Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
la COMMUNITY DEVELOPMENT Permit #: ELR2012 -00141
T l GA . R D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/12/2012
Parcel: 2S 101 AC01600
• Jurisdiction: TIGARD
Site address: 7000 SW HAMPTON ST 128
Project: OMAC 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 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:
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 5 - 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 18000.3
) fJ
Issued By: 1 Permittee Signature: OL A � L.1 CA ki
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.
•
Jul 11 2012 6:36PM Bridgetown Electric 503 - 621 -7123 page 1
Electrical Permit Anplication REC .,
City of Tigard /2412- 1;.,6- Paaoi, rle'„��ot�J( a1 `001 {
l3125 SW Hall alerts, Tigard, OR 97223 .JUL 1 1 012 i Other Perndt
Phone 503.639.4171 Fax: 403.3981960
•
Inspection Line: 503,639.4175 Date Ready/By: ' 0 Bee Pepe 2 far
Intents www.ligard , C OF T1GAF D eftilu o • .tal ratbret.9ea
1!� a °kl`.Y N
" 1rJ'F. �y�y,,,,I tale :ia I ,�eaaeu�l�lnwa,� ,,, :� u, , k5. 11 � ,�..,�1 <i., .,, .. '+�+. ^' r t I In I
4 �r r �to _ I a 1 I _ p'� Y,� `�i • 11 t 11 n I I R. pry crvlYt•}li r 1 In 1 l � C�6� -cur . p�
v U..� .: 1 a�'ffs t..hl.tk,�'... ��. `!:�u1:,5u:w:ilt I� �) �:,. "_'?R•?s.Y..:�•u- 'T:r+LR1sF � -n. lYl i = iS�J�� �!�T;�ISI I h�...., �F_�MYt.e � I �S.l � �.I' . �l.�i;'' ..bir' *+ �'
❑ New construction ►_ • ■ ition/altcrati. - .tenement Plow clunk all •• I apply (submit zsets of pima wAten checked below):
❑ Demolition ❑Other Service es c- - . ._ I imps on more D Balding over dues incase.
where the : :, I Bolt cmkeat D Maims and boatyards.
T N ¢' f .? F hSl�d :1" t i fl�tr•�-" srl , 7: 7431 " 0 �i Floating buildings.
,�� i � I 1 , .. I ' t. .d IZ y ;'. _ exceeds 10,000 at ISO volts or D
� ., , ,r d 5 ,Er ,I ....„ a :., nuts , .ra ..' 1rE m r , w.La ,11 G i. WS to ground. • ' succeeds 14,000 D Cmamendal -use agricultund
❑ 1 - and 2- family dwelling C - . mmercial mdu: ❑ Accessory building
mops for an • hastenetioes buildings.
❑ Multi - family ❑ Master builder ❑ Other. ❑ Fire pump D leelal atioa of 75 KVA Of
� igg j j, I ts _" {�[,.; '1t-vf,r �N, rtx"inu''t.+., '�'raVf!�• -Wi8'„ OE��'e i , . targersepara�yderivedsync
' ta ' ....-L r 6aJa�3c�kA,.Wc+�t.rI):'.:1 rn,suR�;�3..2;331 F31i° •^' OAdditton ofaaW •, tied of D"A ","g", "1- 2 ",'1_3 ", Iffaill.// 100HP or mom Job no.: I ' 5/ Job site address: 74 s 'a $(i(J a Sic or mare reei. , fiatunim D Recreational vehicle puke.
City/Stale/ZIP: D Health-caro fac . es. ❑ Supply voltage kw store starts
!�
D Hssmdou7 600 volbeominal.
Suite/bldg./apt no.: 1 g' l Project name: OM 4 L Dqq &Taos or t ■ armors.
ttls i'.I Ilit'> i Ii1"1 l.:. Ir I '''''''''''...;'-'101;!1! al b 7�aN
Cross street/directions to job site: _ "i ' � ' , p ie.q �y.
N ewreildenttat'- ormaltillandly dwelling unit.
Includes attach garage.
Subdivision: I Lot no.: 1.000 sq. ft. or 168.54
Tax map/parcel no.:
Ea add'l 500 sq. i ,; or portion 33.92 •
u se r v�t• , i,k�'�..r f t sax' L J•„ �" (H l e>c s 181
. rt i p l tl 6 1 Y"" I iF ' t " t? v l+ racy (with Limited txmrtay, - ' 75.00
•;
., I Intl jlai .,fgMi. 't.'. . i I I I .Iw,.:r ", r . a� aS Ulm .i i ... ' '[pL lt above d4. : •) •
Limited l I o (-141,4--- c4-17 IL Y ,.x de ra a->Ic.,71a (. •. • tinnily it) 75.00
Services or . • • Inatallatroa. alheradon, and/or relocation
�{{���gg _ P1..4 h--4 • 4C - 1 200 amps or less ', 100.70 2
..5?:�39; nic gepr , a I' I w �1j �d-1C sl dl 1` 5 'I -1 ...a� qr,± i y x,' 201 amps W400 133
. A -..i, �u t i . .l .�IC IVI i '4 ...01 - -5 i. Su .Mr6: i .
Name:
■ 401 amps to 600 1 • • 200.34 2
601 amps to 1,000 301.04 2
Address: Over 1,000 amps • ;{ • Its 55226 2
CIty /State/ZIP Temporay `- or feeders Installation, alteration, and/or
relacatron I
Phone: ( ) I Fax: (, ) 200 amps or lees 1, 59.36 I
Owner installation: This installation is being made on property that I own which is not tot amps to ' " t� 2 400
intended for sale, lease, rent, or exchange, according torORS 447, 449, 670, and 701. 401 amps to 999 : !.: 168.54 2
Brandt circuits , f,. •, alteration, or tension, per nand
Owner signature: Date: A Fee fbr branch - :to whir
8 ! Q{ , '13g' Grp "�I'i� lu'`�ll� `Ry �- • JT{ f , +,t:}, t� F 2� �. kp ti � 1 a.✓ e zYr '� xtw}u. F• I I' above service . � .. , -r fee
ittl S ",;,..��,,...�.�," T[ tis;u!_y.. �kle {:? .� �'� a � 6 d w 0ar�l h kHDC h are 7.42 2
Business name: B. Fee for branch . without
service or ■• - •', . - - A ral 56.18 2
Contact name: brand circuit E
•
Eaohedd'branch • •' ,... . .. , ., • 7.42 • 2
Address: Miscellaneous (. - or feeder not included)
• City /State/ZIP:h manufirmand .i. ' 67.84 2
&denim, service ..• or feeder
Phone: ( ) I Fax: : (: ) Reconnect only I p 67.84 . 2
E-mail: Pump or irrigation le 67.84 2
Sign or outline li . _• " 67.84 2
• ",; ;';', + * u: �.i/I' �'ilili Yi r'l.M,V�� -. . .u,.t -12..:F , .11 17 2r y �.,- I M l 'kiilS:f�.3r�iIV I c k c ,, s
1' �. ""'�aJl �li..!0� - .glacial ""v."' or t .. -energy -
Business name. In % . a - , a ` _ . - _ hi r panel. :: pel. alteration, or, . -, ion. / , Page 2 _ 7 . 2
Each additional 11 ' • • - • • n over allowable In any of the above
Address: S 7 D / N . /....o r)% q4 /) S 7 Additional i • .,... • (1 br min) 6625/ hr
City/State/ZIP: ''pRTi.�►ND co 2 03 -err 13 brveeti (1 '� �?') 6625/hr
c 1 - 712 2 Fax: ('yr,3 �� - t ► inspections for (1 ^ ` ) 78.18/hr
Phone. (C0 3 ) ) 67.1 11 peetions for w4 • no fee is
90.00/ hr
/ y I��ya..�i� /� ��. a 6 e • - - I d 6 c ram
CCB Lie:
X03874 I E j - _cal Lic.' s c..I Suprv. LIC.: 4177 V - JiF6rri'i i Iii dL I u �1.i.,II .1 _( . - 1 ' 1 n '.I.1 t gigiiale'!. :.?
Suprv. Electrician signature, \ required " a 1 �I Subtotal: L
Pled) - ' (2S'36oP permit fte):
Print name:4', S>f� is.g /�pr DP -I2 -/ St ate a :.. (12%of penult fee) F
TOTAL PERMIT FIE: 1<
Authorized signature: Y'
This permit app • as aspires if a permit hoot obulned within 1181
Print flame: I Date: • Number of � • • . • 4 h allowed per permit. a complete.
liBui ldlaePleneivlH.C- PaimitApp.doo 07/01/10 440461ST(11/OS a
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�l 2 )
Jul 11 2012 6:36PM Bridgetown Electric 503-621-7123 page 3
Electrical Permit Application - City of Tigard
Page 2- Supplemental Information
LIMITED ENERGY PERMIT FEES:
giff."
Fee forll residential systems combined........: $75.00
Check Type of Work Involved:
• Audio and Stereo Systems*
[]Burglar Alarm
▪ Garage Door Opener* •
EI Heating, Ventilation and Air Conditioning System*
1:1 Vacuum Systems*
El Other
,
Fee for eAch commercial $75.00
system
(SEE OAR 918-309-0000)
Check Type of Work Involved:
Audio and Stereo Systems
D Boiler Controls
ED Clock Systems
El Data Telecommunication Installation
I Fire Alarm Installation
HVAC
• Instrumentation
• Intercom and Paging Systems
El Landscape Irrigation Control*
El Medical
El Nurse Calls
p Outdoor Landscape Lighting*
• Protective Signaling
• Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I IlvildIng1PronaAELC-PormitAppdoc 07/01/10 •