "' } a . ...
. I �., «..? ° r s ii . . h r bolo
❑ New construction 7...% Addition /alteration /replacement Please check all that apply (submit 2 refs of plans wliiems checked below) -
❑ Demolition ❑Other ❑ Service or feeder 400 amps or more ❑ Building over three stories.
c , where the available fault current ❑ Marinas and boat arch.
' - -- : " zx._ x.,. ,, p: ° `7? N' ,{ i s , x ' -:q. ' . , 'f. ,' . exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
- :. -,:� � . -° less to 8 8
,Commercial/industrial ❑ Accessory building amps malt o in I ionn . ❑ bu i d n eroiat -use agricultural
❑ 1 - and 2- family dwelling
❑ Multifamily ❑ Master builder
❑ Other ❑Fire Pump. ❑ Installation of 75 KVA o
p < 7 ' _: f t � r i rn - j it s , i 5 ,( r ` � F s e r lyu k ` ; is ❑ E sysoem larger separately derived system.
f, F Q ; _ ;x. trr..3d7.ey� . ..J i,�. caFs .. Iii g� ` 'xltis .1. i"Kv.�a_ tkiii Additi
/ ❑ on of now motor toad of ❑ °A ", °E•• "] -2" �� I.3°
Job no.: 1 '/ Job site address: / D 3/ S W C4 t,44.44-4-- 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: r i 4.y -p,,.. ❑ Health -care facilities. ❑ Supply voltage for more than
0 Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: (761 C:. ❑ Service or feeder 600 amps or more.
r3 ,, c, �Fi' .nyA" y, i' r 1 - s
Cross street/directions to job site: _ � ,: � : , .,
lkmcripaon Qtr .. � �� Mte. - «. Total ;< • -
•
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: ' Lot no.: 1,000 sq. R. or Is 168.54 4
Tax map/parcel no.; Ea. add'I 500 sq. ft. or portion 33.92 I
Limited energy, residential
si:: k ;..I , �t C t. a �€ r t y `� r t7�i 4 tit m e f (withabover . R. 67.84
//�� ., , w �c,h .C,: _ , ��.3_ 3 . r_, .....rae5�,,.lis« E s . < _ . i +. q )
2 4 O [ :0 00 r /1re.J f / 0 ,„, i , Limi ted energy, multi- family 67.84
residential with above sq. ft.) 2
�,r <�� t3a�P���Pr / °f Services or feeders installation, alteration, and/or relocatio
r . ,. aT ,, y . r h G 1` Jam. 200 amps or less " 100.70 2
F _ _ t .... . ,1. .._�M ti I Yfi 3 ac, `,« u _z 7 i 01, 4 1 , 201 amps to 400 amps 133.56
2
Name. 401 amps to 600 amps 200.34 2
Address: 601 amps to 1,000 amps 301.04 2
Over 1,000 turps or volts 55226 2
City /State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) i Fax: ( ) 200 amps or less 59.36
I
Owner installation: This installation is being made on property that I own which is not ' 201 amps to 400 amps ;6285.5°84 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 2
Branch circuits new, alteration, or extension, , er panel
Owner signature;
.I...: �... _,: i � .i r r i ham ! f,, iu ✓ r � Date ` � a �, t5 , x A. Fee for branch circuits with
... t ....'.. >;,,.y_. . iI." r ..,a. :�,-„„,,..7, ..� sif .,a 4 Txcsz ,i' °i. }i, t. T'M . above service orc feeder fee,
Business name. each branch circuit 7 2
B. Fee for branch circuits
Contact name: without service or feeder fee, `
first branch circuit f 56.18 5"1„,/f 2
Address: Each 0d'1 branch circuit 4e 7.42 a 2
City/State/ZIP: Miscellaneous (service or feeder n6t included)
Each manufactured or modular
Phone: dwelling, service and/or feeder 67.84 2
( ) Fax:: ( )
E -mail: Reconnect only 67.84 2
f ; z s €� � Pump or irrigation circle 67.84 2
_ ,::':. ... ... ,,:..�w ti ,2 ?.. . M, .?3,s°�3 .r:. T5 Ie e Gfi Signoroutline lighting 67.84 2
Business name: Bridgetown Electric Signal circuit(s) or limited -
energy panel, alteration, or
Address: 22732 NW Gillillan Rd, extension. Describe: Page 2 2
City/State/ZIP: Portland, OR 97231 Each additional inspection over allowable in an of the above
Phone: (803) 621 7122 I Fax: ($03) 621 7123 Per inspection 66.25
I Investigation per hour (1 hr min) 66.25
VCCB Lic.: 103824 cctrical Lic.: 2.: :7C ;uprv. Lic.; 4177S If Industrial plant perhour 71.18_
(,
Suprv. Electrician signature, requ s"i-, V g >.. aria v � Zs �.:,,,•. }
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Subtotal o ' ; i t
Print name: Keith Steenslid r
D ate: J - ' —( Plan review (25% of permit fee):
Authorized signature:
State surcharge (12% of permit fee): j i 14
TOTAL PERMIT FEE: (lp v
Print name: I Date: This permit application empires If a permit is not obtained within 180
days after it has been accepted as complete
1:1BttgtPvmitagLC ParmjtApp.doc 10/01/09 ' Number of inspections allowed per permit.
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440.461 ST(11 /OS /r.OM/IVEB