Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
111 I COMMUNITY DEVELOPMENT Permit #: ELR2013 00083
T t GA.RO 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/15/2013
Parcel: 1S 134AA01800
Jurisdiction: Tigard
Site address: 10160 SW NIMBUS AVE F6
Project: Billings Dance Center Subdivision: IKOLL BUSINESS CENTER, TIGARD Lot: 2
Project Description: (1) low voltage for Data/Telecommunications
Contractor: BRIDGETOWN ELECTRIC Owner: HANSON, RONALD D
5701 N LOMBARD ST ROBINSON, CONSTANCE A
PORTLAND, OR 97203 -4113 ROBINSON, CHESTER TRUST ET AL
203604 EAST FINLEY RD
KENNEWICK, WA 99331
PHONE: 503 - 621 -7122 PHONE:
FAX: 503 - 621 -7123
FEES
Description Date Amount
Specifics: Restricted Energy Permit 04/15/2013 $75.00
12% State Surcharge - Electrical 04/15/2013 $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 By: AAle 952- 001-0090. Youy a copy of the rules or direct questions to OUNC by calling 503.232. or 1.8000.332.2344.. t I Issued B � Lite L OM 1 4 Pre , /ad
l' � / Perm Signature:
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.
Apr 12 2013 8:44AM Brid town Electric 503- G21 - 71 :1 page 2
Electrical Permit Application E D 1 t.: ' ii i it ? I _I t ti
sil;
City of Tigard 1 2013 Received 5 3 Si PtirlaltNe:EapJ 3 tx�o�s3
13125 SW Hall Blvd., Tigard, OR 9 7223
APR Pram Review
Phone 503.639.4171 Fact: i�D
Inspection Line: 503.639.417 Date/By. Or Perm
Date Ready. luris B 8sa 14aM1 for
Internet: www.tigmd or.gb� I T DING D VISION Notified/Method: Sipplattratal 6ar.mdo.
':: . R of Wll1lt11 j `i ,, ,, . ,w i
❑ New construction (il Addition /alteration /replacement Pteaso check ill t hat apply (submit j sew of pip a wfitmaa checked be :
❑ Service or feeder 400 amps or more ❑ Building over than stones.
❑ Demolition ❑ Other: where the availebb!fault current ❑ Marines sad boatyards.
. ; CATZGORY of CIONSTWI.IcTION exceeds 10,000 emits at 150 volts or ❑ Floating buildugs .
leas to ground, or exceeds 14,000 ['Commercial-sae agricultural
❑ 1 -and 2- family dwelling EJ Commercial/industrial ❑ Accessory building amps for all other idatalladons. building.
❑ Multi- family ❑Master
builder ❑ Other: ❑ Fitt pump ❑ Irrtaaatios of 73 KVA or
,i
❑ Emergency system larger separately d:issd system.
oa'SldTE IN `t1 8 s . 70.1 ❑ Addition of new motor bad of ❑ "A" "E ", 'i -Y "1 -3
lab s ite address ' 1 �q) taoxP or metre. ; occlammy.
Job no.:
1Z _ ZSJ I n l 6 0 S \A•/ hJ , b V S 41 ❑Six or more residential urns ❑ Recreational vehicle ports.
CI 'State/ZI P: �+ v.r ❑ Health -care faatio s. ❑ Supply voltage for more than
City/State/ZIP: err,( t' 1 T Z Z ❑ Hazardous IaeLi 600 volts morainal.
Suite/bldg./apt. Project name: 3; O Service or feeder 600 am or more
g• t. no.: PtG F( 1 5 1 7. . wail yY > t , " � * • . �
i
Cross street/directions to job site Oesedvuw Ol nee i Tai l
"'' New residential single- or taulti -ftmfty dwelling unit.
Includes attached iparage. -
1.000 sq. R. or less 168.54 4
Subdivision: Lot no.:
Ea . add'I 5 0 0 s q . R. dr portion 33.92 I
Tax map/parcel no.: l imited energy, resi�erltial -1 (with above sq. R
75.00
1D6YtI . Qgi TK
Limited energy, multi-family 75.00 2
L 0 era 14 4 .04 7e... - 4JM P.. - 4 104.4-.4, A '-1 residential (with albove sq. 0.)
Services or feedcnt iastallatlon and/or relocadoa
-1`cn ^e+ Sp /- "Pot CI- ��� 200 amps or Tess i 100.70 2
r ` c r Q 20 1 amps to 400 amps 13156 2
401 amps to 600 amps 200.34 2
Name: 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or rolls 552.26 2
'—` Temporary servit:s or feeders installation, alteration, and/or
City /State/ZIP: relocation II
Phone: ( ) I Fax: ( ) 200 amps or less f 59.36 1
201 amps to 400 am 125.E 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 am i 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. epoch circuits - ew, alteration, or cambia, per panel
Owner signature: . Date: A. Fee for branch el oils w ith
❑ 'OPLICAIV'1` I Q'OI St CTC PEIR&kV- above service or r fee, 7.42 3
each branch mire '
Business name: B. Fee far branch ci suits waho t
service or feeder cc, first 56.18 2
Contact name: branch circuit ! .
- - -- Each add'I branch circuit 7.42
Address: Miscellaneous (service or feeder not included) _
City/State/ZIP: lStateJl.IP: Each manufactured or modular 67.84
ty dwelling, service and/or feeder 2.
Fax: ( ) Reconnect only 67.84 2
Phone: ( ) __— Pump or irrigation c.rele 67.84 2
E-mail: '
tt Sign or outline tightng 67.84 2
: : ,..:. ,....,...„,„..„_,,,,.....,0_,.. , : ' if l::. Signal circuits) or l mitedenergy
Business name: ' 1 t- r panel, alteration, or xtension 1 Pa , r 2
�� Lj. (GS / � � r Each additional Insp ge 2 ection over allowable it say of the above
Address: d 7 0 ` I1/4,1 , I Q ( & 4et) S Tle CST Additional inspectiori (I hr rain) 66.25/br
City /State/ZIP: Ub OR ( • I . Z 3 t l i 3 Investigation (I hr Min) 66.25/hr
Vt� � v Industrial plant (I lumin) ' 78.18/hr
Phone: (so; vtfi - 7122, Fax: ( ems ) ea ( "1113 Inspections for which no foe is 90.01V hr
spectfcally listed ' hr nine
CCl3 Lic.: 10"3 62-4 I Electrical Lic.: °R Suprv. Lie.: a 1'77 °t,� i., i n . .t ,:',,',At..,-,:, I� l Li4fff'a. :r:::
t. Subtotal: 7 7
Suprv. Electrician signature, required-- --e., „ ,�. 4 f plan review (25% of permit fee): -
Print name:4,'yam / ..^r P /as l. Date: lot i h i State surcharge (12% of permit flee): CI
TOTAL PERMIT PEE: 5 q
Authorized signature: This permit application expires if a permit is net obtained within 180
Print setae: Date: days after it tea beta accepted as cam pkte.
• Number of inspections allowed per permit
1:\ auildity `PermiuiELCPermitApp.doc 07iLI /t0 440 - 461 ST(Ii105/COweita