Permit (239) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
n
$ COMMUNITY DEVELOPMENT Permit #: ELR2012 -00273
T IGARD • 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/10/2012
Parcel: 2S115AB01900
Jurisdiction: Tigard
Site address: 16200 SW PACIFIC HWY G2
Project: Foot Solutions Subdivision: 1994 -028 PARTITION PLAT Lot: 2
Project Description: (1) low voltage for Data Telecommunications prewire from demark to tenant space
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 12/10/2012. $75.00
12% State Surcharge - Electrical 12/10/2012 $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 503.232.1987 or 1.800.332.2344.
Issued By: Wt 461
Permittee Signature: DM ?PO C 411 OA_
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 projecL
Approved plans are required on the job site at the time of each inspection.
Dec 07 2012 1 2:0 1PM Bridgetown Electric 5 0 3 - 6 2 1 - 7 1 2 3 page 1
Electrical Permit AvolicaticifiCr,;
V IL" . . ... . .. •
.
City of Tigard Recishied
111• IVED ..... y: 1 a- II D : a Sr . Pa °nit '149 L/ ao: a -oo c. 7 3
1111 ,, 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
ir Phone: 503.639.4171 Fax: 503. 59; 1 0102 Dste,Bv: Other Permit:
. , ; Inspection Line: 503.639.4175 Date Rcady/By: 3 44 i_ Ell Sec Page 2 for
Internet: vAvw.tigard.c.r.gov 1 )1 OF TIGARD Notitled/hlethod: i I LP Smppletnental Information
• : ' 7 Ina' , rre.'1 rv. - . , . , , .,,.. „. Wr;:1 , "”g&n.
,.. i ,,.1,0,31 • Ati ,, , . 0 ., s,.. • ' , nntti telnktK =, ' . q ' milli( •,- . I ^ ^ ,' , '''• -
,' .:, .., Awl' '• , ;tie . 14,.;, MI ;MAI,. ,I, i ,, .:_f•ei...
El New construction IX Addition/allerationThiplacement Please check silent .. y (subedit 1 iets Of plartabritidies checked below):
0 Service or feeder ' 44 amps or More 0 Building over there stories.
0 Demolition 0 Other. : wham the svailab fault current 0 Maims and boatyarda.
.l; ' - -',"--'•:' V - i''':• 'Iblel ' '' Ts ' ' ' ' - ' , '' " , '-',, -., , r- . , A.,- , ,T;17,0 `, Inwards 10,000 . !. at ISO volts or 0 Floating buildings.
!.:i4, P. :I: c‘ L , . . i i a .1, -:f. • : v 01 .,... $ .■ , i ,, :.ip!'i. , :iY ,-,,, i . c , , ,,, .1 ,,,,, ..i , i.i.'t.
!taste ground, Or • cents 14,000 13 Comm:Mat-ass agricultural
El 1 - and 2-family dwelling i Commercial/industrial 0 Accessory building amps for all other •. .• Rations. tatilctinp.
El Multi-farnil 0 Master builder 0 Other 0 Fire pump. 0 lastalbtion of 75 KVA or
v Mizr - 13Emet . ge • 'lc). sYlte • larger separately derived system
r" gli ! U ,. 1 , ; , i..: ,,-, ': -.,,•.%,:',-; Addition of new , - Or korl of 0 'A" , "E", "1.2", "14",
100HP or more occupancy.
Job no.: 11 2 Job site address: 11400 w ? ,^:S 5
v.4s..s 0 Six or more rosid - Val units. 0 Roma:boat vehicle parks.
City/State/Z1P: 'C , fa, kl 2.2 in Heallb-care &oil' '. s. 0 Supply voltam for m th
ore an
. 0 Hazardous!. . • • . :. 600 volts nominal.
Suite/bldg./apt no.: q.„2., Project name: c 5t,t■AAiirv..6 0 Servir,1 or feeder ,' I 1 .OID - or mote.
• lt91 1 gi
,
Cross street/directions to job site: .
• Deiniption ' • a , ‘.. Tom •
- 7 ---- New redden dal si , gle ormatti-farany dwelling unit.
. ; Includes attached ■.4 rage.
Subdivision: I Lot no.: 1,000 sq. n. or less 168.54 4
•
Ea. add' I 500 sq. ft .r portion 33.92 1
Tax map/parcel no.: .•
, Limited enemy, fe:i . + tial 75.00 2
. 4ifKiertgAiq` , ..NttWo6 1: 4 4 #400441100**TIllgtilig',i19,1 1 -.11 ; 1: ''-:1Pr'Y'',111-'441" (with above sq.' • ■ )
1 75.00 2
residential (with : sq. ft.)
il.-etw...:Arel V(.,,KNAN- AtitbAA411.1‘,L. .‘•,:i
Services or feed - insteUstionotteration, and/or relocation
200 soups or less 100.70 2
V3/4Iit:1109-lielt;'Vi...10 Iiitikni!.0rl 201 maps to 400 am ; - 133.56 2
r ,Sc. . ",,,,,• .. ,-..,- .:,... '.).:' :C , .;' ,,
Name 401 amps to 600 am ,. 200.34 2
: .
.
601 amps to 1.000 a pa 301.04 2
Address: ! Over 1,000 amps or olts 552.26 _ 2
Temporary servfc or feeders Installation, alteration. and/or
City/State/ZIP: • relocation
Phone: ( ) I Fax: ( 1 ) 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 am ., 125.08 2
-
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 am 168.54 2
Branch circuits- , or, alteration; or extension, per panel
Owner signature: I Date: A. Fee for branch c - ;'ts with
'J;: >I p, . ''' ' above service or - , er fee, .
7.42 2
,- 011- . ..;:: , !416. se,f';•": Aw. '. .., ,..- , , --.,,",... - ' :ch=4',.. ,-.4:,.'t.:',. .4.z. - ..... „ ..., ,.... ,„ , .,f, ,,.,...,,, N,F!,,:-1,;;Ip:r.i, each branch circu
Business name: I B. Fee for branch -* , in without •
service or feeder - first
56.18 2
branch circuit
Contact name:
Each addi blanch ci - 't ,. 7.42 • 2
Address: •
MIteelbineous (. . or feeder not included)
/ZIP: Each manufactured .. modular
City/State 2
• dwelling, service an. or feeder 67.84
Phone: ( . ) I Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E I . or oudine lighting 67.84 ' 2
L iel g11111 ,1tCra lCUi t t l:k ° :r li eriensi e or rief I Page 2 16,08 2
Business name: liatpGMAiN ELEA:I
Each additional Inspection over allowable In any of the above
Address: S7 0/ ili , I-Oak-64126 g - mee. -- r" Additional inspection (I hr min) 6625/ hr
Investigation (1 hr min) 6625/hr
City/State/ZIP: 20CrLigt.11> ciik q 2 0 -- th 1 3 Industrial plant (I hr min) 78.18/hr
Phone: (CAS )/ ... 7 i 21_ Fax: (p ) ea i 7 i2.3 Inspections for which no fee is
90.00/hr
, .. , :fica I listed 54 In min
CCB Lic.: iO3 814 Eliectrical Lic.: - ,.. Suprv. Lic.: a 1 7 71,
Subtotal: 1 , Gt.
Suprv. Electrician signature, reqiiiffst" V-X_,.. ' .....04.-4e, Plan review (25% of permit fee):
Print name: .5-1 eo #02.5 /. Date: e:4' Dt State sir-. arse (12% of pennit fee): q ,"
TOTAL PERMIT FEE: erg, OD
Authorized signature:
This permit applies tba expires Ha permit is not obtained within ISO
Print n days deer It bas been accepted as complete.
ame: Date: '
I
Number of inspecti ma allowed per permit.
IABuildhe.Pennits \PLC-PennItApp dtc 07/011t0 • 4404615T( l 1/05/WWWP.11
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Dec 07 2012 12:01PM Bridgetown Electric 503 - 621 -7123 page 2
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
Fee for all residential systems combined $75.00
Check Type of Work Involved:
El Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
t-
•
Fee for each commercial $75.00
system
(SEE OAR. 918 309 - 0000)
Check Type of Work involved: •
❑ Audio and Stereo Systems •
❑ Boiler Controls •
❑ Clock Systems
Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
. ❑ Instrumentation
❑ Intercom and Paging Systems
❑ 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
1:NB,i i P niia.ELC- PamitApp.doc 07,10 o