Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
I: COMMUNITY DEVELOPMENT Permit #: ELR2013 -00113
T1GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/23/2013
Parcel: 2S113AA00900
Jurisdiction: Tigard
Site address: 16540 SW 72ND AVE B7
Project: Asean Corp. Subdivision: ROSEWOOD ACRE TRACTS Lot: D
Project Description: Data telecommunications.
Contractor: BRIDGETOWN ELECTRIC Owner: PACIFIC REALTY ASSOCIATES LP
5701 N LOMBARD ST ATTN: N PIVEN
PORTLAND, OR 97203 -4113 15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 621 -7122 PHONE:
FAX: 503 -621 -7123
FEES
Description Date Amount
Specifics: Restricted Energy Permit 05/23/2013 $75.00
12% State Surcharge - Electrical 05/23/2013 $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.
issued By: Perm 61 // lttee Signature: 'v // � Z e 69710
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 603.639.4175 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 22 2013 12:59PM Bridgeto•D . EIV 503- 621 -7123 page 1
Electrical Permit Application y
City of Tigard MAY 2 2 2013 ,,, „�.,� :.....,.
�I� "e�it?o?oi -Da/A 13125 SW Ha/1 Tigard. UR 97223 j 'I'y ®F �I'IGARD �'„'�;,�
II
PAOne 503 Fax: 303 I 0 �I� evA Other Permit: Inspection tine: 503.639.4175 yilly
Internet: I ILDING DNISI 1 ►� ku i R d/Wh Internet: www,tig�td -or gov Nupncd/�Ae�Md. cc US 8e -- j fir
. il�lsewsall KaetaaYea
Q �,'. ,! '':! �l.�r�t� Aar 1 .. ' a 4 :r. b rAiP,4 7,7.1 :m.- i:3 s ! .• rT . �.
. ; -, ;'t'.''.,. . i•�t+ M. �:3�r;'I,.. , � -,. . , r'1,” .' �. - r ,;,� �:M1 f.. , -:..•� Il ' �l- .rk- �Sw,.. _: ..�f 9 �� e �tl � � li
❑ New construction "; gAddition/altcreti • replacement Plasm die* dli that . f • plbe . - . ,.. W
0 Savior or geodes • ' mat ror nitro D eaa7 'ewr0om arias.
❑ Demolition ❑Other:
whore tie avai ■ .. - fret Deane D barb= ad boatyards.
. yid ' ` e i • .1 ° ;' - - exceeds 10.000 a • at 150 oaks** 0 Eating bai.p.
a
CI I - and 2- family dwelling Commercial/Ind Comcroial/ind I A cca s soty building • leas to round, a 14,000 0 CaemeriaMra rare
amps for ell caw isediaeans. b,:w;op,
❑ Multi - family y�y Master builder , t 0 (Miter. 0 Piro r D heW4da,of75 KVA
... `''f� *'„ l' , 0 ".;,t„ '` "• ' - ' ' - i.. 4 0 Addition of now • • • of + r% - 1 , 2 y - 1 - 3 - . yam.
.lob no.: 1'3, -13S 1 Job site address: 1 La 51. o : 5W 1 2 wil • A,,.,. 1001W or morn +ter
0 Si. or MOM reside . fiat mass. 0 Boa ots.
asfioaet wtodo p
City/State/ZIP: ec4 , OR 1
1 4 LI 0 licah h care &alit - -. D Supply whip ler nose then
--- - - - - -- 0Ilnsatdaus focal'.. -. 100 volts mondial.
Suite/bldg. /apt. no.: Project name: AS , v Corp. 0 Sonia or ade •
a .y. , t a maw .. .
Cross street/directions to job site: ...,.,:.' 1T''ii' ,`4 § Rif i : mi y '`. .i,T'q'P�,. " : :u�4 eel c''r.'41;
., ~ a "Pad, i4_ ! m , .
_.. - - _ —_ - 'New resliea61 • .: • t trait.
I.cludes attached • .. ,
Subdivision: t - Lot no.: 000 sq. ft- or less 168.54 • 4
_ - lis add•1500 R. -
Tax map/parcel no.. S9• portion 33.92 1
Limited 01040.
++ ' :: < , i W i 1 : Mai . 75.00 2
1.�+ 4/0 Li aaergy. • . ■ . , • , ' 7
mited 75.00
'� c.CCV�r c..1�� 1 0 o am s r 'i1Wt+, .�IMpIO. 0.70 t laWba
,- =� laaTn
C.' '' ` : .. . C ;• , . 201 amps to400 •. • 13156 2
Nettle: 401 amps to 600 ant • _ X3034 2
�._ - . _..-. - 601 amps to 1.000 301,04 2
Address: over 1,000ampuor • Ia 55226 2
C'ity/State/ /.IP: _ Tw strut - or feeders laaretioa. attainder, and/or
Phone: ( ) IT; ( ) 200 amps or less 39.36 1
Owner installation: This installation is being made on -rty that I own which is not :01 amps tee 125.08 .. '
intended for sale, lease, rent, or exchange. according to RS 447. 44 670, and 701. 401 cm t0 16854 =
• Owner signature: 11atc: '-""- � -- ....'-=- :- Or i..._:....:._ -. --
.. A. Peeler • Ci'
. . .. .- .. . . . . ; ; :' . aboas.aeWiee er • - • - rce
Rosiness name: . • ' B. Pee tar branch 1 ..: is weho v
_
service arteedor. Post
56.18 =
Contact name: ' branch circuit
Address: Hach add`.1'IWIiWdr 742
- - - -' -• . • - rf trade roeladaded
City/State/ZIP:
dw iling;o rice ' # fir 67. 3
Phone: ( i I lax:: I ) ' ttacoortaot only 6734 2
E-mail: Pt1mPar w 6734 2
r - _ ~�; I 'aka
-Tr, Sigaorottltinel••. • 67.34 2
- - a_ 4 I . ��IC■ :'i; �'�i:, '•F:� •:•':''.: Rat d1`I , • I r Business name: ' t r r. 2 IG "
Addrms: £701 . i- o Jfite3 r , r r. t�`T Additidniil •, y:
-
C'it 1Statc/ZIP: ' G � q I tnvastigtuiau- (1:lir .• 66,2511
y �� i � ` Q . l lndugaid hr • ' 78.18! tar
r ne: (off )4(2.1 . 712 2 relett: ) 6 $ 1 tnspoctie • 90.t1pt hr
CCB Lie.: t03 p 4 /j Electrical Lic.: - 8- • rSaprv. Lic.: 4 i 776 ' :< .. , -- - i »_ ._ _ K. w' .
Suprv. hlectriciansignature- requireth - ' _ .440',..__ syrJ -e „„e„., — . :; .--, 4t�lY 7S.pe
Print name :4,'10 Sv .vr,.i /. e Date: State :. - of _ ' -•t • •
{42' 4 ofiPanait hgtey
Aulhon l sigAature: rkTA : 11 '' Li. 4°
__ __ •rib pima a :. • , ospi! enif . t} 404 ' • - • ISO
Print name: II Date: _� days a ' • itliisit�'iee� as -• • -
- - -_ - • Number of imperil • • allowed swoons*.
(:auilsoatrem,ial I.C- PcrnwApp.doa unotno 4w- •wisr(ti AA' ca+w+tsa
I
May 22 2013 1:00PM Bridgetown Electric 503-621-7123 page 2
Electrical Permit Application - City of,Tigard
Page 2 Supplemental Information
LIMITED ENERGY PERMIT FEES:
•
AESIO0040940.W014
Fee for all residential systems combined... .... $75.00
Check Type of Work Involved
El Audio and Stereo Systems*
El B urglar Alarm
G arage Door Opener*
O Heating, Ventilation and Air Conditioning System*
El Vacuum Systems*
O Other:
r...
Fee for each commercial $75.00
system
(SEE OAR 918
Check Type of Work Involved:
D Audio and Stereo Systems
El Boiler Controls
• Clock Systems
P K! Data Telecommunication Installation
El Fire Alarm Installation
O HVAC
O Instrumentation
O Intercom and Paging Systems
El Landscape Irrigation Control*
Li Medical
El Nurse Calls
0 Outdoor Landscape Lighting*
C I Protective Signaling •
• D Other '
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1:Ndulldikg1Permits■ELC-PennitApp_doc 07/01/10