Permit p CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2013 -00112
Date Issued: 05/23/2013
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 2S102BA00302
Jurisdiction: Tigard
Site address: 9900 SW TIGARD ST
Project: Subdivision:RTH TIGARDVILLE ADDITION, AMENC Lot: 22
Project Description: (1) data telecommunications.
Contractor: BRIDGETOWN ELECTRIC Owner: TIGARD INDUSTRIAL LLC
5701 N LOMBARD ST 5845 JEAN RD
PORTLAND, OR 97203 -4113 LAKE OSWEGO, OR 97035
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
Items and Reports (Conditions)
Other Desc: Required Ite P (
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 copy of the rules or direct questions to OUNC by calling 503.2 or 1.800.332.2344. ^ /
Issued By: Permittee Signature: Al /9 L
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 22 2013 10:38AM Bridgetown Electric 503 -621 -7123 page 1
Electrical Permit ADplicatioq , EI VED City of Tigard % ,G ir(A Paset ; E7 i &o -IO //-
rii
13123 511f Hall Blvd., 'chard, OR 97223
lime: 503.639.4171 Fax: 503.598.1960f l A Y 2 2 2013 ra " "r i"
hepection Line: 503.639.4175 Lane R t1.. 2 Oar
Internet: www.tiprd- or_gov i t I 1 —
. S , }, _ y}yp�1 g q ;i
:� a ' '� "' " r. $� �„ R A W ! �i '. 'yt b� �Y��4 o.:i�t�Tu�t Xi�i � "� �;lt;
CI New construction '.1 Addition/altereti . ° replacement Plcao. °tae* as : Ctttr6sa ti ma • " diado.d b.l.n):
❑ Demolition ❑ CI Se r t et feeds' . ' asaps a tam[. ■ oVter tired stories -
, rte
»bon, du a4 _ • • r1.dt come 0 Manua sod bourardt.
y
' + 1 h '' 'rr.cc a,"..aZ cr. e% ds 1 0.000 • at 150 Wks et 0 Ram* bu M a.
J tcss 1., jouad, or , - - 14.000 Oca sarnci.i.w. agricultural
❑ I - and 2- family dwelling .. Commercial/indug ■ Accessory building ! Amps 6,r all dim,.' • ei• building.
❑ Multi- fain 0 Master builder • f ] Other: • f ; 0 Fore pump 0 lnrtallatioo of 75 KVA or
. ' , • ', . l 0Addition ocoow wit • t or 0„ - 1•3''..yaen
lob no.: II, .. IA 5 1 lob site addrers: quo Qa gy�T moltP .oanp..tyy. mkt
C ity,'State/%IP: • — � - �/ _ _ ___ —. 0 � ` �r feed; 0 S poly %okay for m are taw L I �� [i , ._ ---- --- ...__- - -___ ❑ ll.ard... oohs s aowi..1.
Suite/bldg./apt. no.: Project name: /� d 1 9G _ , ° Service a S..ser • • 1 amps « room.
c /ter �.il , `s - f"• t , 1 j , � , • Cara Cara street/directions to job site: ' .i�..� a ; i
I or ...."' d.relliag mail.
hdnia stanched _y
Subdivision: 1A11 no.: 1,000 sq. It or lass 168.54 4
: Zia. add'1 500 at 11 • por 33.92 1
map/parcel ap/pircel 110.: • ' Limited eau, no - •
. yra<meys. . r _ 73.00 2
L
tA.Mti _ ' • _ _ 4 T1M 1 r% „,. - • mui ; - family III 73. 40 2
'9 'C!i drtW C erw tit.. " _ � o �, .• fraanldthtak� oodles a doesMM 2
..t ° 4 . I . ; . ' 201 asap. to 400 133.36 2 ,
Name: mops to 640 am 20034 2
-. _____ _______ _ . ._.._ 601 amino 1.000 ,. • 301.04 2
Address: Ova Loon amps or • lts 552.26
-- _______ __._ . - ._ — . — _...... ____________ ____ Tea.pm�.cy serrk - or feeders
t ity/State/ZIP: ia.hMatiaa. � *Wier
Phone: 1 ) lax: ( . ) , 200 amps or leer 5936 1
Owitr i.stalbtioa: This installation is being made ° 201 amps 1 a 135.48 2
g properly that 1 own which is no 401 unix to 599 , 1611.54 2
intended for sale. lease, rent. or exchange. according 1. ORS 447.449: 670. aid 701.
Owner signature: Arle: cane ` ° r ___• sH
A. x for (rarM91 :Elc. - : acw�c�v kY _ -.a:°. e.i : z .,.. _ each brooch circa 7.42 2 each
Business name: , B. Fro for bonen ci .. .. wuur
ho
»_...__ _ __ _ r II bona if feetbr 11rat 56.18 2
Contact name: bnmdl txspalt
Address: , Each add °l 4msch C; uit 7 43 2
Mlaceilti City/Statc/GIP:
-0-- , F Lacs rnanoi d sot isdttdi '
-
dwelling, :orrice feeder
Phone: ( ) Fax: ( ) . , Reroanpet ally 67.04 2
Pump or iirritation c 67,04 2
4 _ —_ _- .__ E-mail: L -mail: Si or outline
.�„� _ � � � . , : 67.14 2
Business name: l t a ` - N NI — , I• _
Address: .6 7 01 Iv . 4-0 • 0 S TlecET , Additional iri{poilia, 1 k a i* 111111111
City /State/ZIP: ', ,`+ s q7 Z • . --ctl t 3 ____ • u,. tti ti air } MI =1111
�
st
Plrxte: ( Industrial plow 11 hr • 711• ltf it
V Se; ) 0.1 . 7 2 w. ) bZ1 7 23 ' ' Inspecnens for which • fee d
90.00✓ lit
CC8 Lie., !43 B:4 Electrical Lie.. ,, .4 Suprv. laid. 44 i 7 lib I y, -"ir' w „t g
_ .ter%
Stlprv. kilec trician signature, aired' r .� � ' I
r r 1
PI= r
Print name: , / 'tr . /.•' I Date: I (}274 of perms fa) 1 •
Authorized signature: — I
TOTAL PERMIT FEE � � r er b
This perma moues expire. Saps:mit is .et .h.i.ed ,loins 100
Print name: ill lam. ' days show it Ur Mini aia.ptail as caa►kaa
• Numbest i rupectioosalbr+wt par permit
S
14tuillietMarmittAeLC- hrgitApp at o?AUIo 441461M1 t
1
May 22 2013 10:39RM Bridgetown Electric 503 - 621 -7123 page 2
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
-'
Fee for all 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:
- q . a ° ea " ` <= ... . !
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
XI Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
•
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems: _
•
*No licenses are requited. Licenses are required
for all other installations
I; ■6uuding\Pemhe\st.c- ramiapp.mo 07/01110
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
9900 SW TIGARD ST, TIGARD, OR, 97223
Commercial - Electricial Limited Energy
199 Electrical final
05/30/2013 00:00
ELR2013-00112
PASS - No C of O
Violation Summary:
Inspector Contractor