Permit CITY OF TIGAR,D ELECTRICAL RESTRICTED ENERGY PERMIT
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COMMUNITY DEVELOPMENT Permit #: ELR2012 -00120
TI G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/12/2012
Parcel: 2S 101 AC01600
Jurisdiction: Tigard
Site address: 7000 SW HAMPTON ST 112
Project: Commercial Care Landscape Subdivision: BEVELAND NO.2 Lot: 18 -19, P
Project Description: Data Telecommunications
Contractor: BRIDGETOWN ELECTRIC Owner: NEIMEYER, JOHN
22732 NW GILLIHAN ROAD 15 82ND DR STE 210
PORTLAND, OR 97231 GLADSTONE, OR 97027
PHONE: 503 - 621 -7122 PHONE:
FAX: 503 - 621 -7123
FEES
Description Date Amount
Specifics: Restricted Energy Permit 06/12/2012 $75.00
Type of Use: COM 12% State Surcharge - Electrical 06/12/2012 $9.00
Class of Work: ALT
Total Number of Systems:
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)
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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 9 - 001 -0090. You may cpy of the rules or direct questions to OUNC by calling 503.2 or 1.800.332.2344. ` f
Issued By: • 1 / / Permittee Signature: D!�- �U 1. t"f �O/�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.
Jun 08 2012 2:38PM Bridgetown Electric 503- 621 -7123 page 1 S�U'
Electrical Permit Application . . , .. . , , .. ; , , ,
City Of Tigard E U E:1 if t , 1...,...: v : , ( ( r Permit No.;t-ih2. viol a� con 0 13125 SW Halt Blvd. Tigard, OR 972 Plan Review
Pha 503.639 Fa 503.598.1960 p lay . Other Permit:
III 1 Inspect w L i no: 503.639.4175 JUN 0 8 2 U I . Date Ready/By: El gee Pre, 2 for
ww.figard. r.gov Notified/Method ' / an • ,. - -, eal Information
: ,t r , .k..4 "R (Il a ui, 1{r�f M:awJf t t , a , yeq Y ,l r� sE F „.i'iNZ,93i • i ,i: nn�r: r -. r v:. ���,,�e 1 ° +. i.
: ., 1 ^ . A � + tirF S 5 4§fr,u 4 } f - tlY 4 . 1 1 ; T.'F�.? 141,1 �ii' t i ( Cake t 1 i } 1 [", , <,• vr f y H ri v,
. . . :L t.Att, 3ai A, kr satca. 19 i t . t , e ' :! .+r R� e
� •,l�rl 1 '1 ����L� �3�•':. .�i:4 Fo-ll M +c - - 1L �I..�..:t" .._ at +- ,ili,rkY�liri *!r�:y3':
❑ New construction % • dditIon/alt. P. ; i9 r,7u r v Plesaae cheek all , t apply (B Peers of plus w rderes - • below)
13 Demolition • Other: 0 UMW or . I + + amps or morn 0 9w1Bap oven sines swam
}�„ `. r• ';� �i;;t? h `,� 1'4 i, {I7jf . e• 1r + . .� + v ya ,� n in T;':',1 -, t wham the oval • l l • fret current Q Mariam and boatyards.
T k,. L� . 1.1I/Ma%.•t•. ' 7 ) +♦ 4, 1 t ii J • ' 'ii h [ ' 1 `I exceeds t0,+ .r+ at ISO wits or OH buildings.
.�tv r.Lj.b.t,,S "' ; f Y ,'',/ J ,. - �x .. R.:t, h Its•
El l - end 2- ihmily dwelling ommer cisi/irtdusftial Mae to ground, p ' cot00 d s 14,0D D commercial-me agricultural
❑ Accessory building amp, f« all • 1 ! 6 urete0atio®.
❑ Multi - family ■ Master builder ❑ Other: Mile pump. II p Installation of 7s K VA or
',tn {��jaW � �ia•n6 , fi + m4. f �7 1"7. r} 1TI ?∎ ''Mr ! 'l l .r 'i i ' a �'' • ' in . Fa �j. r . ,. .G � Addition Y • . O fOr l oad Of i dmivod gyn. a • �+n�d'�i • F ` !� I 0 " W' 94". "I -sn
• Job no.: Il lgett Job site address: i 000 `bw 0 r• aM w IOOHPormorel / occupancy. occupancy. y.
D sec or more : •,: entlel units. ❑ Reaeatioml vehicle parks,
City /State/ZIP: T _ ma , t ... .� o Heaimssase rue I. • -• 0 Supply voltage for twee than
Q Ha 600 volts nominal
Suite/bldg. /apt.no.: Project name: p ; . D Serried or • i! or mom
Cross street/directiona to job site r 1 t tl ef i R'J ei :l? 1 , 1. ° . _ i A. `' , ,,
• _ i / . � ' r"9�t1�'t l Zti' iiii i '?t IZI ':�
lades ormold- hnaly dwdltng tilt.
Subdivision: Lot no.: 1,000 s9. 8. or -; 1111 168.54
Tax map/parcel no.: Ea. add'I 500 sq. or portion 33.92
h v •4 all' �, r 7' ttcran� ac z� m: >, cess n (t� d 7 F 3 f r + . limited., w
L limitedene�', - ��• 1181 75.40
4 g, d: ,' fAl�: 27 ;sit : INA`r�n�,t, ,. 7.-71i..t,;1Y r ? '"tau L 15 � Ri. , ; .,r.. ie. lihabore � I r.
.,.., , tR� ha Limited eosrgy, • ' P _
= :.�•ir �r_- - . - si l_7 '(• ► 1vr,�. r ta
_ . ( ;�. 75.00
Services or -• ' c • . • ,
. � . � and/or relocation
r
T» 7 L E CO/7'/ Lt ai / 0 ' 200 turps or lrsa I I 1.111 100 70
, N ,Ii 11 ' i- - 2r � , !(� ei� i{9 p � i . nt,N. " W K .. f '"- ' ,�- 133•56
"i'l •�� + ,+uffudc,iaJl:.a f a :x1. 3,. � .•a_ . ;1'�+�„� {ii +3LZY:b�,'.T�.'�7b k4 as 1 y 201 10400
Na 401 lumps to 600.1 ! .. 200.34
60 ampslol,+rr�� ,< 301.04
Address: Over 1.000 amps , 4 + to 552.26 .
City /State/ZIP: Tam ea I l or feeders ItattbBatlom, alteration, and/or
relocadols Phone: ( ) Fax: (. ) 200 ampa.or less it 5936
Owner installation: This installation is being made on property that I own which is not 201 °"'p° to 400 1 a . . 123.08
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 •
°. 168.54
Owner signature: Der
Branebdrenita , .alttratian,oreztendes, • - panel
,��j�q1��, y ; q } A. Pod tar stanch i ohs with
1 , t" ,it rt'' '' ll i .7 . 'w 4� h[ p t y 'IEI 1, ff er,CL Ln • Q ". p g•yr t+xttl yt • • �w+' i t i i f r Yhr{,°gil abOVe aCfYi! a fep.
o ., t, i:,�L..,....iii4L.wrf.3,. t, W3yiL•.f2�L'r.9 s li .iti14 •kB.21 vfbd., •_ 1 NCI •i. :1? each. brooch • ; 7.42 j
Business nerve: B. Fee for branch : F. wdkow
service or feed - 1 - - rust
Contact name: brand' circuit 56.18 2
Address: Bashsdd':•I:brmtcisi'
a a2 2
Mlaodlaneoos (' a Ice or feeder not Included)
City/State/ZIP: Each mttmd cta -•:1 modular 67.84 2
dwellin service 1 .'„: or feeder
Phone: ( ) Fax: : ( ) Recoonectonly i 67.84 2
E �r Pump or irrigatio F 67.84 2
:r'' 1: � ; " . a. .k,C,g, ;�' Frig tl � ai•' Ia ,l r� t y s SiPal* *amigo) r , 1.4111111 p���y 6%.84 2
.L LL ✓A,L� -eW� Ija S altered « led on. • _
Business name: ' (� sail. ` tt, • • al altered • •• I' • „ on. 2
Address: 0 f N - 1 F L Q /y� Q ^^ S . �.p 7 Each additional l • • • • a over allowable in any of the above
8 two 7 " Additional impact : (1 hr min) 6625/ hr
City /StatesZlP: D oR co 2'03 1 3 investigator' (I In V ) 66•a5/ hr
e .!
Industrial Plant (1 I l . • ,) 98.18/ hr
Fr: Phone: (OD; >
712 Z. Fax (1 i 0 .1 ) l021 ? 123 Inspections for •
L._ �/v� q �/` �/ listed j I rota
ic. 90001 hr
10 382. , r 11 °. : - 88 - 10 rl)rv. Lic. N/776 i'll1. t t air '31� . _ c I r, , n. 7"' r,3.e1t r r.
Suprv. Electrician signature, • III Subtotal:
1, I 'ew (25% of • - it fee):
Print name :,, • 1e/ra. . e . h.s tic✓ I Date: State i r � +- (12% _
I of permit fee):
Authorized signature: I TOTAL PERM7f FEE: 24 . Yr
The Permit ... • p ... esgd ea Ka psrmdt fang obtained within 160
Print name: Date: day, f It has ec
bean arpead as eompkae.
• Nomtwof'.•�..• � :.. allowed per permit. •
IAltrdldlaskeennIMEf.C- PensaAppdoe 67A1/10
490.4613711 V9SXa0s6W!>8
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Jun 08 2012 2:39PM Bridgetown Electric 503 - 621- 7123 page 2
Electrical Permit Application City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
..I /; s A7 s . r s r siu�rrAs +I I' s y tb's f��us.
.al..,:.�._._. '� .. ,....ut _...... . I.,i ...l1,.�.le;. �.(..� I,�V.ILtI -,.r �n,... ...Y,l. ���+.
Fee for all residential systems combined .. $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
El Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other.
Fee for each commercial $75.00
system
(SEE OAR 918 - 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
/4I' Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
E l Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
El Medical
❑ Nurse Calls
El Outdoor Landscape Lighting*
❑ Protective Signaling
El Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1: Buildsug \PermitclELC.pvmkppp.doc 07/01/10
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