Permit v n CITY OF TIG ARD ELECTRICAL RESTRICTED ENERGY PERMIT
i • COMMUNITY DEVELOPMENT Permit #: ELR2012 -00274
T i G ARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/10/2012
Parcel: 1 S 135BD01100
Jurisdiction: Tigard
Site address: 9780 SW SHADY LN 210
Project: Klupenger Lumber Subdivision: MEADOW VIEW Lot: 8
Project Description: (1) low voltage for Data Telecommunications prewire from demark to tenant space
Contractor: BRIDGETOWN ELECTRIC Owner: SHADY LANE COMMERCIAL BUILDING
5701 N LOMBARD ST LIMITED PARTNERSHIP
PORTLAND, OR 97203 -4113 7720 SW WESTGATE
PORTLAND, OR 97225
PHONE: 503 - 621 -7122 PHONE:
FAX: 503 - 621 -7123
'FEES
Description Date Amount
Specifics: Restricted Energy Permit 12/10/2012 $75.00
12% State Surcharge - Electrical 12/10/2012 $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 503.232.1987 or 1.800.332.2344. , I
Issued By: n .f W t-(1± Permittee Signature: ON APPL/ E/4 7 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.
Dec 07 2012 12: 17PM Bridgetown Electric 5 0 3 - 6 2 1 - 7 1 2 3 page 1
. „ . . .. . — ,
Electrical Permit Application RECEIVE p , . : .: , :, ;: , , ,-. ,
City of Tigard
II
13125 SW Hall Blvd., Tigard. OR 97223 •
DEC 1 0 2012 DatedBy: / .0-7 ill .P No.: / a - ">1 ermit EftiZ ,zDia - Car.
)9-
Phone: 503.639A171 Fax 503.598.1960 oF-nGARD D
7 R e ' i '' e -1 '-
: 503.639.4175
Internet www.tigard-or.gov Dab Ready/By:
BUILDtNG DIVISION N cthod: TI Other Permit:
Inspection Line
: 503.63P.4175 ieriL 6 I II See Poem 3 far
Supplements! Information
; , '''' ,' :AP illa7 _it:41;1..4'6:4
0 New construction El Additicm/altemtion/replacement Phase check all that !. • (aubrdt a heti of *MOM= eherked below):
0 Service or feeder • 1. amps or More 0 Building overthreu stories.
0 Demolition 0 Other: . where the availabl . fault eurrem 0 Marinas and boatyards.
-11 :, rt,,,,, r- 5iI. ■ ^ lagt,",,,,,,p,,u,4,44,,,,y.k.... . , -, • - , — ' -4 .. ,:'-% -AV: , ..i; , ,:,.,;"}::Ili.i 0,,Y,,,,;71,...: CX.Ceed9 10.000 , ,. at lso volts or - 0 Floatios buildings-
if;1 v4waiLyraMikitOWNWRII'4',.: '.e,,.,',.',',7::1,.;.'114N,',10-: less to ground, or • • • . • • 14,000 0 Commereinl-uso agricultural
0 1 - and 2-family dwelling til Commencialrmchistrial 0 Accessory building amps far aft other • nallations. headings.
0 Multi-family 0 Master builder : 0 Other: CI Fir pimp. 0 Installed= of 75 KVA or
■)14 0 El nergency. ...... . larger separately derived system
iiif:',;1X,tillia.;:r.'71 . r! '..' .P 0 Addition anew - .. load of 0 "A", "E", "1-2", " I-3",
zon V J.kt... ,fi ,....t.1 .
100HP or more. occupancy.
Job no.: tit 151 Job site address: 1 60 s y4 es‘,„4, 6,
0 Six or more reside 0 'al wits. 13 Recreational vehicle parks.
City/State/ZIP: -1"-• by pr i st inct, ell 2.1 , 1:1Hcallb WI . ... 0 Supply voltage fin more than
r 0 liamrdenst• • •• • ..,. 600 volts nominal.
Suite/bIdg./apt. no.: il,,k () I Project name: k6pem LANwAti.or- EI Service or fbeder •''s • ,..- or more.
l' :::;..:, l iA
Cross street/directions to job site: Doontadon - : ObL. , rim Tvi0 •
New retddentliall ,.: e - or munt.fantIly dwelling unit.
Includes attached
Subdivision: [ Lot no.: 1,000 sq. fl. or len 168.54 4
Bo. BM' 500 sq. ft. • r portion 33.92 I
Tax map/parcel no.: .
. Limited energy, rta • - tial 75.00 2
vGair&PW2R1r,f1040P00700000ft#01CAVAlgo%gFg* (with above at " . )
Limited energy, mu . tinnily
75.00 2
LOW NItA,Alitit,.. t.W4' i.Asv,. \,_. ( A.b residential (with I. . SQ. ft.)
Services or feede . installation, alteration, and/or relocation
200 amps or less I ,
i ' 100,70 2
Pt - .
•?: 201 am" 10400 am P. 133.56 2
401 amps to 600 am •, 200.34 2
Name:
601 amps to 1,000 ; ps 301.04 2
Address: Over 1.000 amps or , olts 552.26 2
l'emporary servic or feeders Installation, alteration, and/or
City/State/ZIP: relocation
Phone: ( ) I Fax: ( : ) 200 amps or less 59.36 1
201 amps to 400 am , 125.08 2
Owner installation: This installation Is being made on Property that I own which is not .
401 amps to 599 .. .
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 168.54 2
Branch draftee- . , alteration, or ascension, per panel
Owner signature: I _Date: A. Fee for branch - .- ', wish
1 11) NV -,; 0 1 4 Z .,`;" if ;':' ' above service or - dor fee,
742 2
each brmich circ t ,
Business name: B. Fee for branch ••• '- its without -
service or feeder ; „ first
56.18 2
Contact name: branch circuit
- , Each addlbranch ci - "t 7.42 2
Address: Miscellaneous (se : or Ikeda not included)
Each manutboured .. modular
City/State/ZIP: dwelling. service : .. or feeder 67.84 2
Phone: ( ) I Fax: : ( ) Reconnect only 67.84 2
Pump or in 'gallon c • le 67.84 2
E-mail:
. Sign or outline 67.84 2
Y'lAt1fVtUaffaittOitii4iftWOMVIA,4::SIFiA!)1:(i.ig:; s ignal c i r „,i t oo or II „led.at
Business name: I a saRi c panel, &canon. or - ..- on. _ I Page 2 16. 2
Each additional I ,. pection over allowable in any of the above
Address: S 7O Aj , 1...0 61+00 g recer Additional inspectio ,, (I Iff min) 66.25/ hr
investigation (1 hr • ' ,) 66.25/ hr
City/Statc/ZIP: 20M1.,,hda, OR q12 0 .-Lti i 3
Industrial plant (1 hr • n) 7&18/hr
Phone: (c)(4 lid, I - 7 17 2_ Fax: ( SO4 ) 42.1 1123 Inspections for wb' , no fee is
MOO/ hr
. • --'18 - listed i min
CCB Lic.: )03 $31-4 Ellectrical Lic.: - .... 90W, 1 Suprv. Lic.: ti I 7 7
subtotal: -I 4 , ab
Suprv. Electrician signature, reqUiftd' :4C--"C„..kir.-e_e■-,...s0-4....e..../ Plan Jew (25% of permit fee):
Print name:, 4. Sip Ass /../ei Date: - State .•• , . le (12% of permit fee): 4 ,O
TOTAL PERMIT FEE: go4 . to
Authorized signature:
TIM permit applies , on expires ifs permit la not obtained widths ISO
days a , . It his been accepted as complete.
Pdnt name: Date: * Number of inspect' , ,. snowed per permit.
takateineermitsVILC-PamitAppdoe ormino 440
1 .
Dec 07 2012 12:17PM 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 Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage .Door Opener*
❑ Heating, Ventilation and Air Conditioning Sysrern*
❑ Vacuum Systems*
❑ Other:
Fee for each commercial $75.00
system
(SET OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
El Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting* •
❑ Protective Signaling
❑ Other '
Total number of commercial systems: _
*No licenses are required. Licenses are requited
for all other installadons
L\ BuildinglPermitslnLC- PermitApp.doc QN011io