Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
a . • COMMUNITY DEVELOPMENT Permit #: ELR2013 00153
T f C ;\ R D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/01/2013
Parcel: 2S 101 DCO3702
Jurisdiction: Tigard
Site address: 7185 SW SANDBURG ST 100
Project: Fischer Chiropractic Subdivision: ROLLING HILLS NO.2 Lot: 44
Project Description: Low Voltage for Data - Telecommunications
Contractor: BRIDGETOWN ELECTRIC Owner: ARNSBERG, JOHN S
5701 N LOMBARD ST BROWN, LARRY H
PORTLAND, OR 97203 -4113 % MODUN, JEFFREY K
9700 SW HARVEST CT #180
•
BEAVERTON, OR 97005
PHONE: 503 -621 -7122 PHONE:
FAX: 503 -621 -7123
FEES
Description Date Amount
Specifics: Restricted Energy Permit 07/01/2013 $75.00
12% State Surcharge - Electrical 07/01/2013 $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: P A A Permittee Signature: _S(LL 14 6 fL-TC4 77--1
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.
Jun 27 2013 9: 13FIM Bridgetown Electric 503-621-7123 . page 11
. .. .,..
Electrical Permit Apolicatid8 - v ED
i ._.....
_ ... . _.
City of Tigard Received
N Datem 1 Per -- f2(21S3
..._ 13125 SW Hall Blvd,. Tigard. OR 97223 j Plan R
Phone: 503.718.2439 Fax: 503.59819 • . N 2 7 2013
7 8 mit 14° 'fL/ L 20 13
.....
DateBy: Other Permit:
i , . .,. i . , , Inspection Line: 501639.4175 Date Ready/By: Juris: lii! See Page 2 for
Internet ww,v.tigard-orgov CI ' . OF TIGARD Notified/maw: . Supplemental batormadon
1-' . ,..tp40_ryivislom . . -•• .........,,„..::, ,,,,,„.,.,..„.,,,,,, 41 .,,,lokt,91 , 11 r .: 0 ,, rr , , -... A01 ,-, :maigtej; , ,...,, ,
1 I•:,.. ,••,,,,i..•, • vi ,,.., ... ,,o, ,•-•, -,.. .,,.,: •••:-.. , , ., ,. • , : • : .• .! .! , •-• .: , :-..:, til , arrA•;• , !Pelll,' , .t:4'41: -- ,,ingloll.L114..:,i.24L1:20:11MaTIAL, •••.1.-,
0 New construction Addition/alteratio replacement
Please check all that .. • ly (submit I see of plans whams checked below):
xi
0 Service or *btu • 00 amps or more 0 Balding Over throe genes. ID Demolition 0 Other: ,
. whore the avai . • fault current 0 Marinas and boatyards.
'' ', 1 : 1!g.'`r!IVVV, : ''.Vi'i t .'. 1 . 1 .1;:.1.1'.FPV0A . 1144710t40 , 0 4 ,':";; I .r ii Zi . 1 • is .-'.:: • 'i '-:"-...' '.,' V. •, :•'••- -, .:",' '..,' !!•..';i exceeds 1 : • • el / veils CS 0 Floating blikiinP.
less to 2:lewd, or -• coeds 14,003 0 can I:Racial-use agricultural
0
I. and 2-family dwelling RI Conunerciallindu • . al 0 Accessory building an for all a Installations buildings.
CI Multi-family 0 Master builder i 0 Other: 0 Fire pump. 0 lanallation of 150 KVA or
. ' - '"* . !..'..':.•:' , '" , .::V''..i--1 4 'fiq. ' - 041010001041i0fif , :i'' - , „44)0410Ni. •::. .:,..' . . ..:. ''.,.. ': DEme a ' • larger separately delved instal 0 Addition of new or toad of A E" l 2" 93"
Job no.: 13.... 4 I Job site address: 11 85 9,J SoiAove
J'
00HP or more.
0 Six or More r : ' , . ntial omits. occupancy.
0 Recreational vehicle pada.
' 0 Suppiy voltage for more than
City/State/ZIP: .A'r ck f OR, G1114;5 0 Health-care facih ies.
0 Hazardous locati • • . 600 volts nominal
Suite/bldg./apt. no.: lob I Project name: ( CA 0 Service or feeder . 1 . amps or more.
.,!,';'",
Cross street/directions to job site: Deseriolion Oft. • . TINA •
New residential . ngle- or maid-family dwelling unit.
Includes attack- . garage.
Subdivision: .
I lot no.: LOGO sq. B. or less 168.54 4
Ea. addl 500 sq. ft. or portion 33.92 1
.
Tax map/parcel no.: ,
• Limited energy. Ms dential
,
75.00 2
,--: "..7,::;,.; C, ...,... , ,' . ; , ;: - ." . 7,;5::';g , ',..P! . ,; . eri,'$iikatratigr '00;04* iiiit0e. ..• -.•••• , '..' - -.. : ' '‘. ''':...-: -' •:,.',,.. (with above so. .)
• Limited energy, mu ti-family
75,00 2
1■ V6 140-Vis IPALMAAnd ViNANIL eEAkte).11. 1 10 41EALOcia- residential with above sq. ft.)
71,6k.SA/
c - Services or feeders Installationothersdon, and/or relocation
'..,..• ,'-' 4 ,. : 20' amps or less .. 100.70 2
' 201 amps to 400 amps 133.56 2
Name:
401 amps CO 600 amps 200.34 2
Address: 601 amps to 1,000 amps 301.04 2
Over 1.000 amps or volts 552.26 2
City/State/ZIP: ,
. Temporary services or feeders installation, &Bandon, and/or
Phone: ( ) I Fax: ( : ) relocadon
200 amps or less 59.36 1
Owner installation: This installation is being made n ;property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according o :ORS 447, 449, 670. and 701. .
401 amps to 599 amps 168.54. 2
Owner signature: :
. Date: Branch circuits - new, alteration, or airmail*, pr panel
*0411t5' :',:',: -..,:factoSeriii■SsAiti44014; . ', r: -:„,,,,;,, A. Fee for branch ei with
.1 „ ..: ...7-.... „ . .. . .. .. above service or teder fee,
2
Business narne: each bnuich circuk 7.4 2
B. Fee thr branch circuits without
Contact name: : or feeder 7ee, first
56.18 2
• ;
branch circuit
Address: . Each add'i bnuic.h circuit 7.42 2
' Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular
Phone: ( )
I Fax : ( ! ) dwelling, service and/or fiseder 67.84 2
Reconnect only 67.84 2
E . Pump or irrigation c rcle 67.84 2
. ;: ' :;'' ',. : ; :' , . 3 .4 ' ,', ; P■ •• ,: : 2 ' .!:? -, Y,'',11;'', 1 :iV..;.;i i . ;, i,:,:a..';. : ;:ig, 1 1 . 0114,0itaittigit''' , t: 1 l'' . ';-- .. .. ' .: . - : ... :.....: ''. . -.'. ::-:: Sign or outline lighting 67.84 2
.... .. , ... , ,
Business name: Bridgetown Electric Signal circuit(s) or limited-energy I Sec IS A fl
panel, alteration, or extension. I Page 2 2
Address: 5701 N Lombard St. , Each additional biaimetton over allowable In any of the above
Additional inspection (1 hr rain) 66.251k
City/State/ZIP: Portland, OR 9720.3
Investigation (1 hr will) • 66.25/ hr
Phone: (503)621 I Fax: ( 3) 621 Industrial plant (I hr min) 78.18/ hr
Inspections for which no fee is
CCB Lie.: 103824 I Electrical Lic::* 6 ' I Suprv. Lie.: 41775 .. , iticall listed li hr min 90.00/ hr
'I
Suprv. Electrician signature, ,'; -.!; .M:i•' ;ffilln
iii - • . iitr" i !''
'
e i a ..e....2X Subtotal: re2,
Print name: Keith Steenslid Mae: Plan eview (25% of permit fee):
State su , ge (12% of permit fee):
Authorized signature:
TOTAL PERMIT FEE: A 4 4 *
0
-. This permit applies . • . empires Ifs penult is ant obtained within 180
Print name: Date: days a r it has been accepted as camplete.
Number of inspeeti ms allowed per permit.
I: \ BuildingTennitaLC_PalmilApp_ELR_ERE doe Rev 05,21/2011 • 440A61 STO 1/051COM/WEB
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Jun 27 2013 9:14AM Bridgetown Electric 503 - 621 -7123 page 12
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
Limited Energy Permit Fees: Renewable nergy Permit Fees:
. i.:;.!- „`. ,:: ,; :�Ti�iai�:j••�K�l.. #�">ia .. « "lq'. " +"��"i[�!�`��1�6GNAl�
Fee for all residential systems combined 111 $75.00 Deseriodal Oft. I ree 1 Twat I •
Renewable else cal energy systems:
Check Type of Work Involved: 5 kva or less 100,70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
❑ Burglar Alarm Wind generation systems in excess of 25 kva:
25.01 to 50 kva 301.04 2
❑ Garage Door Opener*
50.01 to 100 kva 552.26 2
>100 kva (fee in accordance with 552.26 2
❑ Heating, Ventilation and Air Conditioning 0 918-309-0040)
System* Solar generation systems in excess of 25 kva:
Each additional kva over 25 7.42 3
❑ Vacuum Systems* • >100 kva— no addit onal charge 0.0 3
Each additional inspecton over allowable in any of the above:
0-Other: • Each additional inspection is — 66 25! hr 1
charged at an homy (1 hr min)
Inspections for which no fee is 90.00/ hr
g2Aggg....��,,�_. rttcal listed %min
Fee for each commercial system...—. $75.00 • Subtotal:
(SEE OAR 918- 309 -0000) Plan review. if required (25% of permit fee):
State surcharge (12% of permit fee):
Check Type of Work Involved:
TOTAL PERMIT FEE:
'This permit applies lion expires de permit is not obtained within 150
❑ Audio and Stereo Systems Number of days a her It allowed accepted as complete.
• ❑ Boiler Controls
❑ Clock Systems
►ZI 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 required. Licenses are required
for all other installations
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