Permit . - ; CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
' a COMMUNITY DEVELOPMENT Permit #: ELR2013 -00105
T [CARD • 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/13/2013
Parcel: 2S102BA00303
Jurisdiction: Tigard
' Site address: 9800 SW TIGARD ST
Project: JTD Incorporation Subdivision:RTH TIGARDVILLE ADDITION, AMENC Lot: 21 •
Project Description: (1) low voltage for Data/Telecommunications
Contractor: BRIDGETOWN ELECTRIC Owner: ANDREWS MANAGEMENT LTD
5701 N LOMBARD ST TIGARD INDUSTRIAL LLC •
PORTLAND, OR 97203 -4113 5845 JEAN RD
LAKE OSWEGO, OR 97035
PHONE: 503 - 621 -7122 PHONE:
FAX: 503 - 621 -7123
FEES
Description Date Amount
Specifics: Restricted Energy 05/13/2013 $75.00
12% State Surcharge - Electrical 05/13/2013 $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 95 - 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. / f
Issued By: "C . Permittee Signature: ONv �-(6�/ !6�
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.
May 10 2013 8:38RM Bridgetown Electric 503 - 621 -7123 page 2
Electrical Permit Application , -I 'CENED
gil City of Tigard (3 3 a or � - cnr �
13125 sot Hall Blvd.. Tigard OR 97223 �, AY 1 3 2 013 i tao Revi
Pboae: 503.639.4171 Fax: 503.591.1% t� Wg, Other Permit:
Inspection Lint: 503.639.4175 Qua Roady78y: I 0 he
Wane: www.tipard•as,gov CI OFTIGARD N« t tt�,t' I 1,d r.ait.4
r: Sq• - . .::R iii O,/�pp ,!',ere, Q r. ,, v „ ' " 'f ,-'.r.. ... fi L7.7. ery� . r+•�.��
.:7-:', . . ��� `,' '.acf:% _ pt •. ' . � ., ' � " - �'':i„ ,al* � rX k .. ". •.! $' �. ia17�: l.t�)�� � �T�MYcY:: t�l ��
❑ New construction t V Addition/alteration/ placement i— Karedin* sit end • ••,'6gli rciiiitar..' - tiAta • . it); '
❑ Demolition ❑ Other: D:ier.icoerrfiod r' aspa+ormom r t dii{ovtartitteaasade.
i %bare Ow a • - . Mat caret D Maims ad boaeyarda.
, ' § _ } ,, ' t' i , t . - moods 10.000 a • of 110 oral Wring s Of D Wring bUiI& p
''' ' i 9!`rr , ,� ,
moods Ia n to monad. or -' - _ .. • • 14.000 D Cao>oaoialwae agricultural
❑ 1 - and 2- family dwelling fi •• Commerci�udu t ❑ Accessory building ! amps fir all otter • • ■ ; . , bodelityp.
❑ Multi - Family ❑ Master builder
IN (hhcr • = totes- ❑ losral6tiaoa or 71 I:YA or
l
y;� . .. ..�., 'I '. . w ' � a Add;
� (�Prnagenays largor'aepw.dyetori►od
„,., "7 *":: ± 1 Addition of law . • .. loos or
Jab no.: 13 ` -3 Job site address: 1' 00 S -r— mow°soothe, O y. .t
�lrary (_ . ��' O Six or more reside dad traits. O Itacnodoacl whine prim
City /State/ZIP: t [] tlualtAKareracila . -. (] Supply voltage for ttaonethan
`u ? . - O 1 tarmdous loan' 600 volts nominal.
Suite/bldg./apt. Project natttt: 5 ldg. /apt. no.: p Sr
t(oin0,-- , O s n ,aa or6edae • ■ ■ ,or mom.
ss strect/directions to job site: 1 ;
�l�
_:.. ,� - -' -- -.... to
1rY'111111.�1I111�1 �
_... � -_.- IYe residential M' istalittillilnilly dwelling oak.
Subdivision: I no.: 1.000 sq. R aches 16654
.- r___ __._.----. no: ._.._....-- - - -_ -- •— - 6a. add'1500 sq. It - 33.92
Tax map/parcel no,:
• - ,,, ..,- ,- , � hgdtodandpa - • - 75.00
Lt
� j r+f a rated anDrgy. II
r r t-✓lD r
• r, . [ ^ .,-,'d -e.n of- 4 I E
Seervitteor - wtdt .i_3 111. 75.00
n c � : . -_ ._ ,
r i.:o - co. a 'Ce 6( 1 200 n err le 100.70
, , Q • ;, a; . ''err �• ' ... ... :: ., , -. 201-401V0 to 400 a 13156
, 401 antpa.to ti00 - 300.34 2
Name:
i
_._..._---- ...__.._.. __ ! 601 amps w' 1.000 : , ;r, 301.04 2
Address: j Over',000aatyls or Is : 55226. 2
-_ _..... _ �- Toilworn* . -. a• t�eden haalfaiioat- alteration. arsdlor
City/State/ZIP: —_ -. ___.__ .. _ . ' , r loca tion
Phone: ( ) Fax: ( ) i 200 amps or Inns 59.36 1
--,-- 201 amps to 400 , • : 12508 2
Owner installation: This installation is being made on p that I own which i s notl
{ 401 snivel* $99 ••'.,•- 168.54 2
intended for sale, lease, rent, or exchange. according to ORS 447, 449: 670, and 701.
Owner signature: - putt Ike Fee `� ' "' b ,:.:_ or • , - ___
-_ a_._..._ _ _ A. Fen eiraraedt wirl4
t above saviee of fee.
11 a .� 4 - .,-y.. .:. _.1:1 ; m ., _k w 7.42 3
Business name: ! N: Foe thr et
,---- -._...- --..____.._.._...____... ff service or Corder '- .first
Contact name: 1 I branch circuit 55 i 8
-• - - ;- ■ Hat:h 742
• Address: r�# - .--. - l `I 7
City/State/ZIP: ( Esett 67,8
dwe1 ' El
l'hone: ( ) Fax: : ( ) i Reconnect** s . II 67.84
— _.. __ -.. __ _,_.,._.._ _.-•__ --- I Pumporc ioigsafgnc', • 67.84
E-mail: ; ,
s . . • �"` S+linm.t `' J:::: 67.84
. r: ,[:...r , .
� ;.�..... ' ' S r ' ' Sigarl , "" .. . _ .5 a
Susints name: 'A.:',,,-3.t.-.•,,o � . . v I — 1 r .
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Address:
£ 7 01 Al eL 0 IY L .' }�' ° ' � � S TT2G�"T j , � - � �,lt� iatia) � 6� 3 w 1tr
City /State/ZIP: �1 D O Si Z b ' 1 1"'�est'a fG'Ig ;;` 6615/ Iv
Phone: (tj,p�) • 11 21 ___I Fax: ( )42..i 7123 1— �•+ rA�mt�l� • 1 � 78..18/hr t3 Lie.: 1 p"? r ^ Bla+culcal Llc,: Suprv I,ic.. i— � - � ° ��'°(�� :.• �_ f',
CC
Zvi .. a i 7 7 S .� i..- - - 1. , - — - --=A miN i ; i
Suprv. Electrician signature. require -- . t (,,tom f ,'., • , � Flan .
Print name:,. '/ 4 ,. e r, � /-47, Date: Silo/13
State • r CI 3 o f p sit frcl: i -
Authorized signature: T OTS"' . ' gy m
This Per. sii a , s tTa•rart 4Maissa wino. Ise
Print name: I Date: - _..._._._.__. 4 a iof sY " ii_ewlha
Number of mspeeri • • amid f t>r>m&
1lioikd dneernitalEte PermitAppeee 07/01110 4aU•+ok<felIR I
is 1 1