Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
s: COMMUNITY DEVELOPMENT Permit #: ELR2013 00167
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/16/2013
Parcel: 2S113BA00400
Jurisdiction: Tigard
Site address: 7632 SW DURHAM RD, STE# 105
Project: Avamere Home and Hospice Subdivision: ROSEWOOD ACRE TRACTS Lot: D
Project Description: Low voltage for data
Contractor: BRIDGETOWN ELECTRIC Owner: PORTLAND SW CENTER LLC
5701 N LOMBARD ST BY FELTON PROPERTIES INC
PORTLAND, OR 97203 -4113 ATTN: FELTON, MATT
520 SW 6TH AVE, STE 610
PORTLAND, OR 97204
PHONE: 503 - 621 -7122 PHONE:
FAX: 503 - 621 -7123
FEES
Description Date Amount
Specifics:, Restricted Energy Permit 07/16/2013 $75.00
12% State Surcharge - Electrical 07/16/2013 $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 t • gh • • ' 952- You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800,332.2344.
I
Issued By. • ' /' Permittee Signature:
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 02 2013 2:37PM Bridgetown Electric 503 - 621 -7123 page 1
Electrical Permit Applicatio I IVES , : ,I: ill 1 ,. ; . ,; , , \ ; ,
City of Tigard Received � . P ernwt No.: s - Ct7
J L 2 2013 >�e ll : .// S- 3 r � 3 /6, Z
;42 SW Hall Blvd., Tigard OR 97223 plan Revie,b / 1 • -
L. e: 503.718.2439 Fax: 503.598.1961. D Dole/Bv: � I Other Permit:
i Inspection Line: 503.639.4175 G, OF T1GARD bale Ready13y: If lurk.: ® See Page 2 for
Internet: Information
www.ti d-or ov '= ` Supplemented � .g �) 1� 1;! V Is Notified/Mtthod: I SupplemInformation tiif:•. : O 1:- G '9d _ ti:.,, ..,is +• Bah 1. 1
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check all that (submit sets of e
❑ New construction lddition / alteration , replacement ' ' :; .• y ( a plan w/>tems ahecloed below/:
I ❑ Service or feeder 0 amps or more ❑ Building over
three stories.
❑ Demolition ❑ Other:
e.. '1 ;6C t`�
� ,v where the avail fault current ❑Marinas and boatyards.
, .. "" n i ;il %; ;; f li . <' i '+' F�!`0 ' - `' "" exceeds 10,000 at 150 volts or ❑ Floating ,;,,..:, .�.: ;! :: .�� 4'� >R3 . C wt �_ . :: , - :. ; . ; ' ' , . s buildings.
:, I h less to ground, or Is
El I - and 2 -f ly dwelling Commercial/indus• ia1 ❑ Accessory building � seeds 14,000 ❑ Commercial agriculnaal
amps for all other nations. buildings_
❑ MUlti-famili 0 Master builder ❑ Other: D Fire pump. r ❑ installation of 150 KVA or
F _r TIP i ;_,� ':'' _ s ` i ' , _ ❑ Emergency systel larger separately derived system..
�' ; j �`
' "' "`'�, � - , . `n '' 0 Addition of new tnI for load of
Job no. :4'3,' - . 1 i•r$; � Job site add ress: j . S VI D .A . 100HPormore. occupancy.
a ❑ Six or more res' IeI units_ ❑ Recreational vehicle parks.
City /Slate/ZIP:7 (, / _ D Health -care Mcilin ❑Supply whage for more than
❑ Hazardous bcatim 600 volts nominal.
Suite/bldg. /apt, I no.: / 0 S roject name: /91709 - 1672.6 i',16" f ihrsPf • -. CI Service or Rieder 6 amps or more.
nkq r ∎ : „'I�� a !L-'< !: :' , 1' . I '. ` 774 end ;l,11.. ' '''�1.,,,
I (77% , i „ . L ,. i' 1. , u:. s :�:y, ,: . xF k a: "d ;f`�' 4.i)
Cross street/directions to job site: ./ �_�+� - - - al . - . ion 1, • " r Toes •
i L ' i p New residential stogie- or multi -family dwelling unit.
PA/ 6 Includes attached I .rage.
Su bdivision: I Lot no.: 1.000 s4 ft'm lea 168.54 4
Tax map/parcel Ina..
Ea. add'I 500 sq. ft cr portion 33.92 1
_ ;.; limited energy, taxi - alike/
'...... 7500 2
.. _ = � with orb '
-.. . . _ - °.• ^ ^ � •,��„�,� k ., _ I wl ova . ft''
7:- _ � .. -- - : ; .. .. /smiled energy, mul " 2
. Le k/ rr 3 1 • , residential (!nth I - family
•, it. _: 75.00 _
. )\ " t•Mi( .4 kL a..o Services or In st tioo, Almaden, and/or ca ': o ,.
jL feeders.loala, / reloeatlon
- P..) RT sO: � 1 = 1 ,'`.:5..11' „': ' • :j; 200 amps or less 1 100.70 I 2
Q: ::>r�I+rtty r :
- . 1
201 amps to 400 am 133.56 2
Name:
401 amps to 600 am$s 200.34 2
Address: 601 amps to 1.000 slips 301.04 2
City/State/ZIP:
Over 1,000 amps or rolls 552.26 2
Temporary services or feeders i nstallation, alteration, and/o
Phone: ( ) I Fax: ( ) relocation li
200 amps or less 11' 59.36 I
Owner installation: This installation is being made o property that I own which is no 201 an to 400 atnils 125.08 2
intended for sale, lease, rent. or exchange, according t.' ORS 447. 449. 670, and 701.
401 amps to 599 amhis 168.54 2
Owner signature: Date: Branch circuits - dew. alteratio or ex tension, per panel
I ,;r:.i F k:; - or brarc w
u its ith
z�;,��..1 ; ;i': ; .�]'C4t!1'lr PF�I+I' -
A. Fee f abav e s erv ice nch or ci E fee, 1.42 2
Business name: each branch circuit
B. Fee for branch circuits without
Contact name: service or feeder fee, first 56.18 2
branch circuit II
Address: Eacb add'1 branch cirrttit 7.42 2
City / State/ZIP: Miscellaneous (service or feeder not Included)
Each manufactured op modular 67.84 2
Phone: ( ) Fax : : Q
dwelling, serviceand/or feeder
1 Reconnect only IF: 67.84 2
E -mail:
., i. � Pump or irrigation side 67.84
;' ' .:: "M ` . '' - 4. '; •, 041 Sign or outline lighting 67.84 / 2 2
Business name: , 'Bridgetown Electric Signal circuits) or liiriced .energy
1 alteration, or wrw sion.
Address: 5701 N Lombard St. Each additional inaipecdon over allowable In any of the above
Additional inspecdo61(1 hr mm) 1 66.25/hr 1
City/State/ZIP: Portland, OR 97203 investigation (l hr mm) 6625/ hr
Phone: (503) 621 -7122 Fax: (503) 621 -7123 Industrial plant (1 hr Olin) 78.18 / hr
inspections for whicti[no fee is
CCB Lic.: 103824 Electrical Lic 6 -887C 1 Suprv. Lic.. 4177S e. - 'fall listed 'hlhrmun 90.00 / hr
Suprv. A. ;ljx W1:%"`�';°'o tc l5 ,.'.. :4; -i � ;5i: ; ;:��'y ?
pr .Electrician signature, 11 Subtotal: ���
Print name: Keith �� �3
th Steenslid Date: Plan review (25% of permit fee): Q
State surcharge (12% of pemtit fee): /
Authorized signature: III
TOTAL PERMIT FEE
Print startle: This permit application expires if a permit b not e d within 180
Date: days after it has been accepted as complete.
• Number of inspections allowed per permit. if I/
: !8uildneenmitssELC_PtrmitAn_.EU ERF,doe Rev 05r11,2013 440.4615T(IINSI(OMJWE6 ' /
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