Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
s COMMUNITY DEVELOPMENT Permit#: ELR2013-00013
Date Issued: 01/22/2013
TIGARD 13125 SW Hall Blvd,Tigard OR 97223 503 718.2439 Parcel: 2S102AA03000
Jurisdiction: Tigard
Site address: 8740 SW SCOFFINS ST
Project: Co.Sales Northwest Subdivision: TIGARD HIGHWAY TRACTS Lot: 24
Project Description: (1)low voltage for Data Telecommunictions
Contractor: BRIDGETOWN ELECTRIC Owner: FAWN COURT PROPERTIES LLC
5701 N LOMBARD ST 17237 KELOK RD
PORTLAND,OR 97203-4113 LAKE OSWEGO, OR 97034
PHONE: 503-621-7122 PHONE
FAX• 503-621-7123
FEES
Description Date Amount
Specifics: Restricted Energy Permit 01/22/2013 $75.00
12%State Surcharge-Electrical 01/22/2013 $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 2-001- ))))090 You maaJj obtain a copy of the rules or direct questions to OUNC by calling 503 232 1987 or 1 800 332.2344
44 `�' I
Issued By: l.(/IX Q eel Permittee Signature: �� " 'P l T 1 f V N
OWNER INSTALLATION ONLY 8
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.
Jan 18 2013 10: 42AM Bridgetown Electric 503-621 -7123 page 1
Electrical Permit Application City of Tigatrd RECE1VE
bete/By: ( (3 Si z� a:got rxx�L3
iii
13125 SW Hell Blvd.,Tigard,OR Plan Review
Phone: 503.639.4171 Fax: 503.598,1960 ? pacefied OIhWPsrnet:
6apection Line: 503.639.4175 IAN 2 2 2 01. pate�edrBr:
Internet www.tigsrd-or.gov NotiBa hod ( Supplemental Informatics
i , r'0� � �. '1 l roc d ,!" chi fl iff � P-r S F� a rr
Fr.'yn �a VrSt 't ° ' - ' _ ".q:td K 1 � ��y!
df'Ji;
`. c .r. ` .S l�� ter& ....ad,:.! , I.. •. .:1!ei. R1 i � 4 4to.% ._. '. ..
❑New construction ilr, Addition/alteration/replacement Please eleek all that •• ( ailta[plars writerns checked below):
❑Suva)*or Soda .1 sops or sae G Building over throe stories.
❑Demolition ❑Other: where the evade fault wow 0 Marinas and boatyards.
:.; er revs ta��7i
.;171. `"" f .a t' '`r^k ',:, „ nn;• exceeds 10,000 amps at 150 volts or ❑Floating baildinga
.rwr3c __._,i u,.xe.r:x,. _�r�[ w' i, less to pound,or poeeds 14.000 ❑Commercial-ase agricultural
❑ 1-and 2-family dwelling al Commercial/industrial ❑Accessory building amps for all other Wiaillariees. belle-ass.
❑Multi family ❑Master builder ❑Other: ❑Fire pump. ❑installation of 75 KVA or
�'` 1 , poruarases rc sti xaarapp.. '• , 11,s'”ek,, ,..'.t crS(ixq 's •r ❑Emergency systatg larpr separately derived system.
:' yttd• L.e.«E:+ .'o�p..i,it.sw,... ru4o.....is,, . ,, ut.c,i.°"l.a�l.4all±�,, ,-,4 &;:E ❑Addition of new n�otar load of ❑A'. t?","1-2-."1-.3",
• ��0 I00141Pormoru. euW •Y.
Job no.: t? _o fj Job site address: S 1 St.(4,%s 5 5
[]Six or more reeide0tial snits. ❑lteaaanoral settle parks.
City/State/"Lip: r 0 R -'' ? ❑Health-awe iwtlges. ❑supply voltage for more than
T��./sj ❑Hazardous tocaeapa 600 volts aominal.
Suiteibldg./apt.no.: Project name' Co • 5aJeS NorfAve5i ❑Service or feeder fjpo amps orm°m
\ 1in lIt tl • Y : Y jrr h: ir
ra/jtGi�S
r
Cross street/directions to job site: Taal •
New residential slPgle-or malttfasily dweHiag..it
[.eludes attached pa rage,
Subdivision: f 1.ot no.: I,000aq.ft.or leas 168.54 4
Ea.add'l S00 sq.ft. portion 33.92 I 1
Tax map/parcel no.: Limited energy,r .
p�! { xxe �r.s��ssw >pluR� 'q��. 'ge Fit M I7S , : 75.00 2
,." ' a. •""4- ?, , i t. r ,> ,...;,,..1.,,.....4..,',.,!...;:l,,,0 (ttrldt above sales -
,:,•ww, n,�r..:..$.::iaduL ar.sfu ul:�v.t+....�z.._�;,
Limited energy,mu family 75.00 2
residential(with above sq.d•)
Services or feed inatalbtioaialteratios,and/or relocation
200 amps or lees 100.70 2
,x -/,'xJtU-+ 7 oat .N ylg,alp:
" r ! sw1 8 ?1t rte' 1 201 amps to 400 t 33.56 _2
ae►'�.ari•uQai ai115AO S mail >iin,,.!cl,Ae,I,:iL( ' x
Name: 401 amps to 600 200.34 2
601 amps to 1,000 301.04 2
Address: Over 1,000 amps or ts 552.26 2
City/State/ZIP:/SlatelZIP: Temporary sere or feeders lasttallafios,alteratt..,sad/or 1
n' relocation
,
Phone:( ) —1 Fax:( ) 200 amps or tae 59.36 1
201+naps to 400
l Owner installation:This installation is being made on property that I own which is not 401 125.08 2
1 intended for sale, lease,rent,or exchange,according to ORS 447,449,670,and 701. - _ 168.54 2
Branch circuits Owner signature: Date: A.Fee for branch ' •ts with icon,tar extension,kw
DWI
¢rteR Z.:: ¢ r w art e'je ! -u I �' 'tl above service or r fee,
W' .:1', ,tdit , err 113 r rd;(=w.+.arv.a.... .. ,iii each breach c 7.42 2
Business name: B.Fee for branch cl is wirkad
service or feeder ,first 56.18 2
Contact name: branch circuit
Each add'l branch ci uit 7 42 _ 2
Address: Miseeltaaeoua( or feeder not included) _
Each msnufoctaued toothier '
CitylStatc/Z[P: 1 dwelling,service feeder 6714
Phone:( ) 1 Fax: :( ) Reconnect only 67.84 ' 2
Pump or irripsion -- 67.84 . 2
E-mail:
Signor outline legit 67.84 2
•'r4liy,. ..
n 3 iY � 1 •Signal •circutt(s)or I ,ice t-energy
Business name: '� s •� panel,alteration,or 'on. , 1 Pate 2 _ -7 S,00 2
Eael addtttonal I . lion over allowable let Day of Ike above
Address: S 701 N , `o r r k t 4420 s / r e G�� Additional• ...•;,.:(1 br min) 66.25/hr
City/State/ZIP: ''PORTLAN31> OR 12 0,3—tot 3 Investigation(1 hr ,) 66.25/hr
Industrial plant(I hr •' ) ' 711.18/hr
Phone:(',io3 >km .712 2. Far:(50$ )tee 7123 hapeedam for tro sec is 4P 001 hr
CCB Lie.: 103 824 I Electrical Lie.: ..s$iG 1 Suprv.Liu.: LI II 77 g `,±;, .. `is! . " ,t 1;( t
Suprv.Electrician signature,requited"'-- 'u� -�/ is-view Subtotal: I aJ
Plan review(25%of permit fee):
Print naune:,.i'pe-A, .5-fie. i./ c Y Date: State suritsarp([276 of permit fee): R .0✓
J TOTAL PEiMrf FEE: 1 g 41. Op
Authorized signature: Trio penult applca4lea expires ifa.yasq1F,�, .Neinta a awithin 110 days ether it ha Iran sampl iM-'U-
Printname: Date: • Number of Inspections allowed per prtsit.
1.1BuilduigiPemtitsNELC-PermatApp dm 07/01/10 44044101(1 I/O/COAYWEa
•
Jan 18 2013 10: 42AM Bridgetown Electric 503-621-7123 page 2
Electrical Permit Application - City of Tigard
Page 2-Supplemental Information
LIMITED ENERGY PERMIT FEES:
E0004114 ±O006. ., ..t, 1.,
• Fee for Al 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;
CQMMERgettiL►WOR&;OlC;.,.;.
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
Z1Data Telecommunication Installation
❑ Fire Alarm Installation
•
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ N• urse Calls
❑ O• utdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems: —
*No licenses are requited. Licenses are required
for all other installations
I.vuiwuogllocrmartsic-rusniupp.eoc 07101/10