Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
1 • COMMUNITY DEVELOPMENT Permit #: ELR2013 -00151
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/01/2013
Parcel: 2S112DD01600
Jurisdiction: Tigard
Site address: 15575 SW SEQUOIA PKWY 180
Project: Docusource Subdivision: PACIFIC CORPORATE CENTER Lot: 4
Project Description: Low Voltage for Data - Telecommunications
Contractor: BRIDGETOWN ELECTRIC Owner: PACIFIC REALTY ASSOCIATES
5701 N LOMBARD ST ATTN: N PIVEN
PORTLAND, OR 97203 -4113 15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 621 -7122 PHONE: 503 - 624 -6300
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)
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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: I v Permittee Signature: 54 C_ Are'. A T O'er
OWNER INSTALLATION ONLY 1
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: 11RM Br idgetpu.E Lef ip , 5 0 3 - 6 2 1 - 7 1 2 3 page 7
,..
Electrical Permit Aordicatio* El v ,1.--- .' ,i,I,,,iii,
11 . City SW Hall Blv of Tigard
Tigard
UN 2 7 2013 Receicatvedy:
Permit No.h.R. a 0,1 -ovis
-- 13125 d. Plan Review
ir. Phone: 503.7182439 Fax: 'C)R 97223 J 503.598.19 . Dase/Bv: Other Permit
, . . L, I P inspection Line: 503.639.4175 l ITY OF TIGARD Dale Ready/By: Joris: I ill See Page 2 for tioa
Internet www.tigard-or.gov
5 j TNG DIVISION - "'fled/method
' - - , •r,f.._.,.:.,.. . ,-•:, --•.: • :: --,-,:'.:• - ,.,.. -,. .::. , ::::_.•4: , _ - :r ti:CiAc:
0 New construction IN Addition/alteratio .. replacement Nesse check id that i .. r (submit 1 Sae of plans Wham ehedced below):
0 Service or keder . i . amq3s or more Ei Building over dune stories
0 Demolition 0 Other: where the avails i ie fault outran 0 Marines and boatyards.
> ' ,.... 1i,:?. , ' ''; i :.. ';'.., -.. -: .: ' ..,'..". ...,2 " :,,:.: ..', "'.,.:."_- :. exceeds 10.000 '. i. at 150 volts or o Floating buildings
.
less to gratmd . or eds 14.000 0 Comincrcial-use agrieu• karat
0 1- and 2-farnily dwelling ig Commercial/indu . al 0 Accessory building amps for all nate installations. buildings.
0 Multi-family 0 Master builder ' 0 Other: °Fire pump. 0 Installation of 150 KVA or
; :T. 440. ': :-. - :'.. : ' '-,:;:'-.: SA 1 ' oz ' or toad of El l '7, r-frar,T2'
100HP or more. occupancy.
Job no.: V ... 4 2.9 Job site address: 1%75 rtA 5 0 six er res .. ‘. ter units.
0 Recreational vehicle parks.
City/State/ZIP: ''‘5.-13/ OR. cil 7.- 1 n 0 itealth-care facili , Us. 0 Supply voltage. for more than
• 0 Hazardous local t , ;. 600 volts nominal.
Suite/bIdgJapt no.: i bea Project name:VoyjoraiNete3rIA )4kfrea. 0 Service or feeder .. i ,. i - or mons.
'
Cross street/directions to job site:
iii...'kia'-j-arrnmll•I •
I New residential • ngle- or muld-famlly dwelling unit. Indudes attache. ■ garage.
Subdivision: .1 Lot no.: 1,000 aq ft or less 168.54 4
Ea. ackl`l 500 sq. ft. ,. portion 33.92 I
lax map/parcel no.: .
• . Limited energy. tee' ntial
75.00 2
0,1*,i ,., " i,,,y . : , ', :. .' . . ".-:": -,-:::", (with above sq. -)
Limited energy. mu i-family
75.00 2
LW voi !.. , -c t..1.1 , 4...... ' 1•0 A- A _ +. A. "- l , l' ......A.. kit'. residential (,„,with bave ag., ft.)
latiiftkiigni' ' 7.0 ''.',.., . :,. ' ._,":,.•_
l!r".1.kr:tm'-.A.,2‘d.17(P4)1A1./ Services or feed installationoilteradon, and/or refutation
''.1
:1,:::?•.1.4‘;;IA;Uncefe,eittrilayee4:.;Vt;;.-1::',13,': ;;,.'.-;:,, ... : ...!;: ' .;c3t, , ,., ,-' ....t , 20 0 aluFs Or leas 100.70 2
201 ampsto400ajnps 133.56 2
Name: 4(11 antpstoeoosi4e 200.34 2
Address: . 601 amps to 1,000 ' 301,04 2
Over 1,000 amps or ohs 552.26 2
City/State/ZIP:
Temporary eervlcn or feeders installation, alteration, and/or
Phone: ( ) I Fax: ( ; ) relocation
200 amps or less I 5936 1
Owner installation: This installation is being made on Property that I own which is not ' 201 aiTtpsto400nrnxs 125.08 , , 2
intended for sale, lease, rent, or exchange, according t� ORS 447, 449, 670, and 701.
401 amps to 599 am s 168.54 2
Owner signature: I Date: Branch circuits — 4 ew, alteration, or estentdon, per panel
, :1 toi .:: '::. ,, A. Fee bmneh o cir r nits w
7
.
Business name:
B. Fee breal:Inc:11.° .42 2
M Is without
Contact name: service or fbeder fee. first
56.18 2
- branch circuit :
Address: .
Each add'I branch circuit 7.42 2
Igiscellaneaus (service or feeder not included)
City/State/ZIP:
Each manufactured or modular
6724 2
Phone: ( ) I Fax : ( ! ) dwelling, service tuuLor feeder
Reconnect only 67,84 2
E-mail:
Pump or irrigation circle 67.84 2
,
,,,...;v,i;e'. I ,,'"' i'l !...--,, - . , ;.;.:‘,.;, ,: • ,, . , .... . : . ,. i - .:, sign or outline ughtini
67.8.4 2
Business name: Bridgetown Electric Signtl gy Page ls a • 2
— I
Address: 5701 N Lombard St. , Each additional Inspection over allowable In any of the above
Additional inspection (1 hr min) I_ 66.25/ hr
City/State/ZIP: Portland, OR 97203 ,
Investigation (1 hr mi ) • 66.25/ hr
Phone: (503) 621-7122 I Fax: (503)621 Industrial plant (I hr . in) 7 8.18/ hr ...
Inspections for which • fee is
CCB Lic.: 103824 I Electrical Lic::' 6 ' Suprv. Lic.: 4177S a. china listed min 90.00/ hr
1
Suprv. Electrician signature, - . ell/ tr,&.....e.,.....e27. Sulxotal: 1 . 06
Air
Print name: Keith Steenslid ' Date: Plan - - (25% of permit fee):
-
State sum . ; :: (12% of permit fee): 9
Authorized signature:
TOTAL PERMIT FEE: 84.00
This permit application expires If a permit is sot ebullient withia ISO
Print name: Date:
. days after it has been accepted as easukte.
• Number of inspection s allowed per permit.
1:1Buildireennitb■ELC J Rev 05/21/2013 . 440
. 1
Jun 27 2013 9:12AM Bridgetown Electric 503 - 621 -7123 page 8
Electrical Permit Application — City of Tigard
Page 2 Supplemental Information
Limited Energy Permit Fees: Renewable 3 nergy Permit Fees:
Fee for residential systems combined.., • $75.00 Deeniatiee ' ty 1
Oh . Fee Tool •
Renewable electri energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva
❑ Audio and Stereo Systems* 133.56 2
15.01 to 25 kva 200.34 2
El 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 acce,rdance with
SSZ
OAR 915- 309 -00 0) .26 2
Heating, Ventilation and Air Conditioning 1'
System* Solar generation s stems in excess of 25 kva:
Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva— no additional charge 0.0 3 ;
Each additional in speelian over allowable in any of the above:
❑ Other: Each additional inspection is
charged at an hourly ; l hr min) 66.25/ hr l
Inspections for which no fee is 90.00U hr
s • •• iticall listed 14 hr min
a
Fee for each commercial system ................. $75.00 Subtotal:
(SEE OAR 918- 309 -0000) Plan review, if -, aired (25% of permit fee):
State surcharge (12•% of permit fee):
Check Type of Work Involved: TOTAL PERMIT FEE:
El This permit application expires ifs permit is not obtained within ii
Audio and Stereo Systems days after it has been accepted as complete.
• Number of inspections allowed per permit.
❑ Boiler Controls
❑ Clock Systems
® Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
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❑ 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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I: 113 ui :ding ERfi.doc Rev 03/21/2013
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