Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
lig s COMMUNITY DEVELOPMENT Permit #: ELR2012 -00236
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503 718.2439 Date Issued: 10/11/2012
Parcel: 2S112DC00701
Jurisdiction: Tigard
Site address: 15985 SW 72ND AVE
Project: 72nd Ave Salon Subdivision: FANNO CREEK ACRE TRACTS Lot: 39
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 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE. 503 - 621 -7122 PHONE:
FAX: 503 - 621 -7123
FEES
Description Date Amount
Specifics: Restricted Energy Permit 10/11/2012 $75 00
12% State Surcharge - Electrical 10/11/2012 $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 OA 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: bk1 A PAX A - r7O �1
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.
Oct 10 2012 2:59PM Bridgetown Electric 503 - 621 -7123 page 1
Ele .trical Permit Apnlication . , 1: , , , , , . : ,
City of Turd D919/0V: l D H l / rh1e.: Li • avt,o 3f.
N ri 13125 SW Flail Blvd. Tigard, OR pp a.
a >- Phone 503,639.4171 Fax: 503.598.1960 Datenv: other Perm =
Inspection Line: 503.639.4t75 Oar 1 0 2012 Date Ready/By: la See Page for
hltanel: 'www.tigard-or.gov L NoaR/M
edeihod: I'f s , , , . • Information
p
L� �1 } i'
r 1- �' , �Ux +,:twl>gigim hrr I rrr d J �r' i . n l . .. 1 ��F AC+r i . '4 b . ;r �a'� e a t u x..n. ` ' -, T :' ". { r:
��t Y der e F 2 .7: , 1 a y A D � � AJ' ?;T`C z ,, ,• "i i
� v , ' = � M '� . .i t t i 110 � ."'t4 G
S11eF 1 .,,K -, a t:w zc-i lw.Ll.rvv, ,, f 5.. .71 1 . `� Li , 11 J . r. '4 DW U Ei _ ; ,:.c.. ,.....Y J ..
❑ N- construction /_,, Additi ., • 1 � 1- r ' MOON Please caeca AA,that • , h.' - : feta ; • ;ns wfit -l ow )
❑ D8 1 111ti011 Other 0 8erviao or feeder' ! • amps or more n Butt • -., three steAee
where the avalaab fault current 11 Marinas and
C F t�,�ttFlAi f,f;.w & a E9. •. • ,•rt r. �1 �rpe+ i a l a ' '.;l •4 'y .. ry` : . - y ;: exceed, 10. 0 ' at 150 volts or 11 Flom
..:A aWrY
..rI ,::4,1.1..[ . i..L,'Jn. : :..ICS v...Ri.� L :.4,,a 1 .aX_. . . , Y( 1 'n„ "•"' -'. ;• I:iii V..Y- g
. • •
toss i>Dgtuun4 or " -• 14,000 II C,ommae ^- sgriaeWosl
❑ I - : • 2 family dwelling 1:1 Commercial/industrial ❑ Accessory building buildings.
❑ M family ❑ Master builder 0 Other: 0 Fire Pum . n Installation • 75 Kvn
..Eft E1'^F n i�}p 1 . Kr M 't.t 1 t, Y , WT 't ?� 1 1`?l! "J0Tti' :?tcj+; '�.4 a'.tf.}�F a t '._.k � jj. y , ' > 4:
Sf O Emergm ey sys , . l:s� -.,.. •- demad system.
• k lliPl ..Tr 1.lottl r 4 trrel . /u.v a....1i.kloIL.S,1Lea l. ate.' lit /• Ail.' Yl .'! t 1, 01('?•. s' 0 Addition of nova •••r load of 11 "A", "E", "1- ."t•3e,
100HP or wore. a cupan y.
Job no.. It - T j '�t, Job site address: iQFj�glr8 CAN 12.
• A Vt• OSlx ormna,emd -, antic. 11 Rooeemioeat R •topnb.
city
e/ZIP: I t comp V 6 1 J i.% Itmlte •earn facai n supply . ,. - mare ttm
Iiasardoas t • 600 volts • ' al.
Suite/b dg. /apt no.: l Project name: - 7Z �v� c5...t L� S ' a T v� « orfeedm amps or more t n
� ITI IrJi'01 ; 15 v ' ;111 l 1 t '' 1 , j`i 1�il,ORtr NV!1 p ",.:
Cross el t/direetioas to job site: ->C il •
New residential or multi- '1 gelling , ,1
lodades attach -.1) r e.
Subdi 1 : I Lot no.: 1.000 sq. ft or teas 168.54 4
Tax 1 : •parcel no.: Ea add'I 500 sq. ft, •• portion 33.92 1
,r}� I• LiimRnd energy, • - tial
1 7.r + ,��• V.t,11rr ,)ai5lwui f't4 y lc,� ,,�r� 7ti, aAWN" : - .1 �. ■ ..'E a ', 'i ,• Sr .1 'x 75.00 2
1Y ,'fh r [::,,71
,,
, R:'f iit, 1 _. S . ,V �S ..n...-t.. 7 ' ; ;81 !,, *' g 4. •41 f S thove9q, • .), Limited energy, m --family - fmnily 73.00 2
■ Vat (9 l. 413.. QyICtAiatfe 49A .0 �I�M.fAr[1� }Q residential (with, • • - sq. ft.) I
ServItesor -, =, Installation ,1 , nand/ , rckastion
'10 203 amps or less 106.70 , 2
L� �y V a4i C "M•aN ! 1 S � b J � 1 L `
11 . ,, - . iliva u ,'47'.,":1110t0 ... L "t, J . ?;u S.11 � a ' 4+ � ` :.w r ca � �� 201 amps w400 133.56 2
Nance: 401 saps to 600 200.34 .. 2
601 amps to 1,000 ' • , • = 301.04 2
Addre - : Over 1,000 amps o% 1 •: 552.26 2
City/ •:1 e(ZIP: Temporary . • or feeders lm I latiion, 1• tioo,nid/ar
relocation
Phone: ( )
I Fax: ( ) 200 amps err less 59.36 I
Own -• installation: This installation is being made on property that 1 own which is not 201 amps to 400 • , •. 12508 2
intend - . for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amp to 599 " • " 168.54 2
Branch alteration, extension , - Dana
O w n e r .i _ 1 ature: D a t e : A. F e e f o r b botch c • 'ts with
'1 ; " j�1!1!?}tP' .a, F'17•. ; { - y ! jZ "����1 Dli!)u�i��,}�'�t . , �. is t.v zr - r LIMN service l:yC above aervt fee,
4•Fi ?1 � �i a. I r- . 1., I 'I 6 ,giii' 1iii 17:4'1 tillI� G I 1 r l51 '�M * 7.42 2
.. 1�^reful,. M>vi v ase - L..c..me.nr .. i .k._ ea3.c i's.e�ei...aL�..:,o x .�. d.,e,l,•a•. each:branch ... • t ,
Bust i - name: B. Fee far branch -' with set
service orfeed r ee, first 56.18 2
C . name: branch ccruit
FJmdr aid'I bxe1och • . 7.42. 1 2
' • Miacellaeoas (= , or 'feeder n 1 , included)
Each Wi
City/S : teJZ1P: tred, ,, sneak: 2
tY dwcllinit, service • • • • feeder •
Phone: ( ) I Fax: : ( ) Reconnect only 67.84 I 2
Pump or irrigation ; , - 67.84 j 2
E-mail Si or outline 1' 67.64 I 2
aT-1, Ns P .PAI Cdr AN i.ki k z ..".. a.2? I'.S 16• ...Ib .M E r Signal one it(0) or I.' ,
Busk s name: " LC /1 Danel, alteratiott�or 1 • Facet 1 5 2
^�� ^�� E additional 1, . , a over a r • ble in of the above
•1
Ad : •. S70/ N • 4-06k6/142.0 �y S 7 AdMiaul • . 1(1himin) 66.25/
C i t y / S 1 W: ,A1jib OR M Z' 03 -1 j i 3 a 66.23/
badtrsuripl P (t" •• mid) 78.18/
Phones m a t ? 1 I ' j ' L I F a x : (5p3 ) 4i 1 7 i Z3 L l s p e c a e n s f o r ,• • • n o fee'is 1
'r � Mod ■ 1 - k Fir m
Cal L c.. 1u J B24 E that Ltc.: -] WO J SupN. Li 41776 "VCiii, �ti.111,1��.�1 . . • -' } , . . ..Y..' t.' .:..:.•11:.1L. N e� 9
Suprv. IN ectrician signature, req ' vvV 444/// /(�w^__, . Sato e:
) 111111 '
�fy �,�i reviews2554,of •,- Q.. �1 te)
Print - • :/ , -• �-1. Siff. isms /�Cf I Date: State • (I %or ,' -, " Ste): • ' i
Author d signature: TOTAL' ` 1. _,=E .,; ' tk• f^.'
i lids Permit . . e? it'� -; Iptisi wllk•180
Print name: I Date a alwb0 `,:: . °.roe -
' • Number of - 1:.. allowed per • , -, • ,.,: i
I
L'1BuYdtagkPaash i.C.- ve.nitAwdoo 07/01110 440-4611T(1 IM OM IEB
Oct 10 2012 2:59PM Bridgetown Electric 503 - 621 -7123 page 2
Electrical Permit Application - City of Tigard
Page $ - 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
El Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
El Other:
CQMMERC WO Q : e`: , , ,
Fee for each commercial $75.00
system....
(SEE, OAR 918 - 309 -0000)
Check Type of Work Involved:
El Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
X Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
El Instrumentation
❑ Intercom and Paging Systems
El 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
\Building PermitApy.doc 07/01IIO