Permit •
rt CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2012 -00152
13125 S W Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/23/2012
TIGARD 13125 2S112DA01400
Jurisdiction: Tigard
Site address: 6650 SW REDWOOD LN 195
Project: Comcast • Subdivision: 1996 -048 PARTITION PLAT Lot: 2
Project Description: Data telecommunications
Contractor: BRIDGETOWN ELECTRIC Owner: PACIFIC REALTY ASSOCIATES
5701 N LOMBARD ST ATTN: N PIVEN
PORTLAND, OR 97203 -4113 15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 621 -7122 PHONE:
FAX: 503 - 621 -7123
FEES
Description Date Amount
Specifics: Restricted Energy Permit 07/23/2012 $75.00
Type of Use: COM 12% State Surcharge - Electrical 07/23/2012 $9.00
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 obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: an/ 4'7 4'7 G- / 77 o ,/
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 603.639.4176 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 19 2012 10:39AM Bridgetown Electric 503 - 621 -7123 page 1
Electrical Permit Application Cd . ; I. ; : I:. I ., „, ,
City of Tigard
7 rie
wt 7 0,71 �!: i Permit No.: i i a2 — i .
13125 SW Hall Blvd., Tigard, OR 9 n;.: W es Plan Review
S. Phone: 503.639.4171 Fax: 503.598.1960! Date/By: Other Permit:
Inspection Line: 503.639.4175 ■ Date 1YBY; I eaal Irtormatlao
Internet: www.dgard-or.gov J L 1 9 2012 N„iti / S See Plip2 ftr
�: "i MK �tq1, ? h.kj.," 7 �'' f },3tJau'p J itif 1 rt,e l y '!` -1 l uiP � ' L I r F rrl rr p v iiwv - C vv r
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,Itt' k ; , lea...._ . ,, • • _ .. il` m 1 In , YSl'1„ r 'm =S 3' ,T.'41Y�1 "�.rLI" i ... _:. t t:Sr �L Imo ..,'I,'?
El New construction V Addition/: ,: I i .: IISION mama thedt all r•• u apply (submit' leas o plane w/tterns checked below)
❑ Demolition 0 v awl Q S e r v i c e or : : . . . amps or room 0 Building over Aurae stories.
velure the aver I a /halt CUMIN 0 Marinas and boatyards.
c �,: H � I f L 1 11144 ?ip• ^r R ; VC+ j • d :; e xaads 10.000 e
w R a ii L-I " i ; I ' 7 µ Z" R; M ; , '• ' 9Y31 e: 'i& ' "" at ISO volts or ❑ Floating buildings.
t �� aR a,ak:hWk xa�a::
❑ 1- and 2 dwelling ® ConunereiaUndu - , ❑ Accessory building term to ground `exceeds 14,1100 t7 Commercial-use agriculture]
❑ Other: DF5m p1 ®p. I 0 6ZSWl �
❑ Multi- family ❑ Master builder n of 71 v Atu
R
r:, j5(11'f k . � j .rw,la�mgnc't:.. r ,.i r" ".•" y ulki t i " ,`f , "+vL 'x. orst'� I r. u. y . a r ,,. - DEincrgency a bluer bluer separately derived rob � loa tj..vie_k > ex iLr_nswiul.9nF+tni' a`I:in iskl,�+7i�mi�'i.:leb�lo ' nv rr. ,L u;l'.% ft 0 Addition of a ca bad of 0 "A ", "8", "1_2", "I -3 ",
Job no.: it — SI* Job site address: qMJ ( yyofl LN . Io0H1' or more occupancy. r ❑ Six a more :teal units. 0 1tecremfaoel vehicle pats.
City/State/ZJP: - 14,A40._ oR a'T 214 ! 0 Health-care neat . 0 Supply vobage Pbr more than 1.
Suitefild Ja 0 Heesrdous . ' 600 volts nominal.
g p t. no . 14j4 Project name: o t&c ,44- , �o i � , '$ +aceor : a oe mots.
1� r an iiil!1?�' ..,E ��.Ill��f , o s, Brie .:. C ; 1 r'• ::
Cross street/direct o job site: l _ lr t, i1i�1•
New reatdenttal ° ogle` er mattl:•faloily awaits* unit.
Includes attac , .r garage.
Subdivision: 1 I l no.: 1,000 sq. tt or lee : 168,54•
Ea. add'l 500 sq. � for portion 33.92
Tax map/parcel no.: 1
. y�n r rr n . :ry n � t w. c > f a�0. i ; �" r •-•, �,�� a�µFt7� T i Limited enemy. f 75.00
r
` '.° ,E5ME�iu iiR185_��u�w.+a. •1 .,il.:L:....n''� �.,A,A 3Y "w..;au; r ;:; r r p 4 -iY (with abffe 64 )
rr�� � � L anal energy, • , ily
OW Ve{ &ob ;.,- .: —,1J it ;.,4 - o � G,' - _ ...tr.,. ' residential .:.. 7s.00
I
Services or a luatallaebm and/or Macedon
,� -83a1 taA "u� zy a l r hr xRpi r.� 200 amps or less I 100.70
`k r7 �" ..171 er nxw3S�e �dl_7.4!: ara {alt _!i t AT . , is I ,4 P 1 ' 201 amps to 400 I - 133.56
Name: 401 amps to 600:.... 200.34
Address: i 601 amps to 1,000, , 301.04
Over 1,000 amps , j • Is 552.26
City/Stete/ZIP: Temporary eery • -. or feeders inshllallon, alteration, and/o
relocation
Phone: ( ) I Fax: ( I ) 200 amps or leas 1 59.36
Owner installation: This installation is being made • property that I own which is not tot amps to 400 'r 125.08
•
intended for sale, lease, rant, or exchange, according . ORS 447, 449, 670, and 701. 401 amps to 599 :' ' '- 16854 .
Branch circuits , alteration, or extension?, per panel
Owner signature: Date: A. Fee for brooch • . with �f t Vh } I I a b � , i ' i,GCw i . ' I s ue: s , ' ,,,,,,,z ,eke nil S above service • • r • 5 w,.ttl.l,ir S. . : ai{ L . ".:t�',I`}Oi$.a # - '..�'Lf�:,.u: rySLmx � 'iro each branch •iT. 7.42 •
Business name: I B. Fee for branch mulls without
Contact name: j awake or -_. tee, ibst 56.18 ,
branch cRWlt
Address: { ' . Raabaddd-1 branch 1 , • 1 742 , .
Misedlaneons ( or tleeder not included)
City/State/Z1P: j Faelr , awdular 67.84
dwelling, service feeder der
Phone: ( ) 1 Fax: : (1 ) Recmmect 67.84
Pump or irrigation . 1e 67.84 s
E -mail:
Sign or outline'
yyy���1�...
k • ! 'r , , ± , ^� _ �� 67.84 2
c' n fi�I eta li ti -, !l i.L vE ENS E , ," Si dreua(s) or - . .,
Business name: i� E �-f)1C panel, alteration, o . anion. % Palpe2 75• 2
r+� / n ' �. re �j Each additional I • don over allowable In any of eke above
N
Address: S 7 0 1 • l - O fl B' 1 " S / or Additional ht:. _ -• N
..F (I hr min) 6625/ hr
City/StatetZ1P: • N OR 1i 2 Q i 3 investigation (I hr ) 6625! hr
Phone: (SO; )� I - 71 Z I Fax: (60 ) y i 23 r f plant (l ,, no the iii 7s.la/ hr
d s • Moat listed ':x min 900tYhr
( CCB Lit:.: 4 4 Elloarical Lim: (� Suprv. Lic.: 4 0 7 717 i laat',zi t ° , n • ,, . ,..,; `, ...;_':... ilka , :
c�;t_i
: ' ..il.� , , _ :i1. _L1:,'�I.c- .:."�F a i.
Suprv. Electrician signature, remit Subtotal: 16.0
P • , (25% of permit fee):
Print name: ,;://-1.,, Sl po �S / /co I Date: State • so
e echo (12`% off permit tee): a .
Authorized signature: TOTAL PERMIT FEE: 0t(. 00
The permit a . ... esplres if a peradtb not obtained within 180
Print name i Date: • Number of •. e � wed pera m as
t: dot 07/01/10 1
440-46137(1 trosroo
1. i
Jul 19 2012 10:40AM Bridgetown Electric 503 - 621 -7123 page 2
Electrical Permit Application - City of Tigard - •
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FltES:
Fee for sa residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alum
El Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
El Vacuum Systems*
❑ Other.
Fee for tech commercial ! $75.00
system
(SEE OAR 918-309 -0000)
Check Type of Work Involved:
El Audio and Stereo Systems
�` ❑
•
Boiler Controls
•
❑ Clock Systems •
vg 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
f.1Bailding■PtrmIMELGPamltApp.doa 03/23ro6