Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
'1111 COMMUNITY DEVELOPMENT Permit#: ELR2013 00218
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/29/2013
Parcel: 2S113AA00800
Jurisdiction: Tigard
Site address: 16490 SW 72ND AVE B6
Project: ServPro Subdivision: ROSEWOOD ACRE TRACTS Lot: PTS C,C
Project Description: Low voltage for Comcast cable
Contractor: BRIDGETOWN ELECTRIC Owner: PACIFIC REALTY ASSOCIATES
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 08/29/2013 $75.00
12%State Surcharge-Electrical 08/29/2013 $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 • 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.
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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.
Aug 27 2013 2: 29PM Bridgetown Electric 503-621 -7123 page 1
Electrical Permit Apolicatio4?ECEIVED i ;:1: i.', I .,- , I i ■: i
City of Tigard ? 9 i 3 y Permit lvt.: X 013-��! .
13125 SW Hall Blvd.,Tigard,OR 9722 AUG 2 7 2013 Platt Review Perrnit:
Phone: 503.718.2439 Fax: 503.598.19 Darr/B
Inspection Line: 503.639.4175 Date ReadyfEy: hulc ®See Page 2 for
Internet www.tigard-or.gov CITY OF ii 111W N. •'., Sopptemeraunformatioa
t n gUi, i „:C fN.N < _ 04_'��. r- ye a 777 t, i' U- i' ., - . ..- .* i A14F„ :, u ^h bt;a�u�,tall�r-A a.;:r:1 l tna.Ii rF,+'P41r Z. Y s
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❑New construction $ Addition/ateration/replacement
Please chock all that apply(submit sets of plats widgets ehoakad below):
❑Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition
❑Other: whore the available fault current ❑Marinas and boatyards.
":!K"-_j * ? „ F!�7 w exceeds 10,000 at 150 volts or Floating buildings.
"t'x.ii.n +ak.-�ul f ; 1�,... • . t,rc.,• 4 ! r . i ,r.,,oia a - . ❑ B oBa•
❑ 1-and 2-family dwelling lasso ground,or exceeds 14,000 ❑Cortmrercial-use agricultural
y g 01 Cotnmercial/industria( ❑Accessory building amps for an or installations. buildings.
❑Multi-family ❑Master builder ❑Other: • ❑Fire pump. ❑installation of 150 KVA or
r� ti ; •,. -... ', •3",.. - . : ❑Emer5�Y sY�n. larger separately derived system.
' ``I3 .t��J;+ '#s`ri`" ° t ms, .i e' e i` i " .,,-•,••
❑Addition of new motor load of ❑`A',"E","1-2","1.3".
Job no.: n-jpp-i 1 Joh site address: 11.M qO gW 12 Ave., 100HP or atom. occupancy.
q�j ❑Six or more residential eons. ❑Recreational vehicle pads
City/State/ZIP: i `/JT` a, ❑Hazardous canons. ❑Supply voltage for more than
❑Hazardous locations. 600 V3115 110111111111.
Suite/bldg./apt.no.: I Project name: StAry vt, iI ❑service or feeder 600 or more.
Cross street/directions to job site: torwtatma' ,i�r Qty. • `! / 1' .a?w.r-.!
q Fes Total
New residential single-or maid-family dwells g unit.
• includes attached garage.
Subdivision: ( C.at no.:
1,000 sq.II.or less 168.54 4
Tax map/parcel no.: Ea.add'l 500 sq.ft.or portion 33.92 1
.�a Limited energy,residential
;s ;;;:!;'-<c: :•";}'.5"s;` .�„ } ,, r. (with above s9,4k) 75.00 2
-;.: ';';!!'71-: .•': 7r,yeti,4i;r ..i,,a.�s :(�7jOltO r�:: `.r^ ..r. .ir'- .•
LtM/ Vol "'"1t' exr-;04 Limisidetial( multifamily
1M [ '-""�_'" ,yVtµJL rrsideretial(wiltabovesq.$) 75.00 2
e,µ '(,0--' Services or feeders inatalladoo,alteration,and/or relocation
fit, �,r, -,n. :: 1''y' ':i;9y'jljl%,1,it;; :,,;.,i,,: 'i1 200ampvorleas i 100.70 2
201 amps to 400 amps 133.56 2
Name: ' 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:( ) 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 amps to 400 amps 125.08 ' 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-new,alteration,or extension,per panel
,'`, 0'�,a£• `n -Rte: +1qu r 40.0. ti it"j�. t.,, �4 -'q..d:',,! A.Foe for branch circuit's with
: 5 . ff ^kckd ., .,.NG 'f A?- 'i�f'`,tgc;_:'�} : `..+.:° ••;:I r,:1r�-°
' -
above service Or fender 1$0, 7.42 2
Business name: each branch circuit
B.Fee for branch circuits without
Contact name: service or feeder fee,fast 56.18 2
branch circuit
Address: Each adds branch-circuit 7.42 2
City/State/ZIP: Miscellaneous(service or feeder net included)
Each manufactured or modular 67.84 2
Phone:( ) I Fax. :( ) dwelling,service and/or feeder
Reconnect only 67.84 2
t� _ Pump or irrigation circle 67.84 2
E-mail:
-t ''h T':i';if'}�F;t'F,`hittY�3 1 qi1:'irti•;i4∎ • . • :• _ .. ,..•. ..
�i�•:��!'�`•-:'„��s'"?t'i.i;at,.J„�.a:;:,a�r.�.::_�:llr.��':,i:�t.l, 10�, :�.:_•L sign Of ouduu lighting 67.84 2
Business name:Bridgetown Electric Signal circot(s)or limited-energy i See
v 1 alteration,or extension. I Page 2 1 S-44 2
Address:5701 N Lombard St. Each additional inspection over allowable in any of the above
V Additional inspeclion(1 hr mm) 66.25/hr
City/State/ZIP:Portland,OR 97203 _Invesu
Investigation(I hr min) • 66.25/hr
Phone:(503)621-7122 1 Fax:(303)621-7123 Industrial plant(i hr min) 78.18/hr
CCB hie.: 103524 I Electrical Lic:: 6-887C I Suprv.Lie.: 4177S Inspections P hililarmee is
� +�,4 in 90.00/hr
,.: i ;".,rah: r.,.{$�:WGf pY� nY-7P tl'1M1,177.r-0 '. ,.'. •w,1 -. afi 1':��„•
Suprv.Electrician signature, .. . • n�u.,: r: x �Tr t,:':
p mature, :.,.t. 1.. ..-,.„..14.:x, sublets. 5.6..°
Print name: Keith Steensl id Date:
Plan review(25%of permit fee):
Suite surcharge(12%of permit fee): q,ma
U Authorized signature: TOTAL PERMIT FEE: SSE,ao
This permit application expires if a permit is not obtained within 18p�
Print name: Date. days ays after It has been accepted as complete.
• Number of inspections allowed per permit,
ilauilding\PerreitalPLC PrmeApp.ELR,ERE ere Rev 05/21/2013 440-46157(1 1/01 'OMAVEa
I
I
Aug 27 2013 2: 29PM 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 all residential systems combined...—. $75.00 mm_=: •
Renewable eleetriad energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
O Audio and Stereo Systems* •
15,01 w25 kva 200.34 2
Wind generation systems in excess of 2S kva:
El Burglar Alarm
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
OAR 918-309-0040)
0 Heating,Ventilation and Air Conditioning
Solar generadon systems in excess 025 kva:
System*
Each additional kw 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:
Other: Each additional inspection is 6625/hr
charged at an hourly(1 hr mi )
• Inspections for which no fee is MOO/hr
s "cal list 4hrmln
Fee for gsk commercial system....................... $75.00 Subtotal:
(SEE OAR 918-309-0000) Plan review,if required(15%of permit fee):
State surcharge(12%of permit fee)
Cheek Type of Work Involved: TOTAL PERMIT FEE:
•
This permit application expire ifs permit is not obtained within 180
0 Audio and Stereo Systems days after it kas been accepted as complete.
• Number of inspections allowed per permit.
Boiler Controls •
O Clock Systems
[Xi Data Telecommunication Installation
0 Fire Alarm Installation • •
•
• HVAC
Instrumentation
Ei Intercom and Paging Systems
O Landscape Irrigation Control*
O Medical
O Nurse Calls
O Outdoor Landscape Lighting*
0 Protective Signaling
0 Other
Total number of commercial systems: ____ •
*No licenses are required. Licenses are required
for all other installations •
IABuildingTermitaLC_Pennit.App_ELR_ERE.doc Rev 0021/2013
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