Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
3 , COMMUNITY DEVELOPMENT Permit #: ELR2013 -00048
Date Issued: 03/11/2013
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718 2439 Parcel: 2S101AC01600
Jurisdiction: TIGARD
Site address: 7000 SW HAMPTON ST 216
Project: Empire Marketing Subdivision: BEVELAND NO 2 Lot: 18 -19, P
Project Description: (1) low voltage pre -wire from demark to TI for Comcast cable
Contractor: BRIDGETOWN ELECTRIC Owner: NEIMEYER, JOHN
5701 N LOMBARD ST 15 82ND DR STE 210
PORTLAND, OR 97203 -4113 GLADSTONE, OR 97027
PHONE: 503 - 621 -7122 PHONE
FAX* 503 - 621 -7123
FEES
Description Date Amount
Specifics: Restricted Energy Permit 03/11/2013 $75 00
12% State Surcharge - Electrical 03/11/2013 $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 OAR 952 - 001 -0090, You may obtain a a of the rules or direct questions to OUNC by calling 503.2r3 or 1 800 2344.
Issued By: c L ._/ Permittee Signature: vI ' , I P'—f C : RO'v
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.
Mar 07 2013 4 :30PM Bridgetown Electric 503 - 621 -7123 page 2
Electrical Permit Application • p * EIVED
Received
City of Tigard I Damnly. 3 ( I / 3 Sr :'•ening•g a 0 3 `00 o ci
13125 SW Hall Blvd., Tigard, OR 97223 AR 7 2013 plantteview.
IN on,Q>t
Phone: 503.639.4171 Fax: 503.598.1960 DatetBY: •
Inspection Line: 503.639.4175 Tr A Di1 Dam Ready/By: / I Sea = fsr
C I I 1 iGniW Notmosimetbod: I ( 1 7 ir(Oaaeadoe
Internet: www.tigoprd- or.gov a t, a 1 , ►,
1 W.IM � F , i . w cr •r: >tr 1 i 1 i+ 7 ■ 3 j"y C Q 2 5 1 1 3I , .jr ; F "I` ` } S � C.i4 I " I I "�. tl 114.' I t S ,•,,c-7 ' i rl .
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1:3 New construction 1l Addition/alteration/ w , lacemart - . ,1 .. . 'b .;• .0". 'lab Plied *M e>ladredbeto■+);
• • Service or feeder t' amps or mare 17 Btn oar Uwe shies.
❑ Demolition � hry ❑ Other: where the avaaable ' current CI Mamma and boatyards
. ,� • f W .e;TTT, K . .N.r 14,*r.x` = ;',/' .1F1 §. ' n ; 4 , • daae
,ede 10.000 ,.. at t5O or CI Floating buidings.
``-- , ' = I I U F • e, U .n
.r.Sl u .. eta. la�4L.iauuiwisa 4 , ,
.
. lea to ground, or - •.. - •. 14,000 CI Bela! -use agricultural
❑ 1 - and 2- family dwelling la Commercial/ind . ❑ Accessory building - amps for ell or spans. holdings.
❑ Multi -famil ❑ Master builder ❑ Other • Sim ms IO Walled= of73 xvAor
kp r � i L r� a r m► a a4w y, �£ �r s +r+„ g ; 'h
e :r i' .p P •, , µ� • , ,i1. : •
• Emergency system. large arpar Seiy derived system.
di :)- ' " fr,C,i.�I . k 4,' , „.ru�i •3..- .r..�d2v u�.�i.8.y'.t:4,11iw 11iiaz. •i:•.1A: I , ' "0• I ' ("%`�4 r1::•`,' -nv: • Alma anew •.'• load of 0"A,"E", -2 ." 1 -3 '.
Job no.: y3 - 11-0 Job site address: oo SX,a 4r ti c
10019P or more, oe maaef•
q I a ■fix or more rest •1 twits. Q Rear onal **id' a pad■.
Ci /State/ZIP: - � or ' f 2 Z 3
• >�aaue.wm 0 Supply volia a foe mom than
�' ' , 4 V U R , • sus lanolin 000 voila nominal.
Suite/bldgJapt no.: a!( Project name: V r„.,... i , i • or finder . . .. ' QCOWN.
- Cross street/directions to job site: I F. ��...A Arkgr ' "',: _ �`�il '"' I :'! •. E;. - ■
I , Ne residential el • - oraught. I dweltiaganit
i Includes attached .. . •
Subdivision: I I Lot ao.: : 1,000 sq. R. or lees 168.54 4
Tax mart/parcel no.: ' Ea. !WW1 500 sq. ft. • portion 3192 1
Y 4 r x c 1 esr t or e � . . 75.00 2
?'� "f'i . �p �WW�.1��,,���,.t < •
?,� '�`, r � ! , �^ .y
°u< :: c , - 21it�i( '` sluts. � i' ,w.tf."h:r .:e,1 f_k 7',:4:`L:,c'�y', . P c i31t;. t- v 1 *above 00,•1!
1 1 {�) , //�� /H Aft. I 'ted 'energt rmr family 75.00 2
/14., .JV � �G. Y/ /I 1.-n 1a� Tin' //r- Q S ar<,7. -. ` den with ... -$r1. 12J I I I R
/� or* ' womb, eteratlo■. mower reloads. Cp,.,, 1 201 =pa orless 100.70 2
., • I iii bryne rrizmt:T rret.4+1,1,1 ;rz,, . t•,r ( i _ ..
* , ,3;,' •" , uu j !t�. ^i l it } . ' + : a� , ti 11 A10,4;;:24-A,11? `' s ` s . I 2 01 , amps to 400 13356 2
l r�.' ^ ': i, . Si�h�u5x1�'" •a`�}Setn7._{�d'.'rii7=iu,3���t ir�'!.�`I�:' I :e' I{; + . ' i f W , n, S'y'd ... : . �
. • 4011 maps to 600 :: . • : 200.34 2
Name: 6011 amps to 1,000 r. . • 301.04 2
Address: ' ovir L.000 amps or . Its 552.26 • 2
City /State/ZIP: T p r • se or reecho lmddlatlos. attention, aadlor relocation
Phone: ( ) [ Fax: ( I ) 200 maps or less 1 59.36 I 1
Owner installation: This installation is being made on 1�roperty that l own which is not 2011 mops m 400 = , 125.08 2
I
intended for sale, lease, rem, or exchange, according to 1)RS 447, 44 9, 670, and 101. 1 401 amp • to 599 168.54 - 2
Owner signature: i Date: A. or for brands : • • • with
• c ,_ R a 'Ti 4m : , .:! Tac : y S, - .I;tf '. * :.; r .`' ! `!nerd x+z` ti above stiv1ee or r.. •.-
�"h'r: t � ' r ? 1 fa -4,1. J"-- +t- ; ci ;fi - •' �• t r•t + • j' s . 4 . i 7.42 2
•.:n �� Y • �r ��.}. - : ra3nw¢eaa �•a ; ti a.. , ^ �..,, r - i ''' ? : { ' h :l . t +s�L�.ciebs k. �b
Business name: I B. fee for ` t di -r. , to widamu
service or Seeder • - flat 56.18 2
Contact name: lunch circuit
^-I ada'I branch c• k 742 2
Address: 1 1 • Misedlaneans ( or feeder sot lndated)
City /State/ZIP: I ll service ,:.. • Seder 67.84 2
Phone: ( ) I Fax: : ( ) Reconnect only 67.84 2
F--mail: Ptubp or inig Lion c'• le 67.84 2
• ,A;lu , �1p , _ °� "n K IV + 1 7 µ�M' S � circ iao ti r ; ; g 67.84 2
. Y. �. il-•, ��+ b i. �' �,` �t�uf. �r�t :'�.`y�s:- 7. ° ,,.;.:i�':u:.�:. r �fa7�'",�6St r S �• oitwit(s) led -energy
Business name: ''a1! :s._ al . 7.L:'u a - • . ion. SIM 7s 2
l�I:` ' �{�J ' R1 G (Bath ' PI ^ 7 peed= over allowsbk In slog of the a bows
Address: • S7O! IQ . L - 1 1 O n Pe0 $ E 7 I Additional i. -- '• (1 hr min) 6625/hr '
City/State/ZIP: IPORTI A,JD OR ~ 001613 -4 0 ( 3 Invintigatien (1 hr • • 66.25/ hr
: Industrial plant (1 6r • • .) ' 78.181 hr
Phone: ( ) al '7127. , Fax: (Ce1p3) loLi 7123 . InsPectior■ far wttic no fee is 90.00/hr
;•t'i r'! �r
s•.- It, I, listed -min
GCB Lic.. 103 I E 44 rice! Lic.: - I Suprv. Lic.: 1 4177 " I 'd i7 '?, '.. �
. _. +..,r !:! ' ?n ,�' ..
Su. Electrician signature. f Subtotal: S
sum.
Plan ow (25% °fp:mut ales):
Print name: e ',A. S'i'c sas /'c? I Date: - 3/7h3 State . , • .. (12%ofpermit fee): 9-
Authorized signature: TOTAL PER{4i1z Enk (id/ -
lids permit applies . . Wires 1 '[a ia,lat Obibusd wablis 180
days ■ item !teen aareptisd as eotdpkEe.
Print name: I Date: ■ Number of inspectt • allowed per permit.
L uesPami&BLC•Pern pp.doe 07/e1ll0 ' 440.4613T(I ues/comirea .
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