Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2012 -00119
T L G A R O 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/11/2012
Parcel: 2S113AB01201
Jurisdiction: Tigard
Site address: 16260 SW UPPER BOONES FERRY RD
Project: Game Day Media Subdivision: COUNCIL VIEW ACRES (LOTS 21-44) Lot: 30
Project Description: Data Telecommunications
Contractor: BRIDGETOWN ELECTRIC Owner: PACIFIC REALTY ASSOCIATES LP
22732 NW GILLIHAN ROAD ATTN: N PIVEN
PORTLAND, OR 97231 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 06/11/2012 $75.00
12% State Surcharge - Electrical 06/11/2012 $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 OA 9 2- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503. 23222 .1987
bt in{i1 //
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Issued By: C�' Permittee Signature: D I\�. - f + PG C H -nD/J
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.
Jun 07 2012 10:27AM Bridg 503 - 621 -7123 page 1 5�
City of Tigard � � �... it- No. .
13123 SW Hall Blvd.. Tigard, OR 97223 Dese (( I Permit No. ��(,)'e - L ADD( (
, fi r. Phone: 303:639.4171 Fax: 503.6911.1960 JUN 0 7 2012 Plan a0"10M
.. ;; , ; Tripe *ion Line: 303.639.4173 �,, / Pagel Sw
Inlet>va: wr atdar. . C TY OF TI ' RD t4alaoditded,od: I w T 1 3typemstal lifer•attaa
❑ New construction Lion ►, • • '• 'Uon/alteretion/rgplacament d .,,_ .. ► - 1:
• ❑ Demolition r : D service ar 6aeder I a', oarrot>t 0 Medea add bsgymda • antra the avai .
CI 1 - end ?r8stt4ily dwel tin mer claf
exceeds 10.000 ' 4 a ISO vein vein or O Pleating buildings
g '� /1ndustritt l as to ground. r ' Id. 0 D Lbammaahno agricultural i ❑ Accessory building amps for all other I4 • , fetus, trap.
❑ Multi•�nnil 11 .M - . - „Wider, _ I :. D Fire pump: D Invasion of 75 R VA or
D Emergency syue •, factor sepsraraly derived system.
0 Addition of eaw load of • D A. "S"."14”. "1
Job no.: Job site address: `w 6 v ? / se ir „ Io0lfPor I « Panty
-� - , ” It m mare - - I units. 0 Roeree8ed prim
pr
City /State/ZIP: s • sate 6tsllt. r D gamily voltage air m ra
ore nt
Su iteJbldgJepi Hazardous local • 1 600 volts nominal
tto.: y� /�. r! D- atovioa • . . .. • . .
Cross stroot/directions to Job site:
' - u° r 1. miaraai 11 :`,ft 1M :-11111 al •1i ::. ]fit • -
' Wow repdaotlatd a e-ar mnitl.6a1B7 , • 1 U"
se / i a V . A i . tmdtt atbui 4
Subdivision: Lot no.: 1.000 sg, ft. or leas R . 168.5/ 4
Tax map/peroel no.: Ba. eQd'1300 sq. A. 32 t
Limited anew real - ;rid
Limi (with above s4. + I 73.00 2
ted energy, m , ly
•
residential punk punk .' eR) 73.00 2 fe . ' I. fl deco, ugeratlow • relocation
, „ 1 e 200 amps or teas I Y 100.70 2
201 amps to 400. ! 133.36 2
Name 401 amps to 600 . , J 200.34 2
Address: • 601 amps to 1.000 ; ' . 301.04 2
Over I,000 amtpsp► ' , 552 2
City/State/ZIP: Tee ry ' - - i 1.. feeders laatatladoe, alt mica, and/or
Phone: ( ) Fax: ( 1 ) 200 amps or Ieaa I 59.36 I I 1
Owner inegllatlon: This installation is being made on :propmty that I own which is not 201 amps to 400 am • • 125:06 2
intended for sale, lealease, rein, or exchange, according to ORS 447, 449.670, and 701. 401 amps to 399 am . 168.34.. + 2
1 arenas tirades— r
Owner __ _i_ _ ___.. _____ __� ._I_,.._. : • A. Pee for branch , r • . t @ Dand
above service or . F _ fee,
•
each branch ciao•;!!, 7.42 2
Business name: B. Rea rbr branch el J, w
Contact name service or deader ,.• An
branch chain I 36.18 Address: Bach add'I brunch .: ' 7.42 1 22
•
Mr�
1l (se 1 i' er Wade* sWade* City/State/ZIP: Each mantrilmured i i; .... ,
Medlin*. servIce . .. R feeder 67.86 2
Phone: ( ) Fax:: ( ' ) Recommit only III, 67,64 2
E-mail: Pump or Inlyantan Cl • ' 67.84 2
Sign or outline ii , . I 1 • 67.84 2
1 Signal oheultpa) or N
• 1 . �[e. panel. atmrapiat, , ,. ' , l Pags2 471:Y 2
�¢� eddflipaii I 1 . •
Over eAepabtt tri ey the e hova
'. I / Additional lnapttadort iI! hredrn) . 4 23/brit
• _ . `:� i rr taveadgadorl (I hr nil • i 66251 hr
Industrial .1 i Z Iropatxiafs fawbioh I! 9 : one b 78 16r1s
�� Fax: (00 ` ) 4i r' _ :: : uprv. Lic • 77 . -. .� 1 �_:_.6 , � 90.001M 1 _.eii�i�a�
Suprv. Electrician signature, required: _ I gum; •
permit Pork
Print name: 4 ( s . I , _ SLIP ' ' Date: State '! _
I ' c l,am,ttbak Ul
t TOTAL PERMIT 1E
CZIMIIIIIIIIIIIIIIPAIIMIIIIIIIIIIIIIIIII This Permit■PPtka ' . anima Ile panic is est isbettase stihhtn loo
Date: days one , 1 bas bees ascots, a seasPleta (� LC
Number of impeetia y , lowed paw n& CJ '
r�-�+• 07/01110 .
440461 muASetOMIWBH
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