Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
a
COMMUNITY DEVELOPMENT Permit #: ELR2009 -00139
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639 4171 Date Issued: 05/26/2009
Parcel: 2S113AB00300
Jurisdiction: Tigard
Site address: 16037 SW UPPER BOONES FERRY RD 200
Subdivision: Lot: 0
Project: Oregon State Bar
Project Description: Install restricted energy for voice /data
Owner: FEES
OREGON STATE BAR, THE Description Date Amount
16037 SW UPPER BOONES FERRY RD Restricted Energy Permit 05/26/2009 $75 00
TIGARD, OR 97224 12% State Surcharge - Restricted Energy 05/26/2009 $9.00
PHONE
Contractor:
BERGELECTRIC CORP
6026 NE 112TH AVE.
PORTLAND, OR 97220
PHONE: 503 - 255 -1818
FAX: 503- 255 -1919
Type of Use:
Class of Work:
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 Total $84.00
Intercom/Paging: N Landscape /Irrigation: N Required Items and Reports (Conditions)
Landscape Lighting. N Medical: N
Nurse Calls: N Protective Signal' N
Secunty Alarm N Other N
Other Desc:
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 -0100 You may obtain a copy of the rules or direct questions to OUNC by calling 503 246 6699 or 1 800 332 2344
Issued By: Permittee Signature: JP1104 Q 0 k v
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 an Inspection that business day.
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.
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Electrical Permit Appl ., . �� FOR OFFICE_ USE ONLY
u ,
City of Tigard 4,AY 21 20 Received -_
13125 SW Hall Filvd , Tigard. OR v7
Darn e : p Pent No Ei22c Oc�� -
Phone. 503 639.4171 Fax: 503.59/1 I960 Plan Review
�'�pp Y Other Permit:
TIGARD
Insp. Iwn Liner 503 639 4175 CITY CF TIutrifi® U ,ie Ready/13y: ®Sec Page 2 for
Internet. www.tigardor. De- or. DIVISION Noidiied/Met died/Method
,�,� � r;r ,� r. ml I?I C�l� +fir lJIV�J��Ia ra Supplemental Information
0 New construction : •ili • ddition/altenition /replacetnenl manse check all that apply (submit 2 sets of plans w /itans checked below):
❑ Demolition ❑ Service or feeder 400 amps or more CI nodding over three stories
,�, ❑O ther. Where the available fault carrot
7,�, t t f ci Martine b and I wags. is
C.w � e. ,m :r.4�n1� l ,��; ! ��li ��r' �� ' ;`,,`� - �' +>,�'��Esy.� "�U�ll :m exceed:. ❑ 1.7aahn): buildmgs.
o. - .n. ee ,. ,. a 3..t.. :1...:i,,wr less to ground, or exceeds 14.000 ❑ Commercial -usa
❑ 1 and 2 family dwelling ii Commercial/industrial Ac esso aci1CYlt
❑ ry buildin building amps 16r all oilier mnalal4itwns, buildings
❑ Multi - family ❑ Master builder ❑ Other. ❑ lire pump ❑ Instillation of 75 KVA or
r`' s �> r v i + J± ' y kF ❑ Emergency systems larger se
el�i. +.i r eal Sy s t c is r ' Fi ttra Wr' °011%."7A gc separately derived system
, Sn,t ,bdsc � �Nw�S,_ {r�!ivl�s�sr, t:c .mE�arl. ❑ Addition of new motor load of ❑ "A" "hi' "1 2", .. I -3" — Job no • ! ) C l 2- 3 Job site address: 16o37 54 Gt.,,,' '
100111. or more. Melva icy
/4 0 Six or more c rr4dCmial amts, ❑ Recreational vehicle putts
City /State/Z1P: 17, 4 OR '7 7 ' 2 I / ❑ H.:skirtare lscmhtus ❑ Supply voltage for more titan
❑ I bunions locations 600 volts nominal
Suite/bldg. /apt no.; Project name: Orr, . r J ❑ Service ur feeder MX/ amps or more.
Cross street/directions i : :.;Pe, a t�, t ,i + s' � ",°�, r
ns to jo site:
Dery aloe 14- ,cz tr;
® Talml
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: r I Lot no.: 1,000 sq. ft. or less 145,15 4
Tax map /parcel no.: Ea add 500 sq. ft. orponion 33.40 1
g iY ,, z• � Limited energy, residential
4i iii.1}I,a' ,i / 'c".'7�'1S,i> ilr.FY ,', a: 1,3,',:ti,.' a i;•4t,rlj�r .'1''i °I �: " ,?��� vr,, "r : j , 1 ii wllh above " ft 75.00 2
Xel ' l lt ' L _ . t7� �'Qr4/ �Q/ 4 ( �
Limited trt ( multi-family 75.0(1 2
t P r 1 residential (with above sq. R)
Services or feeders installation, alteration, and/a relocation
F _ r�r
200 amps or less 80.30
w.ew lNe.: ��'�,.e:��.,,: �, ?7�llmii ?r'�Tjf'1r+n N *Yr �"� r n f it �� 2
miwls�, ._..,c., .. :,.a :E£.t,...r,.; :,i,�f, h, u.,..: �a„ ,�k;'�. a :, 201 amps to 400 am 106.85 2
Name: 401 amps to 600 amps 160.60 2
Address:
— 601 arms to 1,000 amps 240.60 2
Over l ,000 amps or volts 454 65 2
(city /Statc/ZiP: Temporary services or feeders installation, alteration, and/or
I relocation
Phone: ( ) Fax; ( ) 200 amps or leas 66.85 I 1
Owner installation: This installation is being made on property that i own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Owner signature: Date:
circuits - new, alteration, or extension, per"anel
Date.
! {J�` n �� I IMF; 'y'!= r �-r{. rvl V-�ral p q - v ,, (,, y fe'J Y,( A. Fee for branch circuits with
RJ;r�„nl' ; • Y.4'� �'�1Yt z� tMr1,'M L1 �� \� F i I'.4µ1, .�.. �7't A t,�'�Y'ti' 'r'e y ( gym 1!
J,l1Rti ✓.+ M4i.. !!. :4. E 1rt.,., M►<�r•lxv,�i .»r. .•r'?+f,.)t:,.,. :';,yt,: above service or feeder fee, 6 - 2
Business name; Bergelectrle Corp. •
each branch circuit
r B Fee for branch circuits
Contact name: wilhuuf service or feeder fee, 46.85 2
first branch circuit
Address: 6026 NE 112th Ave _Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City /State/ZIP: Portland OR 97220 Each manufactured or modular
dwellm ' service and/or feeder 2
Phone: (503) 255 -1818 I Fax:: (503) 255 -1919
—
Reconnect only 66.85 2
E- ml.
, �l Pump or tnigation circle 53.40 2
. J l ndirin . 1 klir '::il m, '.i.�a li /C� 0 t ', tab tl 1 ;. i 1 41w! l m Zrr ew ,M�n , Nr 1 1 ` f .' ! , ..
�° � nLY.�. R y t y�'.w)�.Ct`,� ,�,;{�„+I...at:� �• +f �.ra.n���';4��1; Sign nr outline lighting 53.40 2
Business name: Bergelectrle Corp. Signal circuit(s) or limited
cony panel, alteration, or 4„- -7
2
Address: 6026 NE 112th Ave extension. Describe
Dam 1S
Page 2 I1er _
City/State/ZIP: Portland OR 97220 Each additional inspection over allowable in an of the above
Phone: (503) 255 1818 Per inspection 62.50
Fax: ( 255 - 1919 investigation per hour (Ito min) 62.50
CCB Lic.; 110521 I Electrical Lie.: 37 - 682C Suprv. Lie.; 51215 Industrial plant per hour { X 73.75 s
Cal
St1pTV. G at U r signature, required: / I t t Q • t • tO iii!.. ' ."7. • . • 6IMMM " =1AldlS.±0 ..�'."r'.�!5211- u ;�:r lA
,. I
l Subtotal: 72'
Print name: Jeremy Richmond llatc: ` 2,/ Plan review (2S "! of permit fee).
LLL... State surcharge(12 %of permitfee): i f
Authori'red signature: g q
_ TOTAL PERMIT FEE.
Print name: a B PS Dater. ��21 �p q Ma permit applkation expires if a permit Is Ivor obtained within 180
dap after It has been accepted as complete.
• Number of Inspcchons elk/wed per permit.
I 1au,ldiaglPerm m1F 1.C'- rmmnApp doe 05
440.46131 t r I ■as,cossynD
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Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
Pee 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*
❑ Vacuum Systems*
❑ Other:
TCO �, ;rQi:iaNLt ice:' •2`'',
Fec for sach commercial $75.00
system
(Sal, OAR 918 - 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
Data Telecommunication Installation
❑ Mire 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: 1
*No licenses are required. Licenses are required
for all other installations
•
IlluldinaermitMELC.4unnhApp.doc 03123mr