Permit n CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
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COMMUNITY DEVELOPMENT Permit #: ELR2012 00276
T E G ARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/17/2012
Parcel: 2S112DD01600
Jurisdiction: Tigard
Site address: 15575 SW SEQUOIA PKWY 130
Project: MCDC - Comcast Subdivision: PACIFIC CORPORATE CENTER Lot: 4
Project Description: (1) low voltage for prewire from demark to tenant space
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 12/17/2012 $75.00
12% State Surcharge - Electrical 12/17/2012 $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 O Alic
OAR 952 -
952-001- 090. You may obtain
a coy of the rules or direct questions to OUNC by calling 503.232.19887 or 1.800.332.2344.
Issue d By: l�t dA Permi ttee Signature: al 4PPU C ft rI04.1
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.
Dec 14 2012 2:16PM Bridgetown Electric 503-821-7123 page 1
Electrical Permit Application EIVE i _ .
Sli
City of Tigard t r7 l3 Pl G , �O /� �)OaL7
13125 SW Ha1I Blvd., Tigard, OR 97223 DE C 1 2011 Plan Review
Phone: 503.639.4171 Fax: 503.598.7960 pm�g
Other Permit:
Inspection Line. 503,639.4175
CITY Date Rwdy/8y: r, — �, -i 6, ® Sec Pap 2 for
Internet: www.tlgafd- or.gov �1 �� Notified/Method: 1 r C 3•pRlslnwhllatoraia8on
)'f;i i i �: -era �� ,E 98,i8, rF L : :kS'- 1 . �. ; •Y^ ,,y4.
, - 5 1 44;:�.�,' -' a' 'pip { ' ' gy m. - a .. la.f ox ' mtrrt; .. 5 M4: ' C
- t <-1 '' •
,. :,, o - � T :..to ,.� , [ -
❑ New construction / ;` Add ition/alteration/replacement Please cheek all tint apply( IMO p1 M t.ebeeked below):
❑ Service or feeder 400 amps at more ❑ Building over three stories.
CI Demolition ❑ Other: where the available' fault caveat ❑ Marinas and boatyards.
I ` { b n . :
I 1 1 1 Iii :: l i I i f l�: a g I - y ,„} , c e r l t t � i { � � e ,, < 0 i V ' ` j , Xi 'l exceeds 10,000 M at 150 volts or 0 Pleating buildings
i 3�P 1 . 4 1 _ � ..39AIrdf^a!•;df, , 4 f 1 . 1
❑ 1- and 2- family dwelling ► + Commercial/industrial ❑ Accessory B less to ground. or *weeds 14,000 0 Commercial - uso agricultural
Accso building for all other installations. buildings.
❑ Multi family ❑ Master builder ❑ Other ❑ Fire pump. ❑ Installation of 75 KVA or
�$ * n eF l 7,+Nre . '3 - d w ❑ Emergency syatom larger separately desived system.
I t1u c e l t g t a „ „ c t 1 r , t
r. �w'.:L . �+f.s. - _... . ., o ",: .,, .:.,� ,., „� . , . , .c #�. s. .. - m ❑ Addition of new molar laud of ❑ `A” "E ", «1 _2
Job no. :'2 -,t Job site address: 15515 sW csccombi,e(Nwy 100111' ormore. aoc
❑ Six or more rosidential units. ❑ Recreational vehicle parka
CityiStatc/ZIP: t 610,4 t qi 22 ❑ Health - care facilities. ❑ Supply voltage for more than
❑ Hazardous locations 600 volts nominal
Suite/bldg. /apt. no.: il I Project name: MCPC - ei ,,,,,,,, va . ❑ Service or feeder 600 amps or more
Cross street/directions to job site: aarrri C..
siH.e ,,
try,, Y tt••a
New residential stogie, or matt[- faatlly dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1 sq, ft. or less . 168.54 ` 4
Ett add'1 sq. ft. or portion 33.92 1
Tax map/parcel no.:
A , f �/� L } Limited energy, resioentiel � .00 2
M
:#-%;1114,,t1,1, M.' .t : fix it . ",. R18�'W� 11 `. 71.7 . j4'l, g'M (with
*3,, wuYl .ny _ , ,- i ,. d 7 � - Yx :, avi - .k •, .. � h Fi,,PEA, 3. ?.e '.1 � ., ,t.]'S4��,� : \ w'1it1a Ye sq.
� ` � i c Limited energy. mufti-Wilily 2
l-4w Vet till. M , dl L residential (with above sq. it) - -
till. or feeders installation alteration, and/or relocation
A t_L_ 200 amps or less 100.70 2
JA;!` g 4 ... 714 ' : morilitim ' ' ;; l alt 1,k l>'Ag 201 ampsto400am 133.56 2
401 amps to 600 am 200.34 2
Name:
601 amps to 1,000 301.04 2
Address: Over 1,000 amps or ors 552.26 2
CitylState/LiP: 'Temporary servic or feeders Installation, alteration, and/or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 ampato 400 am. s 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 temps to 599 • 168, 54 2
Branch circuits - taw, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch cir uits with
fi "'.rti. ,R11
lib u; I' ' . ... ' ` tic
', .41 A .,4,1's....-77 '' . $ fi i
, i above service t der fee. 7.42 2
each branch siretC n t
Business name: 13. Fee for branch ci uits without
service or feeder , first
Contact name: branch circuit 5 2
Each add'I branch ci nit 7 42 2
Address: Mlseelinoeous (• cc or feeder not Included)
Each manufactured . modular
City /State/ZIP: dwelling, service an. or feeder 67.84 2
Phone: ( ) I Fax: : ( ) Reconnect only 67.84 2
E-mail: Pump or irrigation ci to 67.84 2
;- �`% rz. 'a ,r ,5 r' l r � ' Sign or outline light g 67.84 2
. H:, 4 :'. i,k ,1;,, , ,,,, ..; t�,: , .h ' ,K a : r e t try signal cirClAit(s) or Iii ited- energy
Business name: ' 3RtO N. �E. r panel, alteration, or oaten. 1 Page 2 �. 2
0 Each additional in ' portion over allowable in any of the above
Address: 7 Q ! N , L r / �� S ( r � t rt:� / Additional inspectio ' (1 hr min) j 66.25/ hr
City /State/ZIP: ?OMANI> OR co 21>3 13 Investigation (1 hr n) 66.251 hr
Industrial plant (l hr in) 78.18/hr
Phone: (So; )i 1 _ 7122. I Fax: (5o4 ) 62,+ 112.3 inspections for whit no five is 90.00/ hr
apectl (ys hr min)
CCB Lic.: 103 ®2r 4. Electrical Lie.: ' . scr' i Suprv Lic ti i 7 I l _ ! ; 2 t t- utl . ' ,� + s , �1
��- Subtotal: ' , �
Suprv. Electrician signature, required- 'C.i e „ �,„ Plan iew (25% of permit fee):
Print name :4, ' . 5 ''e' ,F7,5 /, Date: Stale s . arge (12% of permit Ace): q
Authorized signature: TOTAL PERMIT FEE: 84 , av
This pennH applies on expires if a permit is not obtained within ISO
days e . r it has been ■ccepted as complete.
Print name: Date: • Number of inspections allowed per permit.
111hiadisg\Permitsl LC- PermitApp.doe 07teln0 440.461 f(11/05/COM/WE8
Dec 14 2012 2:16PM Bridgetown Electric 503-621-7123 page 2
Electrical Permit Application - City of Tigard
Page 2 Supplemental Information
LIMITED ENERGY PERMIT FEES:
.410100.4.
Fee for all residential systems combined $75.00
Check Type of Work Involved
El Audio and Stereo Systems*
0 Burglar Alarm
El Garage Door Opener*
El Heating, Ventilation and Air Conditioning System*
I:: Vacuum Systems*
El Other:
-COMPORS
Fee fox sich commercial $75.00
system
(SEE OAR 918-309-0000)
Check Type of Work Involved:
El Audio and Stereo Systems
0 Boiler Controls
El Clock Systems
r igl Data Telecommunication Installation
0 Fire Alarm Installation
fl HVAC
El Instrumentation
El Intercom and Paging Systems
0 Landscape Irrigation Control*
El Medical
El Nurse Calls
0 Outdoor Landscape Lighting*
El Protective Signaling
El Other , •
Total number of commercial systems:
•No licenses are required. Licenses are required
for all other installations
1:1BuikliaitParmitAELC-ParmitAmdoc 07/01110