Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
1:14 s • COMMUNITY DEVELOPMENT Permit#: ELR2013-00209
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/22/2013
Parcel: 2S112ACO2800
Jurisdiction: Tigard
Site address: 14865 SW 74TH AVE 250
Project: FANNO CREEK ACRES Subdivision: 2003-009 PARTITION PLAT Lot: 1
Project Description: Data telecommunications system.
Contractor: BRIDGETOWN ELECTRIC Owner: FANNO CREEK ACRES LLC
5701 N LOMBARD ST 14865 SW 74TH AVE STE 300
PORTLAND,OR 97203-4113 TIGARD,OR 97223
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PHONE: 503-621-7122 PHONE:
FAX: 503-621-7123
FEES
Description Date Amount
Specifics: Restricted Energy Permit 08/22/2013 $75.00
12%State Surcharge-Electrical 08/22/2013 $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)
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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 B _ __� - -ermittee Signature:
L..)
al •40
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.
Aug 21 2013 3: 35PM Bridgetown Electric 503-621-7123 page 1
Electrical Permit APpIi:cahio ECEIVED I, ; !` 1 ! ,, ' ! `
City of 13125 SW Hal r d.,,Tigard,OR 9 7 2 2 3 2 1 2013 Plan Review
Phone: 503,718.2439 Fax: 503.598.1960 pay; Other Permit:
Inspection s DITV�O. FTIG AR- D N ` 1 Tf
ll Internet: o le : - Sup plemental nformation
" DIVISION
. _ Js�. , q.tYyp i -ti.�4!3Yy7 1 -� ��... i . . . , . :o� :� _
� a`^YyQ�a:
❑New construction Addition/alleration/replacement Please check all that apply(submit a sets of plans w items checked below):
❑Demolition El Other: 0 Service or feeder 400 amps or more 0 Building over three stories.
1 t t wbae the available fault current 0 Mafiosi and boatyards.
- :n" ;(1.1.1v,�`>*,',. i5`•`�to . 1�tt a `a c.::i!y k. ems ;1,e exceeds 20,000 amps at 150 volts or 0 Floating buildings.
❑ 1-rand 2-family dwelling &Commercial/industrial amps for ate'Df 0700Opm oca, 0 Comings. -use agrieu4„csi
❑Accessory building amps for all odor installation. buildings.
❑Multi-family ❑Master builder ❑Other: 0 Fire Pump. 0 Installation 01 150 KVA or
;._:r:: i, :lt-Z';,wR':liii ,: ,r iii r .." ❑Emrny wy system. larger separately derived system.
a s :1 , .!}.91`rf,. ne+s,`1. 'D.,I . ATh) 0 Addition of new motor load of 0'A.,."F".°1-2".9■
Job no.: Job site address: }{ti 100HP or more- °a+'va"°y.
i�-5 R +� 8 lA 5 °�W Hers ❑six or more reaiaemle I units. 0 Recreational vehicle parks.
City/State/ZIP: '7%04,61 i Ock. qi i;ti14 0 Hazardous locations. 600 Supply hvolta more than
Su ite/bldg./apt.no.: 2 5 0 Project name:Towm 4ef�1 ak.JQrxas LI.C. O Service or feeder 600 amps or more.
Cross street/directions to job site: �,-:%:.''": i-kq !r0'''.w` ?.::;."• 1 �I ' ' g"�, , W:
New residential single-or multi-family dwelling unit.
Includes ataebed garage.
Subdivision: I Lot no.: 1,000 sq.R.or less 168.54 4
Ea.add'I 500 sq.ft or portion 33.92 I
Tax rnap/parcel no.:
Limned energy,
residential
75.00 2•.Y• .• 2 : ;, k: aO �.':' (with
above sq.W
[� Limited energy,m family 75.00 2
g9L0tAr vo«1AO�. W u J1 s(L����� � r ilt.M✓l..{I, 4D j'r residential(with above sq.R.)
0P-P4 ,. :C yy� CAsji)4 1'1 installation' alteration, relocation
,Reieyii tilled •L3�'SaePfliii;2. .r.
�p�
•i`�k=pl=y` .�*(040 ' .;.... I?:,: . ',T$ *liCr1',; . . - .. 00 amps or
,oa100.70or 2
r feeders oa a{
2 or less
r 201 rumps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
Address: Wimps 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:( ) I 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 to 400
125.08 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: Branch circuits-new,alteration,or extension,per panel _
�;>�ty.l v s s 't ,,::::, A.Fee for branch chain with
'�.;; ..,��A:: �r� :.J. .'p>�coivT�c�r�';e�rsoN"�
above service or feeder fee, 742 2
Business name: each branch circuit
B.Fee for branch circuits without
Contact name: service or feeder fee,first
56.18 `
branch circuit
Address: Each add'I branch circuit 7.42 2
City/Statel7IP: Miscellaneous(service or feeder not included)
Each manufactured or modular 67.84 2
Phone:( ) I Fax::( ) dwelling.service and/or feeder
. Reconnect only 67.84 2
E-mail:
Pump or irrigation circle 67.84 2
Sign or outline lighting 67.84 2
Business name:Bridgetown Electric Signal circuit(s)or limited-energy See —1
panel,alteration,or extension. I Page 2 !�- 2
Address:5701 N Lombard St. Each additional Inspeedon over allowable in any of the above
City/State/ZIP:Portland,OR 97203 Additional inspection(1 hr min) 66.25/hr
Investigation(I hr rain) • 66.25/hr
Phone:(503)621-7122 I Fax:(503)621-7123 Industrial plant(I hr min) 78.18/hr
CCB Lic.: 103824 I Electrical Lic: 887C I Suprv.Lic.: 4177S t--scans for which r the is 00/hr
.'. .,-ficall listed 93 hr
,''a '7 1 ' 7F1N1' t{k ir ! � s''� •ti Suprv.Electrician signature,
Subtotal: 'l 5.eon
Print name: Keith Steenslid Date: Plan review(25%of permit fee):
signature: State surcharge(12%of permit floe): on
Authorized
TOTAL PERMIT FEE: g q�,
Print Warne: Date: • Thb permit appliadoa expires Ifs permit is au a obtained within 180
days after it bas been accepted as complete.
• Number of inspections allowed per permit.
intuildiiglPormucSt.0 Pc mitApp_EL&SRS.doc Rev 05/21/2013 440-4615T(I 1/ut(COMAVEa
Aug 21 2013 3: 35PM 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:
?•� ,..., ,.,.. ....,.,_., a:. ...,.:. ,. ' ++€+,�$:,:+� 'd' . -. ;_�, t+�r.•`:'x�if�j�,�:�SZ^�StYj�,� ..��.y' �e...`".++.�i��;'2"lx�' ,�
Fee for all residential systems combined ... $75.00 Daseriptioa OM Fee Total •
Renewable electrical energy systems:
Check Type of Work Involved: 5 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 Reneretlon systems In exams of 25 kva:
25.01 to 50 kva 301.04 2
❑ Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance with 552.26 2
Heating,Ventilation and Air Conditioning
OAR 918309-0040)
System* Solar generation systems In mess of 2S tora:
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 Each additional inspection is 66.25/hr
charged at an hourly(1 hr min)
inspections for which no fee is
-teal listed .4 hr in 90.00/hr
m
s...,.:...a.......°.r.aL __A..:.:dr.�.�9`' 103es~ V.
Fee for each commercial system.--..... $75.00 Subtotal:
(SEE OAR 91 8-309-0000) Plan review,if required(25%of permit fee):
State surcharge(12%ofpermit fee):
Check Type of Work Involved:. TOTAL PERMIT FEE:
❑ Audio and Stereo Systems
TM'pest application
day�s a It�h w. a„ac�omplete, within
• Number of inspection allowed per permit.
❑ Boiler Controls
❑ Clock Systems
® Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
O Medical
❑ Nurse Calls
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❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I:\Building1PamhsNELC_PermitApp E1R—ERE.doc Rcv D5121/2011
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