Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
>s • COMMUNITY DEVELOPMENT Permit #: ELR2012 -00211
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/12!2012
Parcel: 2S112AC01500
Jurisdiction: Tigard
Site address: 7319 SW KABLE LN 600
Project: Solestruck Subdivision: FANNO CREEK ACRE TRACTS Lot: 23, PT 2
Project Description: (1) low voltage for Data/Telecommunications. NOTE: Different system than the one for ELR2012 -00208
Contractor: BRIDGETOWN ELECTRIC Owner: PACIFIC REALTY ASSOCIATES
5701 N LOMBARD ST ATTN: N PIVEN
PORTLAND, OR 97203 -4113 15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 621 -7122 PHONE:
FAX: 503 - 621 -7123
FEES
Description Date Amount
Specifics: Restricted Energy Permit 09/12/2012 $75.00
12% State Surcharge - Electrical 09/12/2012 $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 obtain a copy of the rules or direct questions to OUNC by calling 503. 232 .1987oor1.8000.332.23444..
Issued By: 1 � Permittee Signature: Ott 34PPU e 4-17 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 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.
Sep 11 2012 1:38PM Bridg F 503- 621 -7123 page 1
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Electrical Permit Application _.
Ill City of Tigard S E P 11 2012 a q ( ,- I �- s �' a .rlot: A t,,�ol) '.2J f
4 13125 SW Hall Blvd., Tigard OR 97223 Plan Review I
r^ Phone: 503.639.4171 Fax: 503.598.1 960 Date/By: Other Permit:
Inspection Line: 503.639.4175 � I i /� + 1� �� Date ReadyBy: i runt B See Page '
Internet waw.dgard- or.gov SUT LUNG 1 i Mil ' , Nat ftalmlcawd: i w , •- teen
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❑ Nevi construction r.I Addition/alteratien/replacement Please cited all that °. • y (a�peta •' •I • low):
0 Service or feeds amps or mole c Rag g' ova .. - , ', • .
❑Demolition ❑Other whe re theavai _ • I &u11 current L Marinas and .
r "•• e9 - .i dPp war ,f[.� .p,+�aa� r W,n>.mgch7Arr+gnn . r ',.;; � . �I• , at 130•s
silts �( �� 'g� ,{i 1 ; �;,, mumoda 10) 000 nits m II .I,
it i'i:dCU ?!l2 l9t15 t ir.r.P:•.,. � i��- �:, �.+& � •r`.,;}I.i;...,aa.dre�>W.,f,ri, ,Y.5,1 ' 1�'7.•�„ f ; .
1 C.....
legato pound, or l .. 14,000 a �. ,,,. „ ■ _ . -. ml
❑ 1 - and 2- family dwelling it Commercial/industrial ❑ Ac • sory building amps for all other dons. buildinp.
❑ Multi-famil ❑ Master builder ❑ • OFire pump. , a Installation
a �, G 4 . 9�` al ��t a �n r
l i - _.a r�rizca I yvF :y [�c� �. ay' Q I . - At , : . 0Emeripmeyeye larger tapers system.
?•�.' :∎ 4 ... . � 4, ...4 .,a,� 12,..... ii.4w r�aU• i ;sti . i.test: YIrctidia6.rlea,,;u"I!n yAr:idr. Y:,75i11�'ar i . �b. n' • . • ,.i- Q/�dd'ticn of iww I. , •r l oad of ■ "A ", , "I-
Job no.: a-1.4.1 l Sob site address: 731 t0011P or mole. li occupancy.
Ke ,D �.V1 13 Six or more raid - 'fir l • stun a occu ncy.
City/State/ZIP: �i-e�t t9 Q, Z2� I O Ha zard oe fao1 I a Surety • • than
0 Hamrdom uN : 600 volts no .
"
Suite/bldg. /apt no.: / I Pro % ject name: O L4 0 Service or Ikeda :'•. y��7 �t
Cross street/directions to job site: I oe. a Pa;::La .x it was ?MN s • •
New residential , i • e- or atult1 s sr, dwelling alt.
Includes Attaehted l',. •
Subdivision: i Lot no.: 1 000 sq. ft or leas Ii 168.54 4
Tax map/parcel no.: I Fa edd'I 500 n . ft. I j • portion 33.92 _ I
p•. # ; , K '. it r• 3 �r,,�, .� m " .iYfl' a J , r 1,1a'y,G r. t Limited energy. '- ;, ^ Ua1
+ ; ;-4 - , rIL �°""' r?::: t l •' r •,1 y t ' (withabovesq. n . 75.00 2
r w ^: rn. , r'�: d,ni ,,u.:17 "tY5
o C-,0 1 s44-4/644
AAA/ DreDertri3S LW 1/1.44A11/ Se.eu�+t�"
Limited residential l'• .� • ■ - s4. ft.) 75.00 2
Services or - - , - •' lostsdlatlon , I , ' , on, and/or re , . ,
• 200 amps or lets I 100.70 2
" ',i ,a ,:1'•1,5 t ,v� r::+5.�c. vv� t �g t a i dF '.' r
•,:� r. �I 8 1 1 9F� ti F rl i vita 71J�i!i' i s ,,,, , I:.u�M1 t t 201 ripe t°4°11 -
,..m.rilci�,),V- e. ca auA9�S:a. 32 nisi r� �... . 7 . _ • • �`.Z 4ti;.i: �Q: 133.36
2
Name:
401 amps to 600 I • ,: 1 200.34 2
601 amps to 1,000 j 301.04 2
Address: I Over 1.000 amp• or - ' 552.26 ' 2
City/State/ZIP: I Temporary : - ... or feeders ins • . , en, alteration, ani/ar
relocation I' .
200 amps or less I 59.36 1
Phone: ( ) I Fax: ( ) .
made on I :t to O°' 125.08 I 2
Owner installation: This instailation is
being property tit t t own which is not
intended for sale, lease, rent, or exchange, according to ORS 447, 9, 670, and 701. 401 amps to 599 s, I 168.54 2
Branch &twits- . alter loon, , !extension, : pasta
Owner Signature: A. Fee nu brace •• J •- with
n' S ��if•I7 ><t'NY±{ s t L 1r0W i• t•nh . 7 i .csSV 1 r r { ' ' , •!. .
;ia1f:. t �i G i ` ,y �, �itJx'Ut i3 y; t • �iiv r ' S �F yPt eachbr branch 7.42 2
G�i { u ,4ca ry r x V �l2m'� fAm. c�ea ti. each breach CrrC •
Business name: B. Fee for branch ci ii uits without •
service or fader .. first 56.18 2
Contact :name: branch circuit iI .
Each WWI branch 1 ft i 7.42 2
Address:
Miscellaneous (" , .; , . or (taller s , Included)
Fachmaeathatured modular
67.84 2
dwelling, service s „, • feeder .8A
Phone: ( ) I Fax: : ( ) Reconnect only j: - 67.84 2
l
Pump or irrigation a l;• le 67.84 2
E -mail
a .R. t "^ "^ ; n e rl , , a a r n , m •
Signor outline ," „ 67.84 2
t ' " i ' iiir;�tt'b •T !.: l lyI � Mr, i:!; 2 � I '. i.3 S 'r� _ ` '' . >i +`a. �,m Si I -
Signal eircatt(e) rr3r ' lead -energy
Business name: lifticidgferakip .>F MitI C,, • nand. alteration. Or .!' •' -' . on. � Faire 2 IS, v 2
Each additional s cdoa over ; , . bit in airy the shove
Address: S70/ N_, . 2-.o_fn a Ate/ S 7 Additional i . • • i; (1 hr mm) 6615 / hr
City,/State/ZIP: 'Pogitbd4D OR 0 1,1 03'`(7 a 3 Investigation (1 la • !;') 66,25/ hr
��r (604. Industrial plant ('I I;s • • s s) 78.18/hr
Phone: (H, v ., �f 17/ I Fa: ) ail 712.3 Inspections tlared ons forwhk"ao.fee is 90.00/hr
' � man
CCB Lie.: in 81.4 Electrical Lic.: Saprv. Lit.: 77� x� S1{ i °4
6,106.F.: r r , ' r .. i'1 `,i Ur �a'
ll al:
•
Suprv. Electrician signature, rogwleer �� el 1
�� ■
Print time:,, ) /mod Date: ! State ;, arge (12°A of • • , : fors):
Authorized signature: 1 ;FFEJ
Tall permit ap.:. on expires ifa' Meat astral. withi 180
Print name: . per : ;
days i. rhhai been ..., - ••rho • Number of limped ... allowodpor • "4.
I:IBOiI®g Wmuda C- ParettApp400 07MU10 440.461ST(t1A017COM/WaH
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Sep 11 2012 1:38PM 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
Check•Type of Work Involved:
❑ Audio and Stereo Systems* •
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System)"
•
❑ Vacuum Systems*
❑ Other:
Fee for each commercial $7500 •
system
(SEE OAR 918 - 309 -0000) •
Check Type of Work Involved ; :
El Audio and Stereo Systems '
❑ Boiler Controls .
•
❑ Clock Systems
•
IZI Data Telecommunication Installation
❑ File Alarm Installation !
❑ HVAC
❑ Instrumentation
•
0 Intercom and Paging Systems , .
❑ Landscape Irrigation Control* •
•
❑ Medical
. ❑
Nurse Galls
❑ 'Outdoor Landscape Lighting*
•
❑ Protective Signaling
❑ Other
•
Total number of commercial systems: _
*No licenses are required. Licenses are required '
for all other installations
1:03uildiryg1Pamit NELC- Permit.App.doc 07/01/10
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