Permit NI CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
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a • • COMMUNITY DEVELOPMENT Permit #: ELR2012 -00224
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/27/2012
Parcel: 2S 112 DA01400
Jurisdiction: Tigard
Site address: 6650 SW REDWOOD LN 350
Project: BMP Subdivision: 1996 -048 PARTITION PLAT Lot: 2
Project Description: (1) low voltage for 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 09/27/2012 $75.00
12% State Surcharge - Electrical 09/27/2012 $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: N 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: Oki 4PPL/C �f L
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 26 2012 2:33PM Bridgetown Electric 503 - 621 -7123 page 1
El tnical Permit lication
City of Tigard !��` -d
DatelBy; Q41-11 la- sc. , :e a s e f No:: . • aD ... =�
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13125 SW Hall Blvd., Tigard, OR 97223 pl Review
Phone: 503.639.4171 Fax: 503.598.1960, Date/By: omarpamilc- .C,7pl '-oe'. ..
. , , Inspection Line: 503.639.4175 S E P 26 2012 Data ltcaay,By: hais : fa s« • : - 2 for
Internet: www.tigard-or.gov Notined/Method: TO 6 Bupp ■• I blformatko
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r�te� r Y R' + 3l. y�,;��^ ;^ C'•tA• q K Y•�1 x�ty: �ijr • � 1 r" IhHm !����:1' 'n 5',52: r."F5 � }Yl 9• T
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r� u re cI.W II [�E:S'ler�yn�c - '
�}r
,�t! 1 s'.r4•itV kittg !'t1d ti. 4 }. 1 f,11•L r 1 r! + i i1 1. y ! i Fi ni F��y: � J . ,N
. . �La�i�Q9�,7upPa - ,..�rza�W- e if.t.�� �ic. .. c...�� nt `S �a ,ii L,.u,. .11� t t...:L. _._� -� ; fi 'f b�F
❑ New construction ►! A.ddition/al.' !''•lv •l':�a. I - Pleas thick ,. ., '; . • iy( atrot'.t oPnmu •u deobetotr):
❑ Demolition Other: Osorhoe «ibodei i or • pit ►g • .' Buse Perim
❑ where the avails • Sault covens 0 Marines aad . • .' yards.
, .�'�' r � y�, 09.•,.a - : }cit,":,nw�o�c�y 4;: 7 i ,,� ?f - ' aaeeads10000 • al15ovolteor 1?1aak
w rig r � :::,, ,. :o.,:, r t 1 c: t Ji�l:, a N;rUe " i � . ' ' r: 3 •i1i S , "', :* mI • leas togrod,or -. .. 14,000 OComruerdet ..-. agr{cuhs®f
❑ 1- and 2- family dwelling ► • Commercial/industrial ❑ Accessory building amps for ail • • ......1 . ions. buildings.
❑ M lti -famil ❑ Master builder ❑ Other: 0 Fire pump. 0 rosalladon • 75 KVA or
� I im r y r1.1: i 'r.•n±:,t.e7, : •ff e•r parch. ii o I P ? 7 , - ,.9teli } ' t t . • ❑ �O�cy • _• � Iu er . • • ..... 5 derived swoo '{a✓ r 7 � ii�i n la2.iih lit: t;!.....lH:11.sbu.'«rt_eii; iiU;a .,:.N b% 13 Maiden of new • . •. Icad of Q "A.. •E", "1 ' . "1-3 ",
Job no.. . 10011P. or mom oecupaocy. w
�'�. 52% lob site address. c30 SSW I wua1 (M. ❑ Si: H or a • I ... • ohs. Q aeaesdnml ..parka.
City /State/ZIP: '1: 1 eQ '1 fl4 CI1Leatth•oare fan0i l.. i I Supply w1. -: for more than
C) Hoodoo . •.•�:
Suite/bldg./apt.no.: . 600wlraao...•:
3 Project name: I a 40.4 -. �p 0 5ealrearteeder.,
� r':I: •.., or ma
: re, y • yy �� y
Cross street/directions to job site: uA4.W14 p� l 1'!��..:.*�° 9i�1�'.�. gli::7,ii. t �', .tzrt� #';f�}�TC: ' -'''' : A
... Newreaddentlai ,,: orfiu r" •• dwelling' . alt.
Includes ottac . • • , garage.
Subdivision: I Lot no.: 1,000 sq. it oilers 168.54 4
Fa ndd'I SOO sq. • • portion 33:92 I
Taos map /parcel n o.: •
Liatfmd
1 P r, •t P r . r r,rv .rgcx - I I :r• .r. �ams. ro I .., " 75:00 2
f ' Waited' energy, • ' ' atrt
I' - `- ++ r p ure :(withI • • • • sq. .. R) _ • 75.00 2
W W V11173.� l �lJt �d 'M""" � 61u i e�j tl>: rosidentisl or + ': InstaBalion elttiatloe; and/of • reloca tkm
5 . 200 turps or less 1 100.70 2
. • R a , ,r ^ .t: ;. 1 ::dee,c+;»rst r 1Tg �p L 1 ju + ff ), ¢ _
igi3 :2 l fk _ t :1 FE i "lf app T T,•rR - u y „ t 201 sIDPsto 133.56 2
401 amps to 600 •• • • 200.34 2
Name:
•601 amps to 1.000 • • 301.04 2
Address: Over 1,000 amps • i • Its 55126 - 2
City/Stete/ZIP:
Temporary relocation or feeders ins allation, a don, aad/or
Phoned ( ) I Fax: ( ) 200 amps or less 1 1 I 59.36 I
wnts tBIIa
instdon: This installation is being made on. property that I own which is not 201 a+apa'to 400 I 125.08 2
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intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. sot amp to 599 ;' • • 168 54. 2
Branch, circuit - I alteration, 11. Mention. Meisel
Owner Date: A. Poo'for thiards'c! with
rl.t4hIt c r • x i, • 6 7 > e:n ,om ,; ;, above:service • . feet
a •r tl. t I +t r f d rC' t� n
•rIti ' •
EeCI1lAa0Ch` I ., 7.42 2
` .r.0 Y : 1:s.. r ,:. c _ . AAmi....,,a, _ 3 t� �. r , v l ` f... ". a td�'�:.tin,,t,A,L,:v via.. )iis+
Busine s nae• B. Pee 6rmtt .. I -. ,, wimp u
-
m service or.t- - first 56.18 2
Contact name: brunch Circuit
Ends add'btaach •i I . it . 7.42 2
Address: A�edlaneoua'(...! .lee•cm:feeder no Included) _
Each mm ued I - modular
City /State/ZIP: dwelling. service • trader 67.84 2
Phone:;( ) I Fax: : ( ) Reconncctonly I - 67,84 I 2
Pump or irrigation I. - . 6714 j 2
E-mail: I
ry�r +� S" t t. 1� 3 ,t +� ++ I x y k � r ' . ' Sign or outline.' - 67.84 2
' ,Mdi , in figk 1 ii t/ I i t t t I gi i- .fir 2' '1M irl' �C " s 8 ' .
Lj b��Jis'i'1"1 hIr,1.1��•'1 :i °1' F' _J� f tG'Lti 91. 1.���.f+. E h St er 1 • _ •♦
B �
• meet, planation, ! - , . I. Pg 2 12
tssine§s name ' i) , �`� EGtRj'C. Eads addlden*hl. • - • • a over allowable
Page
In ' , of the above
Address: • £ 76 . 1 i_. 0 (A.64(20 S 7 e r Additional '+ • _. ' ! (1 ht min) 662S/
City/SteteIZIP: D. OR qn2'03't1 i 3 1lrveatlgplien(,:trr; ht) . 66251 Ilyduelridplmt:(1.•1; mht): 78.18/ •
l (s03) -.7 2. I Fax: (8,4. ) +1 ficti • ; nolbeie _. 9oodA ..,,. .
QQ �'_ I +� . fi I tiered i' no tttl
CCB uc.: '�0� 882.4 1 . E Li `r W ,v I PfY. l.lc.: / 7 l hidH[LF �a i '�j{_!_ �._ .. �'_1!:t . S_ ..,f .i..I� w eq Fie
Suprv. Electrician signature, rear h4 ' F
PI a 1
Print name: , 'yam - .Sr-/ n s /.'ei ato: State.. eharge.(12%ofpe4 ; tee) . q. o
Authorized signature •
I . '?QT $ ' ri '; !; :.` ..
mix wink • . •11 !4111 r.Hip,�eylleil • 'I. ,'02161188
days itle beeaeeef ' ilted;. i ca ` "'
Print name: Date: • Number of • ona:elloamd "`•
1.1smilleatteradtdELCOretitani.doc 07/0I /10 4404615T(nlNi/COMIWE1I ti I
Sep 26 2012 2:34PM Bridgetown Electric 503- 621 -7123 page 2
.Electrical Permit Application - City of Tigard •
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
401#0114310400301 .
Fee for all residential systems combined .. $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑. Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
El : Vacuum Systems*
❑ : Other:
:co itegr o . <:,
Fee for each commercial $75.00
system'
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
El Boiler Controls
El Clock Systems
Data Telecommunication Installation
❑ • Fire Alarm Installation
❑ HVAC
El Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ : Nurse Calls
❑ • Outdoor Landscape Iaghting*
❑ Protective Signaling I j
• ❑ Other
Total number of commercial systems: _
*No licenses are required. Licenses are required
for all other installations
MuiIdB •C-PermitApp.doc 07/01/1
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