Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
I • COMMUNITY DEVELOPMENT Permit #: ELR2013 -00152
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/01/2013
Parcel: 1 S134AA02100
Jurisdiction: Tigard
Site address: 10300 SW NIMBUS AVE P -A
Project: FMC Subdivision: IKOLL BUSINESS CENTER, TIGARD Lot: 3
Project Description: Low Voltage for Data - Telecommnications
Contractor: BRIDGETOWN ELECTRIC Owner: FRESENIUS MEDICAL CARE, NA
5701 N LOMBARD ST 5251 DTC PARKWAY
PORTLAND, OR 97203 -4113 GREENWOD VILLAGE, CO 80111
PHONE: 503 - 621 -7122 PHONE: 303 - 712 -1814
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: 0
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: /'MA J Permittee Signature: f nL TLA T S
OWNER INSTALLATION ONLY r
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 503.639.4176 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 27 2013 9:1219M Bridg�e 503- 621 -7123 page 9 vt
Electrical Permit Aoplicatioh : i, i
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City of Tigard J J il F� t U I J R; F l A Permit 13125 SW Hall Blvd., Tigard, OR 972 3 — •
Phone: 503.718.2439 Fax: 503.598. Y OF i
�Ri � � 1 ' . r i l �l�y iew •
Other a„:
Internet: n www ti S gard- orgov �8L JI:' ll�•7V9S�1Jr� Date t0 twit,
al i la Seep 2 for
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Supplemental Information
; p;.l ' ''F�' :litl t<�'ii ^r,F' � - tip :iL .�y - "� _ - F�°.' Re.C:
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r• .4�';, ., '�`4t'. 7; +:� : *, - :� :e �'��� '.Z :•;�'4� "t ..;v'!I.{yY,��d��i '�w �aa•�~.,�� '•a'�'�" : ,
❑ s
l Y►'/�It 1at+w1x1'ic: ,. sl;;•
New construction Addition/alteratior replacement Please check all that ,, • ly (su sets of plans w,ttems checked below):
❑ Demolitio `
hr . f ul�u� ❑ Marinas sod Duce boatyards.
. :
;, �, : -,, were
a, Sty C... �� r.. _ 5 more ❑ arda,
` ,`.? KKKL ;, f; I I'',. �; ;1 1 ?@F ,. ,,; ; exceeds 10.000 a • at I 0 vole or ❑ Floating b
`. „ ng uildmga.
less to ground, or - xceeds 14,000 ❑ Commercial -use
1:1 I- and 2 - family dwelling ® Commercial/industrial ❑ Accessory building amps agricultural
❑ Multi M aste r builder uPs tar all other ' • tensions. buildings.
Y ❑ uilder ❑ Other: O F in pump.
,rsz. >,�;, ,,�., t. �j,.* ,,, •„�: •' .,W , .,. — ❑ installation of 1SO KVA or
I • : " : , ; ii .'' `,�: .'2,:'• ❑ Emer ro a to rgm sNero d system
' f '' ' a „ • s ' F � �`i•'�?�. • , , ., r . _n�� r r�Mxr?%akD(., , , . ❑ Addition of new . or load of ❑ " ` `1?', •• I st - 2 ly „ derive
Jab site address:
Job no.: %2J _ 1.1V4 10011Pormo e. occupancy.
10300 cillV N t VA ^" A ❑ Sia or MOM reside ■ dal units. ❑ Reaeaticrosl vehicle parks.
City/State/Zip: ❑ Health -cars a .. ❑ Supply voltage for more than
OR 1'ti A� 2 L Data *.
Hazardous !scabs. . 600 volts nominal.
Suite/bidg./apt. no.: I Project name: __ Li . & ❑ Service or feeder r r' amps or more.
Cross str j .rn' -''. .,
ee1/direetio to job site: !'(�, 9:; . �k, =, u ,.,_:l :w..�..' ,d. '2c� �.o.�t - : y' 4.1411.'4! ak =e,
Description OM. Poe Tetsl •
New residential al :: to- or mull- family dwelling unit.
Includes attached _ a rage.
Subdivision: I Lot no.: 1,000 sq. ft, or les 168.54 — 4
• 1'ax map/perm no.: Es. add' 1 500 sq. B. or portion 33.92 I
, ;, : ; ..,, : ,; Limited energy. residential
''` . '.p ;` ':. . •. • '- ; :: (with above eq. it, 75.00 2
Low �� r - • ( I Limited ener mul f amiTy 2
Low VOI ' i pty AJ 2 .. 1 QMAA.e,,rt. residential with , sq. ft. 75.00
, f <+ AMM p _ Services or f insmilatiaa,, alteration, and/or rdoeatlon
._. = a. ,.. ?`. 200arnpsorless
`r :'D� : '�,V A a4T'- 100.70 2
Name: 201 amps to 400 am • • 133.56 2
Address: 401 amps to 600 am • s 200.34 2
601 amps to 1,000 ps - 301.04 2
City/State/ZIP: Over 1,000 amps or ohs 552.26 2
Temporary servlc -, or feeders installation, alteration, and/or
Phone: ( ) I Fax: ( ) relocation
Owner installation: This installation is bein made or 200 amps or less 59.36 1
g property that I own which is not 201 amps to 400: 12508 2
intended for sale, lease, rent, or exchange, accordin tc ORS 447. 449, 670, and 701.
401 amps to 599 amp• 168.54 2
Owner signature:
i g . Date: Branch circuits - alteration, or extension
.. "'I`'; � ,. ; y , , . : : i ' r .'.., A. Fee for b extension, panel
°'" :r �' a"r. } � R� <l� or ranch c' •uit swirh
above servi or f= r fee,
Business name: eac b circui 7.42 2
B. Fee for branch ci - 'Is wirhoul .
Contact name: sery or fe first
branch ice circ - -, it 56.18 2
Address: Each addi branch ci • • 't 7.42 2
City/State/ZIP: Miscellaneous (se ce or feeder not included)
Each manufactured o modular 67.84 2
Phone: ( ) I Fax :: ( ) dwelling service and/ .r feeder
E - mail: Reconnect only 67.84 _ 2
' i :. f'iC+? ",M 0F4a et` :. ;i" 0 � 1 " : �F' ' - 1 , . . -. Pump or irrigation c' • e 67.84 2
: ..::', ,. nxr -0'?ad 1. r Sign or outline limn • 6784 2
Business name: Bridgetown Electric S ignal circui(s) m I'. ited•energy See C
•
pane al or cx 'on. I Pogo 2 � °I) 2
Address: 5701 N Lombard St. Each additional i - ' , a over allowable in any of the above
City/State/ZIP: Portland, OR 97203 Additional inspection 1 hr • tin) 6625/ hr
Investigation (1 hr mi) ` 66.25/ hr
Phone; (503) 621 -7122 I Fax: (503) 621 -7123 Industrial plant (l hr ' ) 78.18/1v
CCB Lie.: 103824 I Electrical Lic::' 6-887C 1 I Suprv. Lic.: 4177S s .- Wall l �16h m a 90.00/1v
Suprv. Electrician signature, sis ` - . , 6''? ~n'a 2":;� i 9 . " =.? �< '7;.`. ,.' 1."'; ,,;
Subtotal: ' 5.0 m
Print name: Keith Steenslid D ate: Plan ' (25% of permit fee):
State sure : : (12% of permit fee): q
Authorized Signature: TOTAL PERMIT FEE: ALL led
Print name: ate: This permit applies • • expires If a permit is not obtained within 180
days site it has bees accepted as complete.
x:1 &ulding\Pertnirs NELC PermitApp ELR_ERB.deo Rev OS/2l/2013 Number of inspection • allowed per perrniL
4 40 - 4u 15111 1A15/coaAVEB
• 1
Jun 27 2013 9:13FlM Bridgetown Electric 503 - 621 -7123 page 10
Electrical Permit Application — City of gard
Page 2 — Supplemental Information
Limited Energy Permit Fees: Renewable I nergy Permit Fees:
1 ., 1!'.. l i1l , .. "C � . -' � Y V nR�'DJ.r�l
Fee for Al residential systems combined.. $75.00 Description Q Pee Total •
Renewable eleet 1 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 . yatenis 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 •.rdance with 552.26 2
❑ Heating, Ventilation and Air Condit oning OAR 918-309-0 0)
System* Solar generation ystems in excess of 25 kva:
Each additional kva .ver25 7.42 3
❑ Vacuum Systems* >100 kva —no addit ! al charge 0.0 3
❑ Each additional i :patina over allowable in any of the above:
Other. Each additional i . > on is 66 25/ hr 1
charged at an hour (1 hr min)
Inspections for w '.• no fee is 90 hr
s• - ificall listed ' hr
V W h ' ii'':. _ �:' - 'i `+.:?. 7'i;•;.�'° �1::" _i:'...<;. �! t R' y3,
Fee for each commercial system $75.00 Subtotal:
(SEE OAR 918 -309 -0000) Plan review, if uired (25% of permit fee):
State su _ • (12% of permit fee):
Check Type of Work Involved: TOTAL PERMIT PEE:
Tido permit appl'. -. don expires if a permit is not obtained within 180
❑ Audio and Stereo Systems days a r it bas been accepted as complete
• Number of mspee on allowed per permit.
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Enstallatio
❑ 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 quired
for all other installations
I: lBuildmawamitAEI .C_Pernd•Mp_ELR_FRE.doc no. O5/212013