Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
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I: -- COMMUNITY DEVELOPMENT Permit #: ELR2013 -00133
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/18/2013
Parcel: 1 S126DCO3300
Jurisdiction: Tigard
Site address: 9900 SW GREENBURG RD 235
Project: Body Sculpt MD LLC Subdivision: LEHMANN ACRE TRACT Lot: 4 -5
Project Description: Data telecommunications.
Contractor: BRIDGETOWN ELECTRIC Owner: ATHERTON REALTY PARTNERSHIP
5701 N LOMBARD ST 2100 S WOLF . _
PORTLAND, OR 97203 -4113 DES PLAINES, IL 60018
PHONE: 503 - 621 -7122 PHONE:
FAX: 503 - 621 -7123
FEES
Description Date Amount
Specifics: Restricted Energy Permit 06/18/2013 $75.00
12% State Surcharge - Electrical 06/18/2013 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: 0 Boiler Controls: 0
CCTV: 0 Clock Systems: 0
Data & Telecommunications: 1 Fire Alarm: 0
HVAC: 0 Instrumentation: 0
Intercom /Paging: 0 Landscape /Irrigation: 0
Landscape Lighting: 0 Medical: 0
Nurse Calls: 0 Protective Signal: 0
Security Alarm: 0 Other: 0 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 copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Perrnittee Signature: ox/ 4 e 7
_oer...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 603.639.4176 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.
Jun 17 2013 11 :45AM Hridgeto 503- 621 -7123 page 1
Electrical Permit Anplication
III of Tigard • 013 , ;,tu2�o�3 -fO 33
! • SW 503 lit3l 639 . 4171 Tigard. S03.S9R.19A i
OR 97223 , � I OFTIGARD � „Aber Poona:
.4171 Fax:
Iion t ine: 503.659.4173
In .• www,tigs B ILDING DNISIO 111 lair -� Peter fur
www.tigard-or.gov �.�. lidermethm
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❑ Osaviecc( • orap ormom O'BsOrdirg oars damlearies.
ID Demolition Other:
. •• where eve. • - . 6ulr oare.e a Mathew led tomtyards. •
i ° 4; : ;.: i at . exceeds 10.000 a I SO alb or 0 Florin boil e
lase to proved, a; • • ... • 14,000 i0 Ccru scroia4mo ainculmn t
❑ I- and 2 -f 'ly dwelling ':i Commereial/ind k•• 'al El Accessory building forUate ,• asitdinas.
❑ Multi -famil • Master builder 0 Other: O Fla pump. i0 Whacks 015
a • y o- . ° ,:: ; , i r':_i o Additi
.. O FmerpeaoY • • DIY *Mod m a n
Addition .load of 0'A ".' - 1.3 - ,
Job no.: ,? .4 p Job site address: t ��
- p�,��� 100HP or mo occupancy. 1`� -.. �•8 O Sia er mare - I units. a Rasseaooasl which paler.
month"
Cil /Stale/' /_I � 1 , r & i q — -- - -- _ O v d oa rc ttaa O�PIY for th"
y 600 wits aWeiud.
Suite/bldg. /apt. no.: 3S Project name: --;, , , „,.. ■ MP Or Nu
Cross street/directions to job site: H--- � - '
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♦'il+ G New ratdcWfa1 ,1 . - ' • salt.
f aelader attacked ,__L_.
Subdivision: t .,tu no.: , ,00
10 a'9• ' arias ' II 168.54 4
-- - --
- -- Ea. add'I 500 rq. it , portion 33.92 I
Tax map/parcel a.: ar+¢ q�auvsa I imitedglgrgy, - -' III 75.00 2
1/d i ±�/ 1. Rtm11Y
r.:. oYg LWYC t,.1.. ., ... ._4_ T�Iy.6A.e `._ .2, r _ A.
■ 75 00 2 or less 100
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' �::; ... : ::1:3:x 20/ � ro400em_ 133.56
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401 amps to 600 — 200.34 8
Name: ,. ,
-- ._.____ -- -- -___.. _ ._.__.._....._._..__.._. _. 601 amplsm 1000 30104
Address: Over 1.1100 amps a 55226 2
- . - -- - _ -- - -.... ar3 :• or le oa. aders imataketi alb oa. sadlar
City /titate /i1P:
relocation
Phone: ( ) f Fax: ( ) 200 amps or Imes 59.36 1
201 amps to400 125.08 2
Owner installation: 'Ibis installation is being made o property. that 1 own which is nt
intended for sale., lease. rent, or iu change, according t t ORS 447. 449, 670. and 701. 401 att 10549 16S S4
Owner signature? __._. Date: _ ._ A. Poe for'; : -• -°' ,may
Il` , `�`� y �abo�va. , � itstiimor ? - , fm, 7.42
Business name: - - — i . t i�o box. ; -' its ritirast►
serviecerlifader - , first
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Contact name: branch .010101 • 6 l8 2
7d� 2 1
grsder ark -_j
City/State/' %1P: _ - Each • ., . —�
dw� l ' „•_ . 6784
Phone: l 1 Fax: : ( ) Rc nniectoaty 67.01
E-mail: -- _ .._...._..... --- pump or 1 67.84
j k Sign orgiil W' ;: 67.84
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Business name:
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70 J . IV . o ... � 1�'' — Au. _ Other Address: I-. fl'te . .tl 0 � � ; ' :'� • I ]iriitiitl' amiiii3
('iryIStatr/ P. f t* "r (!1 0 - 1 Investi /.tar:
Phone: insp vefislplertI1 )!r` • 1 78,18/ �I
9000f1u
Cca Lie.: 101, Li I E,octrical l.ic.: Suprv. Lrc.: - l� 'J 7s o f 1 ^ , , �61ti` .� W�- 'F r1
Suprv. Electrici- signature, raquirett '( f . . , } LM Mini
i. Print name: " e l, -44. S-vee'' ��.s 7.. cif Date: . • f it c *4): thoriz d si: • urc:
. - _ Tai' ?lk1 ,F: MN
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At '1Uis permit a - ' • 1 at if ir li►eptoltam aed Weis 1 '
Print name: 114Y4 irk0104111 al oomjltt•
Date: at Number of inspect • allowed par pant
ili mildteg.PermuiF.LC- PeiniIAppdes 07/01 In 4A14a7S1( i Ilt1 Y'UMIW'I
Jun 17 2013 11:45RM Bridgetown Electric 503 - 621 -7123 page 2
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
Fee for g l residential systems combined.. $75.00
Check Type Hof Work Involved:
❑ Audk and Stereo Systems*
❑ Burglir Alarm
❑ Garage Door Opener*
❑ Heatilig, Ventilation and Air Conditioning System*
❑ Vacu4m Systems*
❑ Othe •
Fee for each commercial $75.00
system }
(SEE OARI 918- 309 -0000)
Check Type bf Work Invollved:
❑ Audio and Stereo Systems
❑ BoilerlControls
❑ Clock Systems
51 Data 'telecommunication Installation
❑ Fire Mann Installation •
❑ HVAM
• ❑ InstruMentation
❑ Intercmrn and Paging Systems
❑ Iandsape Irrigation Control*
❑ Medtcl
❑ Nurse;Calls
❑ Outddor Landscape Lighting*
❑ Protecgtive Signaling
• ❑ Other
Total number of commercial systems:
•
*No license are required. Licenses are requited
for all other installations
1 ::BuildIng ,doe 07/01 /10
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