Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
n . COMMUNITY DEVELOPMENT Permit #: ELR2013 -00173
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/18/2013
Parcel: 2S101AD03100
Jurisdiction: Tigard
Site address: 6950 SW HAMPTON ST 221
Project: Numedics Inc. Subdivision: WEST PORTLAND HEIGHTS Lot: B
Project Description: Data telecommunications.
Contractor: BRIDGETOWN ELECTRIC Owner: WESTON INVESTMENT COMPANY
5701 N LOMBARD ST ATTN: JOSEPH E WESTON
PORTLAND, OR 97203 -4113 2154 NE BROADWAY ST
PORTLAND, OR 97232
PHONE: 503 -621 -7122 PHONE:
FAX: 503 -621 -7123
FEES
Description Date Amount
Specifics: Restricted Energy Permit .07/18/2013 $75.00
12% State Surcharge - Electrical 07/18/2013 $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 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.
i
Issued By: / - Permittee Signature: e e/ePLJC�/ 749/
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 503.639.4176 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.
Jul 18 2013 10:38AM Bridgetown Electric 503 - 621 -7123 page 1
Electrical Permit Application ! r :1•:::.I ; l' 1 : ,1
City of Tigard Daiwa •• '7 � �' 14°.-4 -/.20/_3' -- AO/ 23
6 l h Phone s 03.716 2439 T Fa x 03.550 FIVE ® PDateav: Other Permit:
Inspection Line: 503.639.4175 Dore Ready/Ely: Curb B See Page 2 for Internet: www.tigard-or.gov JUL 1 8 2013 Notifi,,vm thud 7 - - ,, Supptemmt.i Inferential
- : �SiI ++rr ' 1
13 New construction ® Adtiitio n/al . ' rr `' 1 �/ Please cbcek 411 that• apply (submit j se s of plans whiems checked below): ii
I it I I V N ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑Other: where the available fault current ❑ Marinas and boatyards.
%;z. -: ` k
` . ,, ' 'r :'' exceeds 10.000 amps at 150 volts or ❑ Floating buildings.
= less to gratmd, or enemas 14,000 1] Commaciahtse agricultural
El 1 - 2- family dwelling Commercial/'industrial ❑ Accessory budding amps for all other installations. Imildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 150 KVA or
y
w 4 ;L ❑ ncy ay
. larger separately derhred system.
........;,'.. .:r. ": ' , ; )4,0,/'4:4)411.00(.:(:: .:,- .`a ❑Additi000fnow motor load of 0 - " 2,..,
� y
' 10010 or more. occupancy.
Job no.: (2 - 15 ' Job site address: (p q ;0 SW 440044/51A, ❑ sin or more residential units. 0 Recreational vehicle parka.
City/State/ZIP: 11 ql 22 3 ❑ healthcare facilities. a Supply voltage for more than
'f CI Hazardous locations. 600 volts nominal.
Su ite/bldg. /apt. no.: 11 I - Project name: 1 el•i.cAS 'vcG. ❑ Service or feeder 600 amps or more.
Cross street/directi0ns to job site: nas , ors, 1 Rea l J W f • :±
New reaideotlal single- or naltl- family dwelling stmt.
Includes attached garage.
Subdivision: Lot no.: I,000sq, ft. or less 16854 4
Tax map/parcel no.: Ea. add'] 500 sq. ft. or portion 33.92 1
Limited energy, residential
(with above M. @.) 75.00 2
1 (r` L Limited energy, multi -famiy
Law V1114 ., firm tAZw �4tlVtA. AJ1YMuAPLe AO 4amamk 51V AA.11 -. _ deatial�withaovestl. ft;.),„ 75.00 2
CIPAA.c..+ s f t.R.. Services E- I n s : ll ; terado rr
- e
tH °;: l0 j',X' ,! k1Vi ;_' '"%;i' ' `; ' . '..:L. :" `. : ' -+ 20O snips or ro Installer , tYloa 2
feeders lion alteratloa, andMr nicer
less 100 70
Name: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Address: 601 arttps to 1.000 amps 301.04 2
CitylStattJZfP: Over 1,000 amps or volts - 552.26 _ 2
Temporary services or feeders iaatalladon, alteration, and/or
Phone: ( ) 1 Fax: ( ) relocation
200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 12508 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 16854 2
Owner signature: Date: Branch circuits - env, alteration, or extension, per panel
A. Fal for branch circuits with
above service or feeder feu,
Business name: each branch circuit 7.42 2
B. Fee fbr branch circuits without
Contact name: service or feeder tee. first 5618 2
branch circuit
Address: • Each add'I branch circuit 7.42 _ _ 2
CitylState/ZI P: Misedlaneous (service or feeder not Included)
_ Path manufactured or modular 67.84 2
Phone: ( ) I Fax:: ( ) dwelling, service and/or feeder
Reconnect only 67.84 2
E -nail: Pump 1 e
or irrigation circle 67.84 2
.. <<:. . _ . .. .. ,CQL!J;lEIVOIKIlt•: - _ - . . .. • . . - Sign online lighting 67.84 2 I
Business name:s Bridgetown Electric Signal circait(s) or limited See
panel, alteration, or extension_ 1 Pao 2 15 2
Address: 5701 N Lombard St. Each additional Inspection over allowable In any of the above
CitylStateJZIP: Portland, OR 97203 Additional inspection (1 in mat) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
Phone: (503) 621 -7122 I Fax: (503) 621 -7123 Industrial plain (1 hr min) 78.18/ hr
Inspections for which no fee is
CCB Lic.: 103824 Electrical Lic::' • :: 7C Suprv. Lic.: 4177S • :: ificall listed h hr mia _ 90`0/ hr — Suprv. Electrician signature, !Mr ti. t :. -,.r� 77 �`!,ak d .'. ° ` x,714.: i A : �, 4
Subtotal: 1 Ci . 0
Print name: Keith Steenslid Date: Plan review (25% of permit fee):
State surcharge (12% of permit Poe): , 06
Authorized signature: TOTAL PERMIT FEE: 614.00 7
Print name: Date: •ads permit application mires ifs permit is not obtained within 180
days after It has been accepted as complete.
• Number of inspections allowed per permit.
I. 18ailding\ Peimits1ELC_PmmhApp_FLR_ERE.doe Rev 0521/2013 410.46157(I I/05 /COMJWER
Jul 18 2013 10:38RM Bridgetown Electric 503 - 621 -7123 page 2
Electrical Permit Application – City of Tigard
Page 2 – Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
i" _ , 1 4'E'�i,`.r.�'Gi: :•J.0 ; + /. -• � � fGvl. r .�' ]] •' 71 r ,ri.•�: �4
- ..... {.. •:5 , E�, ter. r..e w.r <ana :. c- ..F�4 �r.:: .'r .� _ a �
k
Fee for all residential systems combined........ $75.00 Deserlollea on Fee Total
Renewable electrical energy systems:
Check Type of Work Involved: s 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 systems in excess of 25 kva:
25.01 to 50 kva 301.0 2
❑ Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva (fee in accordance with 532.26 2
❑ Heating, Ventilation and Air Conditioning OAR 918409 -0040)
System* Solar generation systans to excess of 2S kva:
Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva— no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ Other chanted et an hourly (1 hr min) 66.25/ hr
Inspections for which no fee is 90.00/ hr
:,.._ s. •ficall listed Sibs min
• i r :r f>;' � �: r � .tF n l ;y - r^ "' ) .n. �'(P'+ ++: v� ry ..
4:l3f.', 2; . .. S7. Y .I r °!T. 4L .z F ' • 1M_ ti
Fee for each commercial system.. ......... .. ..... » «. $75.00 Subtotal:
(SEE OAR 918 - 309 -0000) Plan review, if required (25%ofpermit fee):
State surcharge (12% of permit fee):
Check Type of Work Involved: TOTAL. PERMIT FEE:
This permit application expires if a permit Is not obtained within ISO
❑ Audio and Stereo Systems days after it Ina been accepted as complete.
• Number of inspections 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
l lauildinglHmciu \ELC_PcnnitApp_F1R_fiRE.dac Rev 05121/2013