Permit rl CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
111 n - COMMUNITY DEVELOPMENT Permit #: ELR2013 -00179
Date Issued: 07/25/2013
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 2S 25/201 0101
Jurisdiction: Tigard
Site address: 16101 SW 72ND AVE 100
Project: OAICU Subdivision: ROSEWOOD ACRE TRACTS Lot: D
Project Description: Data telecommunications.
Contractor: BRIDGETOWN ELECTRIC Owner: PACIFIC REALTY ASSOCIATES LP
5701 N LOMBARD ST ATTN: N PIVEN
PORTLAND, OR 97203 -4113 15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 621 -7122 PHONE:
FAX: 503 -621 -7123
FEES
Description Date Amount
Specifics: Restricted Energy Permit 07/25/2013 $75.00
12% State Surcharge - Electrical 07/25/2013 $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.
Issued By: Permittee Signature: ON / e 1. , ° Gl 69
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 603.639.4176 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 25 2013 10:43RM Brid tEt 503 - 621 -7123 page 1
Electrical Permit Aoolicati , ;) l: ,: , i : ; ; , ,
City of Tigard JUL 2 5 2013 R 7 411 PennitNo£ 4 . Oa -DD /79
13125 SW Hall Blvd., Tigard. OR 9 Plan Revie
Phone: 503.718.2439 Fax: 503.598 OF TIGARD Date/By. Other Permit:
, , , , ,, , . Inspection Line: 503.639.4175 ni iii Ir DIVISION Date Rr Ready/13y: 3ut1f
�e r St:" Pane 1 for
Internet: www.ti d-0r v NotifiediMetbod;
tl� �o tle a as nllnformatioa
.. - , , :).� ., r _x _..1 - - � Wa d rmfu:�u:rwu' - - s Ili
• -, . . ;.f!•r .. .. .. _�. lii�7- : °i. ^�Tn ::-f' _ ;� _ .... y
v�tii :IYi,.�.�' t
❑ New construction ® Addition /alteration /replacement Please check dl thatapply (wbrnit sets of plans Wire= checked below):
❑ Service or feeder 400 amps or more 0 Building over three storied
❑ Demolition ❑ Other:
. . - where the avnhilabla fault current 13 Marinas and boatyards.
„ - da'�:�a1, f� ice _ _ -
.... a','i 4- . .., .. ;,'� ?:a.F� .: ,• _ _ - •,. ercceeds 10,000 aahpe ffi 150 or ❑Floating buildings.
❑ 1 -and 2 family dwelling ® Comrrcrcialrndustrial 0 Accessory building to so o or axoeeda 14 volts ❑ Commercial agricultural
❑ Multi-family amps for all °� i"°"°' baildiags.
Y ❑ Master builder ❑ Other: • ❑ Fire pimp. ❑ Installer of 1 So K VA or
rt <' ❑ FSnerS�r sy larger separately derived system.
'' , _: c` `' <'f4i !
;', . ❑ Addition of new moter load of ❑"A". ' I.3'.
Job no.: 11 SO l; Job site address: ((p 10 1 SW 7 Z „A AIL looHP or more, occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State/Z[P: 'prL1av4,1 , Oct -1I 214 ❑ Health -care facilities. ❑ supply voltage for more than
V no.: 100 I OA C U O Hazardous eor feeder 600 600 volts nominal.
Project na me: V ❑ Service or teals 600 or more.
Cross street/directions `S 4:r.�Ft.A.'�! K.:,F F y - ," ? .. ,1 - ;r yG . , ii. a.
rections to job site: r'` '` * "` , � = % .
Description Our. Fee, Tsui •
New residential single -or mulddamlly dwelling unit.
Indudes attached garage.
Subdivision: Lot no.: 1,003 sq. ft. or less J 168.54 4
Fa add'/ 500 sq. ft. or portion 33.92 1
Tax map/parcel no.:
Limited energy, residential
:n',? ;lKSru; t,: (witb above sq. ft.) 75.00 2
(� 1 Limited tnhtxgy, multi- family 75.00 2
YV'Y,,w w,. e yy�we c, 40 ►*' %pate , •f - residential with about . ft.
Lt. Low i_I- R�Rlabl4e:' =,': 1,71„...7...u.::::,2 •' .
t/ ( ""`c Services or feeders iaeiailatlon, alteradon, and/or relocation
' 0 T _ 00 amber or less 100.70 2
Name:
2201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Address: 601 amps to 1,000 amps 301.04 2
City /State/ZIP:
Over 1,000 amps or volts , 552.26 2
Temporary services or feeders installation, alteration, and/or
Phone: ( ) Fax: ( ) relocation
200 amps or less 59.36 I
Owner installation: This installation is being made on property that I own which is not 201 to 400 amps 12308 2
intended for sale, lease, rent, or exchange, according to ORS 447. 449, 670. and 701. 401 amps to 599 amps 168.54 2
Owner signature: Date
Brandt drcaita - hear, alteration, or extension, per panel
": 0>.} ,88t.AIYT i ;`- Zy`(_`40i ° A. Fee for branch cir wWt
: , f .. ''` , . abov service or f eeder five,
7.42 2
Business name: each branch circuit
13. Fee for branch circuits wlihora
Contact name: service or feeder fee, fast 56.18 2
branch circuit
Address: Each add'I branch circuit 7.42 2
City/State/ZIP: Miseelhumoas (service or feeder not induded)
Each manulllcaued or modular 67.84 2
Phone: ( ) I Fax :: ( ) dwelling, service and/or theder
Reconnect only 67.84 2
E -mail: Pump or irrigation circle 67.84 2
. . . : . : ... ... ..... ',. 0 t `eT'„ . _ Sign or outline lighting .84
t;�6 2
Business name: Bridgetown Electric Signal circuit(s) or limited- energy See
panel, alteration. «xte
emission. ( Page e2 75 2
Address: 5701 N Lombard St. Each additional inspection over ellowaMle in any of the above
Additional inspection (1 hr min) 66.25/hr
City /State/ZIP: Portland, OR 97203 Investigation (I hr rain) 66.25/ hr
Phone: (503) 621 -7122 Fax: (503) 621 -7123 Industrial plant (1 hr min) _ 78.18/ hr
Inspections for which no fee is
CCB Lie.: 103824 Electrical Lic::. 6-887C Suprv. Lie,: 41775 since! fisted '/r hr min 90.00/ hr
Suprv. Electrician Sl A ?('nJ is l:'•1' �lI R . ...t :- •l.h 4`.=7..1:..1 w 15
gnature, ',+ I -..td `i a a t f . 7,.:ii 1�`+x `{r i F
Subtotal: 1S. 06
Print name: Keith Steenslid Date: Plan review (25% of permit fee):
State surcharge (12% of permit fee): 9.0o
Authorized signature: TOTAL PERMIT FEE: 8 tri
This p ermit appnntlas expires if a permit b not ebtdoed within ISO
Print name: Vote:
days after it has been accepted m complete.
1: aura
• Number of inspections allowed per permit.
Ingperm5oELC PsmiiApp_ELR_ERE.doc RevOs/21MI 3 440.461ST/I I105/COMM1YEa
Jul 25 2013 10: 43RM 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:
Fee for a residential systems . combined ... $75.00 - ""etimii - rnisse •
Reaevdable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 13'3.56 2
Audio and Stereo Systems*
15.01 to 25 kva 200.34 2
0 Burglar Alarm Wind generation systems in excess of 2S kva:
25,01 to 50 kva 301.04 2
0 Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva (fee in accordance with
55126 2
OAR 918-309-01140)
0 Heating, Ventilation and Air Conditioning
Solar generation systems in excess of 25 kva:
System*
Each additional kva over 25 7.42 3
0 Vacuum Systems* >100 kva — no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
0 Other. Each addition& inspection is
66.25t hr 1
charged at an hourly (1 hr rnin)
Inspections for which •0 fee is
mow hr
; - Meal listed 'A hr min
W77 -V.e44C;i-Z,Mart-r;TE:7TAk7.1ng.nMinglitV':
Fee for fia,11 commercial syStem.0000•••■•••"0.14•11.00 $75.00 Subtotal:
(SEE OAR 918-309-0000) Plan review, if required (25% of permit fee):
State surcharge (12% of permit foe):
Check Type of Work Involved: TOTAL PERMIT FEE:
Ibis permit applkation expires if a permit isnot obtained within 380
0 Audio and Stereo Systems days after it kaa been accepted as complain.
Number of inspections allowed per permit.
El Boiler Controls
Clock Systems
El Data Telecommunication Installation
Fire Alarm Installation
O HVAC
0 Instrumentation
Intercom and Paging Systems
O Landscape Irrigation Control*
O Medical
O Nurse Calls •
O Outdoor Landscape Lighting* •
O Protective Signaling
O Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1:93uildineennitAELC_PermitApp,ELR_ERE.doe Rev OS/2112013