Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT •
• COMMUNITY DEVELOPMENT Permit #: ELR2012 -00142
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/12/2012
Parcel: 1S133AD16200
Jurisdiction: Tigard
Site address: 12700 SW NORTH DAKOTA ST 180
Project: Rain Dance Properties Subdivision: 1995 -073 PARTITION PLAT Lot: 3
Project Description: Data Telecommunications
Contractor: BRIDGETOWN ELECTRIC Owner: PACIFIC CREST PARTNERS SCHOLLS L
22732 NW GILLIHAN ROAD 7000 SW HAMPTON ST, STE 130
PORTLAND, OR 97231 TIGARD, OR 97223
PHONE: 503 -621 -7122 PHONE:
FAX: 503 - 621 -7123
FEES
Description Date Amount
Specifics: Restricted Energy Permit 07/12/2012 $75.00
12% State Surcharge - Electrical 07/12/2012 $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 y obtaiin of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
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Issued By: i 4 .Ld( 1YL Permittee Signature: a • 14 & t / Qr�
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 Ina 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.
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Jul 11 2012 6:37PM Bridgetown Electric 503 - 621 -7123 page 4
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Electrical Permit Apalica CEIVED
City of Tigard B y: - 12,1/ z ' PermhN• • ' era 00 ¢0-
III 13125 SW lull Blvd., Tigard, OR 9722 L. .1 I. 2012 Phap Review :
le Phone 503.639.4171 Fax: 503.5280 nat&BV: Oder Permit:
Internet w l w. ti 503.639.4175 . I OF T9GARD NO '" ' I(� Su ,pe„t 1 �.ae.
!I1 ,. k I I
�„`:;�„, p '.,. i. S I q !' Sls,rrls9 •' (7rm w y r w.� ,'- n , ' r y : ' x ,_ 1iC9i1" 'DIY'" q rr� iI1,9 v ma w ,I r4ryf - n •i•,
•r� '! � ...�ti+ `� ��,.: ?w.vm. N, "'�:��,� ,ty,. y '�: .'�.� l�i.,a.t.:.S,C�Sa4�. '.._;1:141i. ._ .4 . � ) .,i I
El New construction ditloNalteration/freplacetnermt
Remo elect all apply (submit j' eats of elms Whams cinched below):
❑ Othetr: ; 0 Service a . _.. - ' ' I amps or more 01 over three stories.
El Demolition
when the anal I. huh dined ❑ Manna and boaoyarda.
;Fir' :' ly ^ . ,di I o fn � rz: ,, -, , : ' It , r � ,,: Ott Tr atrr "t ,rr w t?�a i 1 . y :.�•,,.� 'i.:
I, �a' hcL "llt¢I) - it � _;MSF C;It 1., • • .as i �Dr, , bii c�aa 11 ''f . n,3,y `� gi ^ uyr ' I�' INS exceeds re ground, : � ce ds 14,0 volts 0< ❑ F�Iial-use agricultural
leer
INS re grormd, •, exceeds 14,000 O Conmoercial -u
13 1 - and 2- family dwelling :;c 1 ommercial/indu ,. • ❑ Accessory building amps for as o , .. installations. buildings.
❑ Multi -fame ❑ Master builder i ❑ Other ❑ Fire pmep CI r0®alletion of 75 KVA or
y 'r ::', Ai ' .t zrv1;u l 1 '. :1 }_, Tr Iqq ∎ 71; 1 - 1 7 1 r f 0 8merproey s brats swaralety derived eyeta
:, v, ".. i 0. . . " 1 • ' m ' I �P'ti a I } I . ' J , . ' , sr l 4' '''s' P: ` .' Addition of new! � • or toad of
ai.: IAI 3Ya,;...:�u�1y a...f+c . I �' enW. I., t7, klEd .c.utl�n,Lw:ll wnU:? .Rl +� :I ❑ 1 ❑"A", `E`. x`1 °. `1 - ".
Job no.: +a--36 S Job site address: 1 a 70 p Sou M VP' HP or more;! occupancy.
0
❑ Six o r mine ;; 'al units. sm
ert0oasl vehicle parka.
City/State/ZIP ❑ Haallh•caa frail. -• . O Supply voltage for more than
47 CI Hazardous emrdo r ; • ; '. 600 volts nominal,
Strife/bldgJapt no 7 I Project name: t�- l'tC.L ; �❑ or names y q�(
Cross street/directions to job site: 11 1 : .. -FII I � .` 11 G Pi ! , i "� :�i�. ai i� 1111
tr'°"'^��I I1�"� t�f.=t^tl� tl�>• ..
New 1 . gte- or malt/ - fatally dwdtllig unit.
Includes a .- 1 garage
Subdivision I Lot no.: 1,000 sq. f. or i 168.54 '
Tax map/parcel no.: Ea. add'/ 500 sq• i or portion 33.92
i Limiter! energlr, r 1, • . , isl
I 1::4 Y. e +w z ",WVmC� ,� wr�s,?yryre'y 1" LC ,o '.T I? 75.00
I �
.;yi+(4 l''f lr ui lYJ :i .:. - +n,. , 1 2 1 ,4;. E' I .. r: r4 r" (wi hAbove st t
�! 1 . 5 � / 7 W/i�jL • roidentisl (_ sq. fl) 75.00
Services or ., :: inetaflation , alteration, and/orrelocation
r ���� 1 200 amps: or less I, I 100.70
r„ =r' ').1,1 'I .. L , z0 h to I °i t ' I I L' I. `Irkftn Ifa FTSIO t i a 7r I .1 i 1i'" r r -
.., k0 , . X :-114 4,:c•- ..J...1Zi?.._ L., a.n....1 8 . l l• . - c0,t &:,..., .,...,,u. x 201 errrpu to 400 , • a 13356
401 amps to 600 : • 200.34
Name: 601 mops to 1,i 11, II •
301.04
Address: over 1,000 mope . m 552 6
City /State/ZIP: Temporary sere or feeders iaafalallon, alteration, and/o
relocation
Phone: ( ) I Fax: (I ) 200 amps or less ' . 59.36
201 amps to 400 .: • s 12508
Owner installation: This installation is being made oft Property tat h I own which is not g
intended for sale, lease, rent, or exchange, according t¢ ORS 447, 449.670. and 701. 401 amps to 599 •, . • 168.54
Branch circuits ew, alteration, or extension, per panel
Owner signature: Date: A. fee far branch , with
,{' I L FI ?�:! a I 7 ou I iii 742
J : ... _ �•. f IJMC{ ._ e {j Q �,y,�N�y i£ �Y +'pS� ' LV,� d.fl t NJ y µ]C�Yi service ,in � GF1 • _•,ti ` 1 . ',L'I :J;,1- .AU :,:bia'Uif � YSLLiI { ' ft4:1 .: ;:'i._ :,;,..a ,5.r. nr�:ela:Asrki C6Cb �aafb
Business name 1 B. Fee for lam b ?I ,,- , is without
aetvice or ,oral 56.18
Contact name: branch circuit i
•
Each am'I lxatrdm;, . , 742 •
Address: Miscellaneous (. e or feeder not Included)
City /State/ZIP: d ling. service . I I 67.84
Phone: ( ) I Fax: : ( ) Reconnect only I 67.84 •
Pump orirlgesio. , le 67.84
E -mail:
. il r .. ;, p�7V .r f y ,r riw S m r� Slgooroatlin0 67.84 .
i:i..• �k,1. ..
. +. ; 5. =, &a ',a' �iifFi disZtrairjt �m.,i.,i . £ . ",Icy> _ � VIZEM '�i 9FFy ''`I•' Signal dredge) T.. .
S4tWGIVI SLE. v G Panel, alt eration, t 2 . S IN
Business name: t Each addltonal ' • on over allowable (o any of the above
Address: £ 7 0 / IU , 1_0 tx.g • , IJ S 1 svxer r Additional , -• ..., (1 hr min) 66.23/ br
OR 1 investigation (1 bri.. , n) 66.25/ br
City/StateJZIP: ' iJ D OR � 12 1 3
. Industrial pima (1 ,• • ,) 78.18/ br
Phone: ( SO )�I - 1122- I Fax: (11 4 ) 421 1123 Inspections for alb no fee is 90.00/ hr
«� Q nl��r�a.., / 1775 Hate aim �y� _
/ CCB Lic.: 10 3 vj4 I E c trica1 Lic.: - % 1� S uprv. Lie.: r. :::'Y!!��rt3Sh�'. i.ii ' - . 1' ;1 1 �. _ ... /.�{,.. P ...,- �i�?t9.iii�i ; i7
` Subtotal: - is -, Suprv. Electrician signature, re nBer "'"'' •'( �� ......, p1 ' , _ lean (25% of permit fee): •
Print na ,' � Si' vs /�Ct 1 Date: 7 -i Z •/ Zr State = (12•/. of permit the): 9 070
TOTAL PERMIT FEI3: ge 0-0/
C
Authorind signature:
This permit a •, • , - • aspire. permit's pot °'seised within 180
Print name: l Date: • Number of ' :"• - .. b sdowod pa permit.. a complete.
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1: •.doc 01/01/10 440.4615T(11/051COMIWEB
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Jul 11 2012 6:38PM Bridgetown Electric 503 -7123 page 5
. Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
Fee for ail residential systems combined . 1 $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
t'& 21,1 h .:3, uu._�.�.� ^aw..�
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
® Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems: _
*No licenses are required. Licenses are required
for all other installations
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