Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
• o COMMUNITY DEVELOPMENT Permit #: ELR2013 -00163
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/10/2013
Parcel: 2S112DD00701
Jurisdiction: Tigard
Site address: 15836 SW UPPER BOONES FERRY RD
Project: Durus Construction Subdivision: 1994 -006 PARTITION PLAT Lot: 2
Project Description: Low voltage for data
Contractor: BRIDGETOWN ELECTRIC Owner: PACIFIC REALTY TRUST
5701 N LOMBARD ST ATTN: N PIVEN
PORTLAND, OR 97203 -4113 15350 SE 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 07/10/2013 $75.00
12% State Surcharge - Electrical 07/10/2013 $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. ATTENTI • , : a ; • • law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -001 r + rough OAR 95 101-1. '0. You may obtain a copy of the rules or direct questions to OUNC by callin . 2.1987 or 1.800.332.234
Issued = : — �% _ / Permittee Signatur .
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 08 2013 3:24PM Bridgetown Electric 503 - 621 - 7123 page 1
Electrical Permit ApplicationRECEI E
City of Tigard 1 p eg 7 g 3 P iano rho.: Et4e- O/5-60/63
13125 SW Hall Blvd., Tigard, OR 97223 JUL 8 2013 Plan Review
• k. Phone: 503.718.2439 Fax 303.598.1960 p Other Permit:
Inspection Line: 503.639.4175 pate Renayig 0
Internet: www.tigard CITY OF TIGARD Motitied/Methoy rurim: d sup ple Page for
latent won
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Cl New construction NI Addition/alterationireplacement Please check all that apply (submit 2 sets ofph,ns w /items checked below): 1
❑ Demolition ❑Other. ❑ Service or feeder 4 )0 amps or mom ❑ Building over three stories.
;- „1 , m ; , ,. i :. , : N where the available fault current O Marinas and boatyards.
o ` * ,y a u e QF r t exceeds 10,000 amps at 170 volts or ❑ Floating buildings.
El [ - and 2 thmily dwelling Commercial/industrial 0 Accessory building less to ground or exceeds 14,000 ❑ Commercial -use agrieuNmal
❑ Multi amps for all other i arr6sllariom. buildings.
y ❑M aster builder ❑ Other: ❑F pump, ❑ Installation of 150 KVA or
? . ` `. y ^ c. ;t`I; a : ' z• n. t. •.; • Em ergency system motor toad of ❑ "A larger separately derived system.
:''; ❑Addition of new - E", "1- 2 ", "1 -1 ".
Job no.: 1'7 Li tor) Job site address: OS $i& S! UPP7;� Bt)ONf�6 )rS.QRY 2.17. F 10oHPormare. Occupancy.
etion
❑ Six du mor res irteet i al units. ID Recreational vehicle pad®.
City /State/ZIP: T6ARp, OR . G1' 13 Hw w kb & sped. CI Supply for more than
k 13 Haau 600 volts locations. 600 volts nominal. !
Suite/bldg. /apt. no.: I Project name: i ) &i. e. C.t'3NSl'Q1 citoki ❑ Serv10e or feeder 600 or more
Cross street/directions to job site: = i ;!ii C1 : , ' 4 . - ; -t. ' 17,4 1 1Ll `.- 1u.. L f st :r.°
D emerietlon Orr. yea Twat L • i
New residential single- or multi- family dwelling unit.
Includes attached garage,
Subdivision: I Lot no.: 1,000 sq. ft. or less 168,54 4
Ea. add'1500 sq. ft. or portion 33.92 1
Tax map/parcel no.:
"'' GFr' :' °i =� " „ f•^ Limited energy, residential
f'' 75.00 2
1 ,` 5 . �i�., Q� � � ( with above s R I
1 r Limited crier molt - t'amil 75.00 2
Law VO1'Tt1.0�, cnst,IAANZ, , fivdMti 4L kb - )romikhN1- residential (with above sq. it) -
RenewahhiEned! ',:,•,,-., ',:,•,,-., :' ": s:` it elY''., °, "i
O��A
'io-k- T.: c W'. I... e# LA ,t , � app ': Services or feeders installation alteratb
's ,:' ,!,-o. and/or relocation ;
e-';4- 4,,,;I! W ` '' ` '!'P;l0447 200 amps or less 100.70 2
I' 201 amps to 400: .. 133.56 2
Name:
401 amps to 600 200.34 2
Address: 601 amps to 1,000 301.04 2
Over 1,000 amps or . k 552.26 k 2
City /State /ZIP: Temporary service. or feeders Installation. alteration, and/or
Phone: ( ) I Fax: ( ) rebeadon
- 206 amps or less 59.36 1
Owner installation: This installation is being made on property that 1 own which is not 201 amps to 400 amp 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449. 670, and 701. 401 am to 599
Owner signature: Date: - extension, 2
amps amp 16854
_ Branch circuits a • ,alteration, or exte n, der panel
`4. ,; 44i?), 410 }t a' is ? "i,; ; ': :::(.' '.; : r,' :, A. Fce for bus eir • 'ta
a serv ice or f : • = fee , 7.42 2
Business name:
eac branch cite
,
B. Fee for branch ci - is without
Contact name: service or feeder f first
branch circuit 56.18 2
Address: Each edd'1 branch c' .• 't 7.42 _ 2
City/State/ZIP: Miscellaneous (_• a or feeder not included)
Poch mamrfacturnd or modular 67.84 2 •
Phone: ( ) I Fax:: ( ' ) dwelling, service and J. r feeder ,
Reconnect only 67.84 2
E -mail:
Pump or irrigation cr• 67.84 2
4/ . .' ";i !•..•:'i'ki:h ;: ', .r.:._ -± .:,.a ':117.:.--'..1 - S ow outlineli n:
. x r8n B)*b 67.84 2
Business name: Bridgetown Electric Signal cireuit(s) or Ii 'ted- energy See
- : panel, alteration, or -. , ion. I • Page 2 in. 00 2
Address: 5701 N Lombard St. Each additional ins . dos over allowable in any of the show
Additional inspection I hr min) 66.25/ hr
City /State/ZIP: Portland, OR 97203 , Investigation (I hr mi ) • 6625/ hr
Phone: (503) 621 - 7122 I Fax: (50) 621 -7123 Industrial plant (1 hr In) 71.18/ hr
Inspections fbr which o fee is
CCB Lie.: 103824 Electrical Lic::' - 6 - 887C ; I Suprv. Lic.: 4177S s • - ificall listed 55 min ` hr
Suprv. Electrician signature, - ••.n.� _ r- Y4 1E
�. i � 1. a„ �.''� t!F f `y��)'' r: .�'�i'. � �.[il *.Y2L'.K.3.^�I5 � `•'
Subtotal: 1 . a 0
Print name: Keith Steens] id Date: Plan • iew (25% of permit fee):
State sure , _ :: (12% of permit fee): c i 0
Authorized signature: TOTAL PERMIT FEE: &A .0-6
•
Print name: I This permit applies ..., expires if a permit is not obtsited within ISO
days a .. it has bees accepted as complete.
• Number of hug:t do s allowed per permit.
I:\Buildiagl ottlit AE1.0 PermitApp_ELR_EREnec Rev 05/2112013 440 11/09COM/WEI
Jul 08 2013 3:24PM Bridgetown Electric 503 - 621 -7123 page 2
Electrical Permit Application — City of T gard
Page 2 — Supplemental Information
Limited Energy Permit Fees: Renewable energy Permit Fees:
Fee for all residential system .. ,':�•. ���;`�n; � �; ``:� ^'�.�`? � ��� •
s combined... S75.00 puctpuoa Om m Fee Torn!
Renewable electri at energy systems:
Check Type of Work Involved: 5 kva or less 10030 , 2
5.01 to15kva 13356 2
❑ Audio and Stereo Systems* 15.01 tots kva 200_34 2
❑ Burglar Alarm Wind generation systems in excess of 2S kva:
25.01 to 50 kva 301.04 2
❑ Garage Door Opener* 5(1 to 100 kva 552.26 2
>100 kva (fee in : ee with
0 Heating, Ventilation and Air Condi t ning
OAR 918- I • nt 0) 552,26 2
System* Solar generations. terns in excess of 25 kva:
Each additional kva r CT 25 7.42 3
❑ Vacuum Systems* >100 kva - no addict.nal charge 0.0 3
Each sdditioaal In pection over allowable in any of tie above:
❑ Other: Each additional i ,. on is 66.25, 1
charged at an hourly • 1 hr min)
Inspections for whin r no the is
s r ifical listed !6 hr mm 90 40! hr
i7..1 ,:;.Q , ` : k t$? t', # atiV�t I,',; ,r �.c4. . y
r n 1t;;.• SL a F "i� . ,. : i : � ^L ; r w' • �..,^,�,.'r ,k '`: k
for ._�..,. � • • �- ' -:. ='v � ;•,.:; I• �"�' :.�� 3ws�::r�:>::;.f� 4':.f.. �} :��,- »�°�
Fee f '�' -�
o each commercial system. ......:„. S75.00 Subtotal:
(SEE OAR 918 -309 -0000) , Plan review, if - • aired (25% of permit fee):
State sur harge (12 %ofpermit fee):
Check Type of Work Involved: TOTAL PERMIT FEE:
❑ This permit applies on expires if a permit is not obtained within 180
Audio and Stereo Systems days r r r it has been accepted as complete.
• Number of tomcat , • allowed pm 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 r ' uired
for all other installations
I Buildin$\Pami t PermitApp_EI&ERE.doc Rev 0.721/2013