Permit •
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
az COMMUNITY DEVELOPMENT Permit#: ELR2013-00217
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T I G AR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/28/2013
Parcel: 2S113AA00700 •
Jurisdiction: Tigard
Site address: 16436 SW 72ND AVE B5
Project: Tesla Motors Subdivision: ROSEWOOD ACRE TRACTS Lot: D
Project Description: Data telecommunications system.
Contractor: BRIDGETOWN ELECTRIC Owner: PACIFIC REALTY TRUST
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 08/28/2013 $75.00
12%State Surcharge-Electrical 08/28/2013 $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 ru r direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: �< — —/ /� ermlttee 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 11 : 00AM Bridgetown Electric 503-621 -7123 page 1
Electrical Permit AntolicatiofiECEIvED ; „, .:,..t
City of Tigard
1
13125 SW liaft Blvd.,Tigard,OR 9722:6A
Phone: 503.718.2439 Fax: 503.598.1
Inspection Line: 503.639.4175
Internet: www.tigard-or.gov UG 27 2013 '
CITY OF TIGARD Date.Reaeivedy: I,/_ ,
Dtellay:
Duro Ready/By:
NotifiedAdethod: 17p3 A,-j-- Permit No': ' '6,6)-6_13-clod-) 7
Ober Permit
ii....,__ i lill See Page 2 for
- 1.1--'C.. I Supplemental Informadea
1 m 14/ •-'
einittartareelNitX"/rq:7**W; %,!!)„r.:.:::.`•. atAVISION:*-.:3',.::;,,::-.:,;. ';',15z-' us,gwrir,,,..1.,,,LMT-FrirrarIMPL....mitiffi;
CI New construction Addition/alteration/replacement Pleaso check all that apply(submit a sets of plans write=decked below):
0 Senriee or feeder 400 amps or more 0 Building over three stories.
O Demolition 0 Other: where the available fault=era l:I Marinas and boatyards.
0:11.#3ntri..1#4,31V444****NOW-'''''''',X2glit*OeftW:.:-kig.7.: ;;; :'i,!..i.'!:"::):.■'k..:;': -.f.t. exceeds 10,000 amps at 150 volts or 0 Floating buildings.
less to ground,or exceeds 14,C00 0 Cornmercial-use agricuaural
Ej I.and 2-family dwelling III Commercial/industrial 0 Accessory building amps for an other installations. buildings.
0 Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
ttv.,.,,...... .,: ...., r..;.;.....:..-;1,,-,:,...:vn:i,,.. .,,...,.. r: ., _,,:ii, 0 Emergency system. larger separately derived system.
;14,f,'.2.084V:41.f.,4;:r4i.e1, -,1 :.".:.i"-1'...-7 P . .'':4 .'•:-..a .:,,.. . .7,,,t9.1 "...'!,'.''.--4':: 'I.''•':' '1.:''l '•!!:'"! 0 Addition of new mote(load of 0"A","E","I-2".-1-3",
100HP or more. occupancy.
Job no.: %1)-5 i q Job site address: I b 41,49 5141 1 tvat•
a Six or more residential usiin. ['Recreational vehicle parks.
City/State/ZIP: '17%640- OR 6117.:/-4 a Nealth-erce facilities.
a Hazardous locations. 0 Supply vixen.for more than
600 volts nominal.
Suite/bldg./apt no.: Project name:"1-141. )J-4b--.. 0 service or feeder 600,.......or more.
I.3...Z. 1.iik, ';': NEEIT.S.::T.7.P.T7Majaar4Wj
Cross street/directions to job site:
Desaiodoe Otr, Fee, Tsui •
New raddendol single-or multi-family dwelling unit.
loelndts attached gouge.
Subdivision: Lot no.: 1.000sq.R.or less 168.54 4
Ea.addl 500 sq.R.or portion 3392 I
Tax map/parcel no.:
Limited energy,residential
75.00 2
;','''..,l'finl.551ilftNiaigat$101041010***Ari-;‘ :':::::, i'::,''ll''..:-q!'.f.,,,;s'., ''..-;,::::Fd (widi above sc ft.)
Limited energy,multi-family
75.00 2
Low vo iLu .chitittvet ...ktertk, 6,44.0.1.4. Au 4-21mAkf residential(with above sq.ft.)
' --Ralaniabiti, ,,',:.- :::f4-:','.I:..,i7,':',0;41erarie21,,,,,:.:..i..,;,':• : :
- ' 1'f"
intoxsri Services or feeders installationlalteration,and/or relocation-
'-'.,':r-'.'.:•:41-31i-• . • ' ..-..r.,,). ;r. 1,a;vg-',4il't il,'T.:::E::,,:.,..i.,-,r‘":■• :.,:.43%;Ttli44,,i,t.:, ::::::,::,....„-!.=;:i4!: 200 amps or less 100.70 f 2
201 amps to 400 arnps 133.56 2
Name:
401 amps to 600 amps 200.34 2
Address: 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP:
Temporary services or feeders Installation,alteration,aid/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 ampe to 599 amps 168.54 2
Owner signature: Date: Branch circuits-new,alteration,or extension,per panel
A.Fee tbr branch circuits with
••21,,;:-', 4+;:-.!':?F' IN .'0',,:•,••,r. • '..,•y,.v.!! •'? lq.4.ttliia.,.,It..Nrs11.,er#A,. .r?rp"."••,..A i 4.'.,-',.•-...- above service or feeder fee,
Business name: each branch circuit 7.42 2
B.Fee for branch circuits without
Contact name service or feeder fee,first
5C 18 2
branch circuit
Address: Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
City/State/ZIP.:
Each manufactured or modular
67.84 2
Phone:( ) i Fax: :( 1 dwelling,service and/or feeder
Reconnect only 67.84 2
E-mail:
Punm or irrigation circle 67.84
2
::.;i4; ,1!............................................................................ - -.', ' -. l' I . ':'::: ":.,'.;,'1• Sign or ouftlne lighting 67.84 2
Business name:Bridgetown Electric Signal circuit(s)or limited-energy. I See '14 4)4
i 2.0*
panel,alteration,or extension. Page 2 li
Address:5701 N Lombard St. Each additional Inspeedos over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
City/State/ZIP:Portland,OR 97203
Investigation(1 hr min) •66.25/hr
Phone:(503)621-7122 I Fax:(503)6723 ustrial plant(I hr min) 78.18/1u
/
1,44Indrupsctions for which no fee is
CCB Lie.: 103824 ."< Electrical Llc. , . ::7C - Suprv.Lie.: 4177S specifically listed Vahr min 90.00/hr
Suprv.Electrician signature,
Am" - Subtotal: -7c-.
Print name: Keith Steensiid Date: Plan review(25%of permit the): --
1 State surcharge(12%of permit fee): ' ".•a/-
Authorized signature: TOTAL PERMIT FEE: f.Od
This permit application expires If e perish Is not obtained within too
Print name: Date: days after it has been accepted as complete.
Number of impeceions allowed per permit
MaildinePertnital.C_PestollApp PLA_Alidae Rev 0921/1013 440.01 ST(11/1:1S/COMMIB
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Aug 27 2013 11 : 00AM 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& Magi KO' -:,4::,--TIE=rkarMETT:TEAM'
Fee for a residential systems combined..-.... $75.00 DAPIPtiall 01;2'• Vet Taal •
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70•
2
5.01 to 15 kva 133.56 2
0 Audio and Stereo Systems*
15.01 to 25 kva 200.34 2
Wind MI:ration systems In excess of 25 kva:
0 Burglar Alarm
25.01 to 50 kva 301.04 2.
0 Garage Door Opener* 50.01 to 100 kva 55226 2
>100 kva(Ike in accordance with
552.26 2
OAR 91E009-0040)
0 Heating,Ventilation and Air Conditioning
Solar generation systems in MVO of 25 Imes
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 additional hupectian
charged at art hourly(1 hr min) 66.25/hr
Inspections for which no fee is
90.00/hr
'foal • •15 hr min
Fee for 101 commercial system--.-.......—. $75.00 Subtotal:
(SEE OAR 918-309-0000) Plan review,if required(25%of permit fee):
State surcharge(12%of penuit fee):
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Check Type of Work Involved: ram,PERM7 FEE:.
This perolt a pplieadoo expires Ifs permit is Oct obtained Main 180
days after It has beim accepted as maspiett
0 Audio and Stereo Systems
Number of inspections allowed per permit.
O Boiler Controls
O Clock Systems
IX] Data Telecommunication Installation
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0 Fire Alarm Installation
HVAC
O Instrumentation
O Intercom and Paging Systems
O Landscape Irrigation Control*
O Medical
O •
Nurse Calls
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0 Outdoor Landscape Lighting*
O Protective Signaling
O Other
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Total number of commercial systems:
*No licenses are required. Licenses are required
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for all other installations
LIBui1hg1PennititELC_PannitApp_ELP,ERE.doe Rev OS/21/2013
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