Permit n CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
' COMMUNITY DEVELOPMENT Permit #: ELR2013 -00161
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/09/2013
Parcel: 1 S134AA01800
Jurisdiction: Tigard
Site address: 10240 SW NIMBUS AVE L1
Project: Priority Footwear Subdivision: IKOLL BUSINESS CENTER, TIGARD Lot: 2
Project Description: Low voltage for data
Contractor: BRIDGETOWN ELECTRIC Owner: HANSON, RONALD D
5701 N LOMBARD ST ROBINSON, CONSTANCE A
PORTLAND, OR 97203 -4113 ROBINSON, CHESTER TRUST ET AL
203604 EAST FINLEY RD
KENNEWICK, WA 99331
PHONE: 503 - 621 -7122 PHONE:
FAX: 503 - 621 -7123
FEES
Description Date Amount
Specifics: Restricted Energy Permit 07/09/2013 $75.00
12% State Surcharge - Electrical 07/09/2013 $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 throu AR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 232.1987 or 1.800.332.2344.
Issued By: k `�0� Permittee Signature: x'`7 &
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.
Jul 05 2013 2:23PM Bridgetown Electric 503 - 621 -7123 page 1
I
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Electrical Permit A licatio ECE{VED . <;;; ; „ , , ,
City of Tigard pp Da�i
patedB 7/le � nIl Permit No.: EL./2.-,/O /3 - (JO 110 /
13125 SW Hall Blvd., Tigard, OR 97223 JJL 8 2013
Plan Review
L. Phone: 503.7111.2439 Fax: 503.598.1960 p Other Permit:
. , Inspection Line: 503.639,4175 CITY G A D Date Read) 2 for
Internet: www.tigard- or,gov JE OF 1 T I W7f3 D Notified74n • ] I m
3,!i »y`r * . {'�i'1i•' }`v�w" iii(' }.: `'1:�� •::� . .:r:..•: :v �1 r.
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•IC: ;;:,... "•;f:'1' ,�i i,�;c.': ` .�•a � .. - _ - - � :so. "r,y ',,, ,, , "Pf�!;,'•° �.'.i' �� -Ir+'j.G G� y�
'
. >.,, � � � ,., • 'Fy '1f.�,,t � �_� t :,Lt�•,:.,,;uy.n: �' L .�. , . 'w:- , ��}10E�33 C.. ��Yi. .,
❑ New construction Addition/alteration'replacement ' Please cheek all that .ly (submita sets of plans w/Itoms checked below):
0 Service or feeder I I amps or more 0 Building over three stories.
❑ Demolition ❑ Other:
•1,
i ,„ where the ava0ab( • fault current Maniacs and boatyards.
?r ri ?ifit't1 �1 lyili' :" `a:. 'r .a ; ' a i ,-I; . 'i : c i': i.;:. ;r"" - " ^ , • .
rf... .f -.,.. �..a,°�� ti `r' -
.. � .. - exceeds 10000 at 150 volts or Floating buildings.
❑ I- and 2- tinnily dwelling ,� Commercial/industrial building - less to r ail other or -' • - - 14,000 ❑ buildings.
❑ Multi -famiOther: -use agriwltural
l ❑ Master builder
0 O D Accessory ump. ❑ nstallation of 150 KVA or
ing
�:`
:,.,: ut'H: t .,,
=: <;�. � : �,�'si<' �, t cy1 +•:. .w:;��� ,.. _ ❑ Enrergenry sys •
larger separately derived m
.. ,_;; t. t:t;�v(:I'.It.'i�T ). • 5 F • 0 :40 !. ,,,;��;, ' I� i _
^�' ., �;'.' ' •'::_... '.:';.< , :,=_ DAddition. of new or load of 0 "A ",••p;•1 "1_p,
Job no.: 1 ti j I Job site address: (Q 2 4 et ' J >' J 1,A80 f e / E. occupaa
D Six or more res • units.
['Recreational vehicle parks.
City /State/ZIP: -"T760.-a, Al') 111
2' ❑ Health -care (=din -,. 0 Supply voltage fm more than
tJbl 1 I r ` Li -- D Hazardous locaho 600 volts nominal. Suit
dg apt. no.: L i J Project name:') - P Socti.. v,(„pted ❑ Service of feeder ' ' I amps or more.
Cross street/directions to job site: ? ., 4 11t'gl, : I ` . fro' ( -' s ice . , v 'n tl^ EP•:q y
,'
.' 8..1w
New realdeotlat al ,: le- or mold- family dwelling nor%
__. Includes attached i rage:
Subdivision: Lot no.: 1,C00 sq. ft. orless 16&54 4
Tax map/parcel no.:
Fa. add'I 500 sq. ft. r portion 33.92 1
Y „, ; ,. * . ;, ; , I , ; . „ „, ,�. Limited energy, rot”- tial t/M
'^.' r + :'�: "i`r141A;',•r4��n'I? . ; :j ±; ., , 'S v - etch above tY�, ' 75.00 2
l Limited energy, mul 1- family •
, \!'151 . ccfa IAA 1vu S( ,4Wh., gitgAAMprie . At IPMAAAAnt residential with : • • a9: ft.) 75.00 I 2
TICK
l.OJ1t)ia Services or tasWlati° ' a iioa, andlo f i;
Itera relocation
•1? .' u _ t. N - r i:! ?i . ..: 1:_I ;,Id; •.: - ' '.; ', 200 amps or lees 100.70 2
Name: 201 amps to 400 133.56 2
401 amps to 600: 200.34 2
Address: 601 amps to 1,000: , cps 301.04 2
City/State/ZIP: aver 1,000 amps or ,:. is 552.26 2
Temporary servi or feeders installation, alteration, and/o
Phone: ( ) I Fax: ( ) relocation
200 amps or less 5936 1
Owner installation: This installation is being made on property that I own which is no 201 amps to 400 :, 125.08 2
intended for sale. lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
401 amps to 599 . 16&54 2
re
Owner signature: Date;
�, � _ Branch circuits - ; . alteration, or extension. panel
:4� 'i:;:.4 '7
tt. ..,.b.,tI�7' "r' "7;s r5 - -: - . Fee for branch cl
:',..` :: ^'r~' - -n p,...iw1..'; .. � 1 .. jl 1 ,4.. M :1� - I > r . •'Y ��"��,}�' :-�`i•. ; ' : A F ' Wn with
above service or f,- • - fee,
7.42 2
Business name: each branch circui
B. Fee for branch ci • its without
Contact name: service or feeder f- first 56.18 2
branch circuit
Address: Each add•I blanch c'' it 7.42 2
City/State/ZIP: Miscellaneous (. - ' .. or feeder not Included)
Each manufactured modular
Phone: ( ) I Fax:: ( . ) dwelling, service , •''•r Ibedir 67,84 2
Reconnect only i 67.84 2
E lV �; ,v ! Ptanpor irrigation ci; le 67.84 2 •,., . %'.a:,; °, s "i , ,iv t; ; 7 *a k, y ' iii - ' , ... -._ . _ , - Sign or outline fish
NI j Business name; Bridgetown • 67.84 2
dgedown Electrle Si gnal circuh(s) or 1 , and -energy I . 14 co
panel, alteration, or •' ,.: ion, Pace 2 2
Address: 5701 N Lombard St. Each additional • -, on over allowable in ally of the above
City/ State/ZIP: Portland, OR 97203 Additional itopuedon,, i hr rain) 66231 hr
Investigation (1 hr mi, ;) • 66.25/ hr
Phone: (503)621-7122 Fax: (503) 621 - 7123 Industrial plant (1 hr !,1 ) • 78.18/ hr
Inspections for which' • the is
CCB Lic.: 103824 Electrical Lic: :' 6 -887C 1 Suprv. Lie.; 41775 s . ificall listed )4 min 90.0 hr
,, T-. ,,� L p. —`. . r.:1; :it ;+s
Suprv. Electrician signature, I s' 3 '' r. e 1 F k Asa,,. ls� :i hJs
Subtotal. ` yarn
Print name: Keith Steenslid pate: Plan . iew (25 %ofpermit fee):
State sur (12% of permit fee); 6 t.Or6
Authorized signature: TOTAL PERMIT FEE: 811, rso
Print name: Date ' Tbia permit sppileaapn aspires if a permit is not obtained within ISO
days atkr it has been accepted as complete.
' Number or inspeoriois allowed per permit.
1.IauildinalPermics\FLC PermitApp_ELR_EREdoe Rev (512112013 -040.461 ST( 11IQS(CQ14L'W?a :p
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Jul 05 2013 2:24PM Bridgetown Electric 503- 621 - 7123 page 2
Electrical Permit Application — City of Tigard
Page 2 — Supplemental Information
Limited Energy Permit Fees: Renewable 00 , ergy Permit Fees:
.f ,.,•,,: .,, .r „w..; . . .. .... ... .. . ... " }%; �' ' }t:`S'sl %a: ' :•. ��;' �, i• "�' •'�.'�•�_ " 4^`Y n o� 'n�.a^a � r{! r ,
Fee for all combined..,.:... Dual. a •L'q. , . 4 _ �__ ' a d m : .�%}�+5 �� a{Li
residential systems combined.. $75.00 •
Reoe �� t ep ss' irr"'>•s�r�
wabie electrl 1 energy systems:
Check Type of Work Involved: 5 kin or less 100.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems*
15.01 toes kva 200.34 2
Mod Burglar Alarm ad generation :tenth: excess of 2S kva
25.01 to So kva 301.04 2
❑ Garage Door Opener* 50.01 to 100 kva 55226 2
>I00 kva (fee in ; with 552.26 2
❑ Heating, Ventilation and Air Conditioning _ OAK 918.309 i)
Systems' Solar generation , ms in excess of 25 kva:
Each additional kva ; vet 25 7,42 3
❑ Vacuum Systems* >100 kva —no : •
charge 0.0 3
Each additional . ; on over allowable in any of the above:
❑ Other: Each additicrial ins i9 66:25/ hr I 1
charged at an hourly; l hr mien)
inspections for wh' no fee is 90.00/ hr
s . - 'ficall listed br in
^ - ,..,,., .r. tT1 n; :i;J .: 'I' ; ;fi;r.i :�Y . •;.� s�i�..�._ ,fi N .. rr..... i
Fee for ask commercial syste $75.00 Subwtal:
(SEE OAR 918- 309 -0000) Plan review, if - . •uircd.(25 %of permit fee):
State : .. (12%ofpermit fee):
Check Type of Work Involved: I TOTAL PERMIT FEE:
This permit ap • ' ' ' • expires if a permit ix net obtained within ISO
❑ Audio and Stereo Systems days a, .. • r it hap been accepted as complete.
• Number of inspe - allowed per permit.
❑ Boiler Controls
❑ Clock Systems
® 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 •
1:1aut}SmalPermlteELC Pmm'vApp_E1.R.RE.Ooa Ray 051214013
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