Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
s • COMMUNITY DEVELOPMENT Permit#: ELR2013 00017
T t G D A A 13125 SW Hall Blvd.,Tigard OR 97223 503.718 2439 Date Issued: 01/23/2013
Parcel: 1 S133AD16100
Jurisdiction: Tigard
Site address: 12730 SW NORTH DAKOTA ST
Project: Sorrento Animal Hospital Subdivision: 1995-073 PARTITION PLAT Lot: 2
Project Description: (1)low voltage prewire from demark to tenant space for comcast cable
Contractor: BRIDGETOWN ELECTRIC Owner: NICOL PROPERTIES LLC
5701 N LOMBARD ST 11629 SW TEAL BLVD,APT D
PORTLAND, OR 97203-4113 BEAVERTON,OR 97007
PHONE: 503-621-7122 PHONE
FAX 503-621-7123
FEES
Description Date Amount
Specifics: Restricted Energy Permit 01/23/2013 $75 00
12%State Surcharge-Electrical 01/23/2013 $9 00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio&Stereo: N Boiler Controls N
CCTV' Y Clock Systems: N
Data&Telecommunications N 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 $84.00
Other Desc. Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other applicable law All work will
be done in accordance with approved plans This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR
952-001-0010 through OA 952-001-0090 You may obtain a copy of the rules or direct questions to OUNC by calling 503.232,1987 or 1 800 332 2344 T/,
Issued By: /vY V �-c �O Permittee Signature: k 4P• Li C� l 1
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale,lease or rent
OWNER'S SIGNATURE: Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the Job site until completion of the project
Approved plans are required on the job site at the time of each inspection.
Jan 22 2013 9: 58RM BridgetownnEElectric 503-821 -7123 page 2
E o�
lectrical Permit Application � ECE V E rk
City of Tigard JAN 2 2 2013 f a 3 i 3 Sr elaieltla '�UQ�0►3-room
Si
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review Other pit;
Phone. 503.639.4171 Fax: 103.598.1960
CITY .r,a�Apnt�te/BY• V1 ayepap!tar
Inspection Line: 503.639.4175 Cl l 1 OF 1 j l ll�a�ate Ready/By:
1
lrrlesrtet. www.tigard-or.gov BUILDING DIVISl i 0d: T J s.,w-ems is ri.a«oa }
A11r:Wa + •7PF; x0+1€ ,, a` r' . q 7 t r k 1�t,- r 7 "'p
t � 4"$ .x1•°. S �# ''� k yyIIl � �Wt;�:t�yyv�• ,��,�,0.i�,i�'yl��• a ',;. !t i :�i�� ..''. �. ��D� ..l,,._•
O,•l'''
i. 0 -.li.r 1,K„,:._,. �6)sii:w„0txs,..r1414 n,.rc�o.344.+.. • li.itgaLWISl•.i4:13 .V,: a.,•... alt,.. , t'' y : .��.
r .ns .. . Please„,vin inttat ..ty(/ �I.. ' ,, clnoltedbelow?
❑Nee coriiltrttctioci ( Addition/alteration/replacement 0 service or feeder.+,ampsoriuin j+= ding overtire stories.
❑Demolition ❑Other: where the available .: k almat O Marinas and boatyards.
;,. b n•• :sror1+4.. + er 7C rile s»,,r t,..„,n >• ,+M. '�' exceeds 10,000 as l59vel 'D Plowing buildings.
' i:4 1 f a�a.:j,:;i;,, ..a 3i 1-ai •,1,,u a.:..?.sign.6 ti;g 1 T �i' :�•. leas to grovad,ore..-.. 14,000 ❑Cowmercial•use agricultural
❑ 1-and 2-family dwelling IR]Conimerciallindustrial ❑Accessory building snips for all other • buildings
❑Multifamily ❑Master builder ❑Other: O Fire pump O Installation of 75 KVA or
r �,a. .� ":";::.'4.auqu. :rg:ti +1 b Swsip ti:s:61 yu-)-ps rrry d , ;, +rr»-v, s 0 EanagencY aYasrn•
larger separately derived system.
t4 .01 ` 4:0743$04` SM, ❑Addition of new in, • load of 0`A^,"E","I-2","1-3",
><, rk+r. rt.iefnK`Fanut7i.+SnatL.sC.r'.ud»Fe7! urw x xw:...x.•,io�na
l00}iP or mom. °OC°PSOeY
Job no.: r2 ..c5 t.t g Job site address: \V'�3 D U kiur-144 � • Osa«mare -. •.
drain. ❑Recreational vahtcla parks
.
CIHealth-care Scilsu 0 Supply voltage for more than
City/StatelZlP: �';��,� D1� �a 3 Olisrovdotla I. 600 volts nominal
❑Secv oc or 6sed r + amps or snore.
Suite/bldg./apt no.: Project name: So r r{, to :nw ! l�c S p;+c f l elk,, n , Y. �'1 ,�,,�rid,'ar Y4J?" i',
Cross street/directions to job site: •tr'11111.?sue
New residential sl i•. -or'multi-family dwelbug unit.
Includes attacked •rage.
Subdivision: Lot no.: 1,000 sq.R.or less 168.54 4
La.addI 500 sq.R . portion 33.92 I
Tax map/parcel no.: Limited energy,re s - '
'-!4-: r 8 . un. A" +ry>,II.7:rr, v w 1 i V. e i 1 >f -..;,, .•:. (with libove q•
75.00 2
y •:: 4 • .+a fµ=i..... ...:nd,...vsliwt.eitien:_<., .. .^rx .uttra,.. •'._
Limited energy, family
71.00 2
residential(with •• -aq ft.)
/o 144JL 7 raw r ire ^ Gy7 c r K k o -1-t...,_
Services or teed• Installation,aiteratioa,and/or relocation
r p 200 amps or less 100.70 2
S �j iii•cu•awe ii .1 a €,."nc��tt�r+ °" ,mow ,, i"` 201 amps to 400:• 133.56 2
;.j sb i!811 ft , x, •.otas Cs 'U 'Aa.e.:m,.,i.3 Nfi •...
iu u.a.,01.•srsar1,1 .nikr.: .aua• 401 snips to 600:' • 200.34 2
Name: 601 amps to 1,000•.'pa 301.04 2
Address: Over 1,000 amps cr ,Its 552.26 2
Temporary servIc-or feeder's i natal adoa,alteration,and/or
City/State/ZIP: relocation
Fax:( ) 2 'nips or less 59.36 , I
Phone:( .) 201 amps to 400, t25 08 2
Owner installation:This installation is being made on property that I own which is not 401 amps to 599 ►68 51 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. Breath dam_ ,alteration.er extrudes,per panel
Owner signature: Date A.Fee fir brands c' • with
w 5; t ..,,,,!,-.11,;-
7aa +l i P�• ^ s dr. a 6aiti9....Ird w:..-+. <a.:.m. ....,-, above service or -•- fee,
each branch clrc t 7.42 2
Business name: B.Fee for branch ci uiti wimp a
smote or feeder ,..,fire 18 2
Contact name: branch circuit
Each add'1 brunch c! t 7.42 2
Address: Miscellaneous(ie ice or feeder not included)
Each manufactured, modular 67.84 2
City/StatelLIP: dwe tutg,service •or feeder
Phone:( ) , RReconnect only 67.84 2
Poe:( ) ' 6714 2
Pump or irrigation•• ,
E-mail: _ Sign or outlineli 67.84 2
(. w w t 1 e " ..Y.1•‘,•:,'k.. x '5 Signal circuit(s)or .. - _,
n a •
Business name: .��. panel,alteration,or•• `ion. � I Paget 7 S.04 2
p1ai� W ,QV r' ^^ -} Each additional i peetioa over allowable in soy of the above
Address: , 7 0/ to J . 4a-0 f)'l6 < ' ,J S + '"� ' Additional iaepecti r (1 hr min) 66.25/hr
�p 1�D ,.(�,� Investigation dripa(1 1 •. 66.25/hr
City/StstcIZlP: 1 �� 1 f Industrial plant(1 min) . 76.181 hr
Phone:(503)al 7 122. I Pax:(, )44.I 7123 Inspections make is 90.00/hr•
CCB Lie.: 10.5 82,4 I E Lic._ TG I Suprv.Lic.: 4 i 77t , rmiti`r,. . :": ,;!', yet + 1..
_ Subtotal: R 5.o d
Suprv.Electrician signature,requ�i ,(„Gj/� _�j - •., review(25%of permit fee):
Print name:/re;','}4;4
sr1' ...as/'et/ Date: State charge(12%of permit fee): R.u a
I TOTAL PERMIT FBB: 41 N •00
Authorized Signature; Tbis permit applldstlon expire.esperssit;if ee ebtained within 180-
days after it Yarn been ace:ptd as eass$sle.
Print name: Date: • Nambor of inspections allowed per permit.
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