Permit (221) •
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit#: ELR2012 -00207
T E GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/05/2012
Parcel: 2S115BA02500
Jurisdiction: Tigard
Site address: 16200 SW PACIFIC HWY X
Project: Marshalls Subdivision: 2004 -015 PARTITION PLAT Lot: 1
Project Description: (1) low voltage for Data/Telecommunications
Contractor: BRIDGETOWN ELECTRIC Owner: SN PROPERTIES PARTNERSHIP
5701 N LOMBARD ST 1121 SW SALMON ST
PORTLAND, OR 97203 -4113 PORTLAND, OR 97205
PHONE: 503 - 621 -7122 PHONE:
FAX: 503 - 621 -7123
FEES
Description Date Amount
Specifics: Restricted Energy Permit 09/05/2012 $75.00
12% State Surcharge - Electrical 09/05/2012 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: Y Fire Alarm: N
HVAC: N Instrumentation: N
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N 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 5033..232.198 or 1.800.332.2344. t /
Issued By: Ablilly oh-1 4 1 Permittee Signature: KI APrU e - riD^+
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.
Sep 05 2012 1:42PM Bridgetown Electric 503 - 621 -7123 page 1
Electrical Permit Applicatio
City of Tigard S E P P 2012 RD y: 41/4.- i Z s� ` vomit ct,t. ,a0 o a-o 7
Phone: 503.639.4171 Tigard. F5 03. 97223 D anRmisw ataxia.. `0i3y
• . �� ��fiQ TIGARD DatedBy: otlrer'Permit
n� :: w�w.ii ard-o .g
ov DI�IN DIVISION Not 6 Ready/By: Jade � El See Page far
cot a l
Ti I Srspplemetllaforeaaekp
Y.�1¢,' �;�`fi e`�f.�: a h�� �Y ��� /±±pp� ':a • f� „C�f tY ; � � j : ' •.. (� ' � ( �7tl I„ � �:,�' - ; +, {l�r . . mn+t f�ar.r ti . � ,
+. $ • 4 ..1 , � i rd �: v i'..,r i L'r' r t �. k. ` ,4 , • aii1m3'_ .. slit �1' t.t2'S i ,7 T rL g w d c-i,i Jl: nil . rr .i.
i- 9 : }. td . 11' 1: 1 , • t . . ... �t ln�: Asu ......m.3.e_.iv, ; Sl y •. `Y• ,... , . , 1 't a r, i t.L lho . .. F Y•∎ e
f' Phase check alt that - • • ly (submit Z sets of Mama checked below):
El New construction � Addition/alteration/replacement
❑ Service or feeder •' ,•, ernes or more ❑ Mulcting ova tires atoriea.
El Demolition 0 Other:
where the avanabL theft current ❑ Mariam and boatyards.
I ,�y clew .. ,�ruf5 4r'1.V'sw'a.
•. ri6tt^t ;FC' rt ian U . , I � 7
" f � � � i \1 0 d 10000 exceeds , M volts Or Floating �liSD p•
`,.`ta•.•, .,����i• ?,. .�.57 II11'' :.f ��i' t.i � I 1 15,5 g. �b���.k1�n-�- �� t� �1� � 150 ❑ Fl
g
+' Ir ,ataUiS'S�i3rta,fd,,.n1 I� .4r. it ritrra ' ,1 %• '.::�• . N °!„ ' ` •• lose to ground, or exceeds 14,000 ❑ Comrner ial agricultural
❑ 1 - and 2- family dwelling ea Commercialindustrial ❑ Accessory building amps for all other astallatioaa, buildings.
❑ Multi - family ❑ Master builder ❑ Other: ID Fire pump. ❑ lostallatlon of 75 KVA or
y ruy r
l ::oa. rf ryw ryyali Y apw' a'. ri < ❑Emer separately derived
i 'w . Y r ,�'g r { i r so l , v M io p l. t • 1 1Vh:!;i BAY n pee ly system
0 }i y" it 2�. , , :�: l2;t 1 y 9 5 1 '. J d, . e t . r t` a ❑Addition of new r etre load of ❑ "A •`F","1 -2", 1 -3•
rt, � .. 1.115¢: x(i
Job no.: It - y/3 Jpb site address: I1!?.r00 W VGt (,. AviA t00l {P ormore. occupancy.
Six or more reside vial eats. ❑ Recreaunnal vehicle parks.
City/State /ZIP: r'�' ,, , 1 . r c111,1..4 a ` ❑Healthowe facilities. ❑ sappiy voltage for mom than
' ^___ - _�� ❑Hazardous locations. 600 volts nominal.
Su ite/bldg. /apt no.: X I Project name: CAl"►6Mc61 l IIAINf inks AJi O service or feeder 600 amps or more.
Cross street/directions to job site: a ..- r : WISP " Sf v ' D �t'A !�' , ' lt: ,
- -- - t a New residential ai vie- or muiltt-faadly ding unit.
Includes a ttached garage.
-
Subdivision: Lot no.: 1,000 sq. ft or less 168.54 4
T map/parCel n0.: Ea add'1300 sq. R u portion 33.92 1
Tax
}, ,� Limiteddenergy. tali lential 75.00 2
"��rtT N f1'I' 9 �` '' ' a l n i :F 'l w -1�i t i? ; s 12�rtil*''lrY . ;. -1f,;; `;'y ir. 1� J �]d (witliatimvese.ti{)
LOW 11 . _ rr... .ou .,..11.0 .4..4 } . t :;l 1 . N � rr2H maideo
J ' g i.. e.' A
Limited energy. znut.Sumly
l V0t VI'SlAAAk 0 yVl .. oktm at.``3ro dal(with 'Wove a4ft.) - 75.00 2
Services or feederI installationodi3eration, and/or relocadon
1► • 200 amps or less I 100.70 2
-•'talc C i.' c f. ,- . r�r i ,'ZO <I. `9jI ; 7 r T r` '_ ".rc• 6 .-,: . amps
to 400 a
't; e ,.`,� fi y
r, �i + r� r ;. n n :r, � y r s, a � +i a I . a' ° ' :� J ,, ;< 201 133.56 2
�t�,> ,. eta I s : 401 amps to 600 era 200.34 2
Name: I 601 amps to 1,000 a spa 301.04 _ 2
Address: Over 1,000 amps or 552.26 2
City /State /L1P: Temporary •or feeders installation, alteration, and/or
relocation
Phone: ( ) l Fax: ( ) 200 amps or less 59.36 I
Owner Installation: This installation is being made on . r . sty that I own which is not ZOl amps to 400 areje 125,08 2
intended for sale, lease, rent, or exchange, according to • RS 447, 449, 670, and 701. 401 amps 00599 anus 168.54 2
Brands eltrtilts •. , alteration, or tom tension panel
Owner signature: Date: A. Fee for branch nits with
r fee,
se
fl' .,ie rp { 't I tfx'�r. ale t.,1.,T.w !+1K. a . stet or - .:..; ee,
>, a'r' ••.' Al 'gEit61! • t?. w' � E L;,ti9 1 3 1�, .11 E 7.42 2
ro ..en'. 1111 d1.o:cu. J... �r dLtLlful; 46L..IU.'lSVr.4f;�llt �.. !i each branch , - .
Business name: B_ Feeler branch ; , Its without
service or feeder • . , flat 56.18 2
Contact name: • branch circuit
Each tdd'I branch • curt 7.42 2
Address: Mlsedlaatous ( , , e or feeder got headed)
City/State/ZIP: I Each manufactured modular
dwelling, service ; ,, , r feeder 67.84 2
Phone: ( ) I Fax: : ( ) Reconnect only • 67.84 2
E-mail: Pump or irrigation c le 67.84 2
4'Zikil' rr 'yq - lir16,cfi9•fG"; . l�.W �f t'"llns� :",'il.'�. 1. '�.' `'•'� �'� " S ign 1cu outline 67,84 2
a . � .,,... ,.. , , r.. , .. r ,. �. I.: � � ° Signal cirt:uit{e }or itedtoagy
Business name: Q C panel, alteration, or -. , erica. 1 Page 2 -7 5. 2
""� � V4 ° • �� Each additional i • etton over allowable ha any of Mt above
Address: S7 0 / N . i_.0 ok ei P/) S 7'ie 7 Additional impend. (1 hr min) 66.25 / hr
e � ���� 2 — lirve!xigntbom(I.� •I.1 66.25/hr
City /State/ZlP: D �, Z Q I ! Industrial plant(I , , .,.) 7s.18/ hr
Phone: (50S )i,I .. 7 12 q, I Fax: (te ) 621 711.3 inspections ibrwb' no fee is 90e0rbr
ifical listed • hr rain
CCB Lic.:
10382-4 I Errical Lic —8 g7c, Suprv. Lic.: 417 7 t tIrli `', d llri Ti.. :riT ° : E.r... .Ti' L'T kl`11 :r itl!t •.
; •k
Subtotal: .
Suprv. Electrician signature, requ'ilear '4G -.� Plant view (25 %ofpennitfoe):
Printname:,,.A. .-C-Ries' vase iri I Date: State :•,, ergs(12%of permit fee): 00
Authorized signature:
TOTAL .P•ERMIT•FE13 :. .814 GO
This penult apptie • so aspires of s pues1$spot obtained within Ida
days a I • • It fns been atapaed as emplets
Print name: Date: • Number of i , -. •. : allowed per permit.
i
r.''rrildingtP rmit ELGperaitApp.doc 07/01/10 I +a- 46trr(iIdO Ot&WBB
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Sep 052012 1:43PM Bridgetown Electric 503- 621 -7123 page 2
Electrical Permit Application - City, of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT F*ES:
Fee for all residential systems combined- .. $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and .Air Conditioning System*
❑ Vacuum Systems*
❑ Other. �
•
Fee for gah commercial ! $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
E] Boiler Controls
❑ Clock Systems
L i g Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
CD Instrumentation
El Intercom and Paging Systems I .
❑ 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
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