Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
N... COMMUNITY DEVELOPMENT Permit #: ELR2012 -00188 •
Date Issued: 08/14/2012
- if G A I: D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 1S136DA02300
Jurisdiction: TIGARD
Site address: 6900 SW ATLANTA ST 110
Project: Comcast Subdivision: FRUITLAND ACRES Lot: 5
Project Description: Low voltage for data
Contractor: BRIDGETOWN ELECTRIC Owner: OREGON EDUCATION ASSN
5701 N LOMBARD ST 6900 SW ATLANTA ST
PORTLAND, OR 97203 -4113 TIGARD, OR 97223
PHONE: 503 -621 -7122 PHONE:
FAX: 503 -621 -7123
FEES
Description Date Amount
Specifics: Restricted Energy Permit 08/14/2012 $75.00
Type of Use: COM 12% State Surcharge - Electrical 08/14/2012 $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 $84.00
Other Desc: Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through OAR 952- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
/ /
Issued By: ' A Permittee Signature: DN P p p ( .. SCAT .T'
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE: Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 603.639.4176 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept In a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Aug 13 2012 12:52PM Bridgetown Electric 503 - 621 -7123 page 1
Electrical Permit APPlicationRECEFF
ID
City of Tigard D - ` 13125 SW Hall Blvd., Tigard, OR 97223 Q U 13 012 1 K - 1')_ ill k. z �, t Z. - v 1? t 4$ Review
r Phone: 503.639.4171 Fax: 503.598.1 , Inspection Lint 503.639.4175 �r y� �A�F�rr !� �p� : : r I Se. Pap 2 far
Internet www.tigard-or.gov Cfl H 0L! .R `'�.: [ ;6•D d: ( SupplenmW Information
�:4 •. , , < uti 1 a,yr .H y 4' r 7s K ° Y ", } ••r 1 ; l•li4' ...[ tj .l r 'a. iIIT 7 rt,,+:it I �',. Yi{ ra•`• •Fit.0",71 a cevcl.i .':"I a zY In�{;< s. t ie .?
r . �f J� ' . � 'U gir 'i° r . v f , ' i , x � i - ,�' �, k r ',PA :
;- 4 ih1S.311,...tc_:iT g•. 'v!iSlh.r'" :._,.4.3..E3- 13,..3,.i� ,,.,..,,, 5�3:'I G .,uV . b is •{l'.... f7 - _.d.. .�x t Y �.:. :1•.`iC:irs{:l i1
❑ New construed= 1.• Addition/alteration/ •placement � all that apply (e a vian Wham checked eelont
❑ Demolition j O service or feeder 400 amps or more 0 Bad ing over l stories.
❑ Other: where Me avmlabk limb current ❑ Marinas and boatyard&
"rvrT ?ter mss ,air e2ns t1t '�eMM;K = JtiJ now, r y ,,�: i "' k'i meals 10,000 at 150 bud
'La • ;�� •" p x (, y I = y q'J } O P>aat7n8 tdu+6s
„1. •`l.•' `iE2i2i1� fL Sri• vJ... ac: Ylr... sa. P3 : roLtctlAl.+.n¢al110 .•�.�rL.l.: ••. � !!.' + 14v �.t�l 7 r less to ground, or cameede 14,000 ` 1 CoI mentid -use agricultural
❑ I- and 2- fenhily dwelling , r: Commercial/industrial ❑ Accessory building amps for an other osauadoms. buildings.
❑ Multi -famil ■ Master builder r ❑ Other: O Fire paw 0lnetelletion of 75 KVA or
r:• " OP ater sleet lee derived
r+ .. „r s f'°�1 R?9,t :�:ttf•�N'<U� F45 + .f �•I a" rC '{rw r . 0 a. , f l t rc{ y; :.: � + aq�e. r v, l it' �y � �Yay BCr separately system
f` . 0' . 1 :11'f 4 i .. ' r l 4tr_.., 4 ....�lv ".1- llAL , ' -8lu6. ,6 r r t.zi.ailow.. • .L , . • 1 �"• ' ❑ Addition of now moor load of 0 "A ". "E", "1.2". "13 ".
Job no.: 11.40 Job site address: (pq& iM ler0llp Or more oocupetny
❑ six to owe reside..tiet units. 0 Recreational %chicle parka.
City /State/ZIP: T' t fri on I ❑ tiam
ltbrso $ei ace. ❑ Supply voltage for more than
• ❑ I1aaarelour locations. 600 volts aril.
Suite/bldg, /apt no.: 1 1 o Project name: _ A iutis f [hawks or boo ss
or mo. r
1t I $r , 3 lF' ,'a'l� , a� -) '� t' C nF9wJS c
Cross street/directions et/directions to job site: F � i' ' h l 'i Marla_ JS '1a, ;
New reiddeotW sink- or muld-family dwelling unit.
Includes attached ptisge.
Subdivision: I Lot no.: 1,000 sq. R. or less 168.54. 4
Tax map/parcel no.: • i Ea WWI 500 sq. it �r portion 33.92 I
� ry, n _ Limited energy. residential 74.00 2
� .;N h.qI.,�Uy•�tctxiy,l^ •[pe��jI f t'" {p;y�1NZ,+•nl� tsw7�p.�w7liJ el +Sar+1u•w�•t y,�lyli.0 I'�}���7}j�� STa1. ��JJ�� (with toveet J{��
1 � .1.L`!q:l 'Ili tdS�:u G•Tr . lis!JI WF 11 •4 flL IL M Vi'I I � t { TEN 1.4=IM'I ctl'I' ( ith alcove vy.1 t
.CW v o`�- p,,�w V�.IAiMft/. i ,p� �� , residential (with tbovc sq. t<) 74.00 2
L
r � S"
Services or feeders Instalbtlon, alteration, and/or reloeadoa
200 stops or leas 100.70 2
}- ,4,.I'Y' -.••7 ,1K rr•{, ;�r t v�. ;.rl•nN i h!' t,4 S; f?' „, 5 4 201 7 Naps to 400 amps 133.% 2
a i '' ,.',.!,11111 i..., ttxec w•a l '1,l r O i ,.1.10.t.a5,,t.iki,: n • . ... ,_ 4-- A `t�-{
Name:
401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: i Over 1,000 amps CT 'ohs 552.26 2
City/State /ZIP:
Temporary service or feeders Instillation, alteration, and/or
Phone: ( ) I Fax: ( ) 200 amps or less 59.36 I
Owner installation: This installation is being made on property that I own which is not 201 snips to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 to 599 see ; - 168.54 2
Braotil drealta- new, alteration, or entaasiou, per nand
Owner signature: Date: A. Pee for branch cirpits with -
Jl H f - r .s (k Tl; 'larEMSIi7714 t Ki
r � t4! xl t:? e, `t`n u+'� t r +`1 6 � � a `le „'� t ��F :. above
br e th c ir r @6der fee, 7.42 2
bLfn.li - ,.. .,Q'bxl.li•s,u�:LA=Wku:1 J• fi r. � l . • .u, ltt 'nkarl. Slr�.i.�i r .t. p �e i` each breech Cn1611.t
Business name: B. Fee for branch ciruits without
service or feeder leo, rust
56.18 2
Contact name: brancb circuit
Bach addl bract circuit _ 7.42 _ 2
Address: Miscellaneous (service or feeder not [minded)
City/StateIL1P:
Ruh u teant�cnnbdeamodeiler ' I 67.84 2
mg, service anolor thedor `
Phone: ( ) I Fax:: ( ) Reconnect only 67.84 _ 2
lrmeil: Pump or irrigation Ci'vle 67.84 2
��, g �I�,r �,r :.1'r
iS4 "2 i.,fil fr 3 4 C'„ R w r r , r e Ip 6�1p4 �"c'Nr I i p. c p•" ��'.h Sian or 11. 67.64 2
iin7ga,of+, r ,:...} .Jl._.. >�. 1. .c...la.. � ?.. .�n +. .P.�.r.�'�3iG;fZfidL�a, .all' .� - J. : •i,. "• °.err Sigh #IcfltCnlO(3)_
CelLldtCd- erletgy 0 0
Panel. alteration, or extension. 1; Page 2 15. 2
Business trams: '' t , 1 S�*' Bach additional inrpeetlon over allt wable In any of the above
Address: £ 7 01 N . t...Orn.t3cw `£ I e Additional 'inspectiar. (1 hr min) - 66.25/ hr -
City/State/ZIP: PO1 TL D OR 112Q -17i 3 Investigation (lhrmen) 6625/
IseLaU181 plant (1 hr men) 78.18/hr
Phone: (SO )4ft I . 7 i 22 I Fax: ( , .L ) 621 7123 Wpm:dons for whit no fee is 90.00/hr
Meal listed men
CCB Lic.: ti: e. , Suprv. Lic.: •E '
r�4 l , i ', t u 4,1 t - " r
1a3��T E - - • ,,` up LI 77 , 1 �, C..'� 1, ... �� ... :.i.,. • �`� f . rte 1{{ , r
Suprv. Electrician signature, red
u " Se ;4 , rO. 3tirttof "jf
r - Plan avisw (2395 of petmiE &e):
Print name:, jfd,, S - i4' 07.:s /tea/ 'Date: State surharge (12% of pariah fee):
TOTAGUIRMIT•FEE i s .
Authorized signature: 7bbr permit application e:ptres1f ppirttleb' set .Waked within 180
days afar blur been melded u cos plita -
Print name: i I Date: • Number of tospooticse allowed per permit.
l: lau1dieg\Pono141ELC•PermitApp.doo o71b110 440461Sn11AGS/CO /Ea
J i. . .
Rug 13 2012 12:53PM Bridgetown Electric 503 - 621 -7123 page 2
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
Fee for all residential systems combined .. $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
I '
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other.
Fee for each commercial $75.00
system
(SEE OAR 918
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
FS Data Telecommunication Installation
❑ Fire Alarm Installation
❑ I iVAC
❑ 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
I: 18uildiryporrohaFrr.p tApp doe 07/OVIO
.