Permit •
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
,
I: COMMUNITY DEVELOPMENT Permit #: ELR2012 -00239
TIGARLD, 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/17/2012
Parcel: 2S 112DC00500
Jurisdiction: Tigard
Site address: 15895 SW 72ND AVE 120
Project: Watson Chiropractic Subdivision: FANNO CREEK ACRE TRACTS Lot: 40
Project Description: (1) low voltage for Data/Telecommunications for TI
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 10/17/2012 $75.00
12% State Surcharge - Electrical 10/17/2012 $9.00
Type of Use: CMS
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 503 232.1987 or f / 1.8000.332.2344. 7
Issued By: 'Y C Permittee Signature: OM 4 IPL I &4 1 , / QM
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 16 2012 9:54RM Bridgetown Electric 503 - 621 -7123 page 1
Electrical Permit ADplica ' ECEIVED , • f: (f ., ; . . ,: ; ,
City of ligarcl r I0 /7 /1. Se' I ,e�,nrtrm. :'ELI 7O) 00 -39
13125 SW Hall Blvd., Tigard, OR 976thT 1 6 2012 Plan Review �'
. - kr Phone: 503.639.4171 Fax: 503.598.1960 DeteB Mee er Penult , 10,020 I �. • 00/ 73
; , . • inspection lane: 503.639:4175 up( /1[ T ` , . Date Ready/By: • IIll SSe. • .. 2 ter
Internet: www.tigard. or.gov OF NNotified/Method: l 1 Cev on
. "
SY 14 K ,p, .; ra' ,• ae n7 k r m� �a ru , t
WIC �
•1 ' el :.�ttla.i... :d.4�'o ?'�Le �Ykci��- �. . `. a� X1�"lj ".'�I:t. ! ..,' 'kL�icSi.�k9�..,..isSe'�.rT ff! 1 ', ,.e.b :. n --' ' i 1 tl e_. [ n.. : •i ° � ����
. J 6
❑ New construction ►a Addition/alteration/replacement Please clear en. ; •.. t ' Iy ( • ,,, 'sea,- . wrilao: -, = . , ):
❑ Demolition ❑ Other: 0 Service or feeder 11 .. ` °` Cisco ri itildin9. ih`~ °O°0°
where die avails!: Scutt current ❑ Marinas and .. atyarda.
r' 1 f• ���/ ":"ss1FP72?" rkwem qt- ee H i4f har{+ if;i .. :',; I
4 :� r
1 . ;!i e "`.!'[ r h ,a`1!� �. J t �}. 1. , !!U :L' volts Komi*
i 3 p c 5( L th Y i �' 4 i f ®CCeede iD, at ISO 0! • \w•."
, i" t '1 CLI l.l;S .. .ud r fad.: rl4, �t,J.c :r,n+4:!zi.tr'�. :'t ;7 :.i'I Ytr' IPk�.4i .Ag' „�• ".:" pm a
13 1 - and 2- family dwelling ► . Commercial mdustnal ❑ Accessory building s ip LOar .n • . ug. O com t agricultural
for alt . .. : fl
oru. W114114;1.
❑ Multi -fail ❑ Master builder ❑ Other. D Fire pump. Omsostmdon of 75 KVA or
% 7 °, 1PRY. i �i ri W.r. .77WirT , *Rl� � iH•i a �f ', ' _
• ' h t 1 l . Uay 3 �" aa' .. e . r ;, ,p D i9 r "A", ". d) 3 system
,. t � i 4 .t, 1 - � 1 e r �i � . .I: f �+ L .r3
�f' t• , y a .,r - yK :f�, Se# l- I O »A »,'�", °I »' »13,'
'' � �,.,.� I..,t�„�:r °r vd. , e., ,,ta..,,..l � au(f°Lt;,u.�:. dxr T• . -le.i. y D/lddlttef10f00W ••!toad Of
Job no.: �1.. I 5 tJ Job site address: t 5 ti c e i viki • bkve., ooeapanoy.
D Sur ar mac real • . , wets. Recreations! le padre.
City /State/ZIP: �� ❑ Heahh oar re foci • I -s. O Supply v more than
rat . a
❑ Itazardoea locaho 600 volts
Suite/bldgJapt. n•1 ■ 1 ., 0 I Project name: N ' .. f1, ,„ DSmweeorfeeder ..amps or moss.
Obi `��""`"""" y - e�rrn (�C •: i }� Yrtsa ;��@
t . XRIM.�, .'!6u LLSP 1 , F 1 ( f ;va i i�"it`i1K:JSPA�� 1 •• fit',
Cross street/direct . Y to job '•te:
, II�iB1sZ •
New reeidendal _7a or nnlu-'fiisiiiq'dwediag ,, L
Includes attar , - ' r. rage.
Subdivision: I Lot no.: 1.000sq, ft. or lens I : 168.54 4
Tax map/parcel no.:
P.a. edda1500 sq. ft portion 33:92 1
i � l Limited energy, • oriel
1 75.00 2
S lct`" 9 `:`Iw r.rnc, .i c , .7.1 . prt Uy` l
7 l' a t,, v
a i F i h 'ti .(�, r,���� .i M1 . 1 t "h 1 f ; ' i' ' 7 f � i ei ■ �� �W111! aylvr0 SQ. i �, •
Lax/ la9LYAU iZ' /1 i'L w,. 0 i2. , 14r,>Wi : .si 6r. J..{.rLLawi i. 1 L residential
S� _ 1 Limited ,mu'•�•ly,
�4W \ICAa.�p ukth p IM.. Otikt A Au tltA 71 '(wath I • • 'e sq. ft.)
7S.OD 2
O Services or ' ; iscsfdlatIon, alteration, reiocadon
h 200 amps or less I, 100.70 2
.`• : ( �� .
'
. �' ��7b�s�e I xi,sp.$v:ls�•u j
uz�t�ket•:j .,� t a- i } r• j�•;em r..,�, � '. .
ti '.tit•'4> Y+:l.;�f.�eha - r . ( 1 +1 1 y ,..- i I.,i0 . . :r to 400
; . < Y. a� 'yf�.�r�aii�Se.� :�.i..v 1 +''`� - : � �; �, . " " "�r's 201 sal t� �� •. 13336 2
Name: 401 amps to 600 200.34 2
1601 amps to 1 U00 I, 301.04 2
Address: Over 1,000 amps or • •: - 552:26 2
City/State/ZIP: Temporary ; I I or feeders instapwdo/ ;'ai don, and/or
relocation,
Phone:'( ) I Fax: ( ) 200 amps or less I 59.36 1
Owtser Installation: This installation is being made on property that 1 own which is not 201 ampsto400. .1 125.08 2
intended for sale, lease, rent; or exchange, according to ORS 447, 449, 670, and 701. 401 pb 599 " '' : 168.54 2
Brands eireldti.� -; , alteration. eirernotdon, .1mnd .
Owner signature: Date: A. Foeilir branch - a with
� ,. i . l , i it'n d r j , -,:' i3 I II Wir� ^ M "An?., v�� y" at1W'e9elVieD 0! -, fCe,
i r:
: '{ th .: E� �a: l., r. �, a ii . .. h ... ,au i m4::t_.» _v «? ,, ,. �, 1 e sh llranCtl t 7.42 2
Busiae$S name: ti. For for tttaa� w�o
service or feeder I ,. ; first 56.18 2
Contact name: branch cireitit
Each trip brancb it 7.42 . 2
Address: Miscellaneous (. -or feeder not.incladed)
City /Stede/LIP: Each manufactured i' mo 67.84 2
dwd1ie esrvice •, feeder
Phone: ( ) I Fax:: ( ) Reconnect only I 67.84 • 2
E-mail: Pump or litigation . le 67.84 2
�1 :�,�'. '! t "I 3 tphlr���pAr�r,l� ... 1 , 5 aw R �i l&y° Sign oroutlineH ; .g ' 67.84 2 • �fP i .�r•,. S t g nal amigo) or -1 G
Business name: � �,1Qc � . panel, alteration, or l `sion. 1 Pelpe2 ` " J. , 2
#'� , s."' E,tr, s P. r` Each . addidoa01. ; • V ' n over allowable in any die above
Address: £ 7 01 N . L O n� g /) S 7 12Gb Additional , -. , : (1 hr min) 6625/ hr
City/Stdte/z1P• t3 � � Ali investigation (I hr. ,' o) (6.25/hr
' . :. D Z' 3 t 3 Industrial plant (I , , ' in) . 78. i g/ br l
Phone: ( ) . 7 i n . . Fax: ( ) Inspections four vita roar fen is ,
I o 1 �' h i !� htroai �aa n 90 Wilt
CCB Li rr to , , , �r, yy pp,���
103� 8 1 Lir : � r/ I Suprv. I.iic.: N 17 7 b + t i t.. �k ¢� iii . i( i J .. ,:s niiiiii'
Suprv. irlectrician signature, '4r c' ell �� . ,Sttbtoed : • 5 ' ■ d` Plan 'eW(25$Op:emitfee)::
Print name:, ))GEC,, S?e 0- l. I Date: State. , , . • - (12Si of erlitit -, • n
TQT t' ;r :. - • i 4,1.,.....' .
Authorized signature: Tom. malttk worm: if's P,iri0d�t:p4e whhl#via
Print name: I Date: � a . , at its itee ce . " - •
• Number ef ;.... . a16A:id ol*l i.
I :1BuildisePormits∎E C•PmradApp,dca 07/01110 440.4615TO1 I5/COAUWm
- I I.
Oct 16 2012 9:54AM 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 Wotk Involved:
❑ Audio and Stereo Systems*
I'.
❑ Burglar Alarm
❑- Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ • Other:
Fee for each commercial $75.00
system
(SEE OAR 918-309-0000)
Check Type of Work Involved: •
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
Data Telecommunication Installation
•
❑ :Fire Alarm Installation
❑ HVAC
❑ • Instrumentation
•
❑ Intercom and Paging Systems •
•
❑ Landscape Irrigation Control*
❑ : Medical
❑ Nurse Calls
❑ 'Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other �I
•
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
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