Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
s • COMMUNITY DEVELOPMENT. Permit #: ELR2012 -00129
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/25/2012
Parcel: 2S112DB00300
Jurisdiction: Tigard
Site address: 7257 SW KABLE LN 300
Project: TRANE OF OREGON Subdivision:"HERN PACIFIC TIGARD INDUSTRIAL I Lot: 5
Project Description: Data Telecommunications
Contractor: BRIDGETOWN ELECTRIC Owner: PACIFIC REALTY ASSOCIATES
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 06/25/2012 $75.00
12% State Surcharge - Electrical 06/25/2012 $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: Permittee Signature: Dot'/ APP/eA 1 1014
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 21 2012 11:09RM Bridgetown Electric 503 - 621 -7123 page 1
it wr s Electrical Permit Applic ,; . i t I rl-sOirn C ia.. 1 • .;, , , ,. , ,
City of Tigard I' I *I i2 l / t ElQ. 42 f Q,Z '� Q
13125 SW Hall Blvd.. Tigard. OR 947x3+ 1 2 2 Date/By: 4 /� e3- Pe rmit N..
Phone: 503:639.4171 Fax: 503. 398.19 Aate/Bv: C>IherPermit: r'f t �a W� 7
IaspoctionLina a 639 g 4175 c � ;/ r ��l�7ftyyip DateReaM/Ely: l BI B,ePaee2
laternet www �r ov , , h l 1 t� I ' , 'f ( 1 supplanentel ra6rraadee
a
„ e,C Z u n n } 31 nry 7rr } nr ,., }.rs
�I.� ., � ,�,'( (�� tv, '( I �i I'a�c ,�,0}' @ri"'iFtll '1 s - 11 ,,ti
' i fa au . vise i g 1 x1fS ig ��n� i .�SR�.r1= w6s . ,�:�.1' ,E 1 v, 7 � , N/M� FI � " I . { + ' r lilt 33 f . i � t .
s.. , . „ �Yi`:,i�1�': - 1. I :^,�'•'. �i '`r � : S> .Lk_ � - � - J a ..�. sYh`t6�SJ+,i:i3ha:
Addition/eltereti • • replacement Please "
❑ New construction �:' deck u • 7: apply (submit 2 sets of p lane Wheels checked below:
❑ Demolition ❑ Other: Service or -- • R 00 amps m more 0 Building over three stories.
whore th aver ' . Salt current 0 Mains and boatyards.
CiHr j ett• ; nr � ,��.f� s �� 1.; ri a , , � � v: s st e , � • s 1, h. ,, a "� E • 7y� excee 10 1 1 r at 1SOwlb or O la
.1:. 9'iV':kr � •, � ,, {{,r�•, ♦�y'; �! �' � :, ��1 1 Ps m
m i :- r�iNtl!•rh, !.[w /4IIL �� � ;.G�L "7. i� +� ,.✓'tv
❑ l and 2 - �mlly dwelling °..' CommertaaVind al CI Accesso boil less to ground, ' encode 14.000 p c�rrnercim -mo agricultural
Multi - family ❑ Master builder ❑ Other: Accessory °F ire / g �f immnm;om >madinea
a on 475KVAor
�',G 4 # 1 r t 6iF } 1 s ( kNi r p n �n m v xw .•_, -. DEmcgeneys l arger separately derived
�•� {' u , �d L I 'r I s l u � i , f u "r ", • A , L4 r.1 std
q�4Gn kur. .t J:Y [: ✓it LLt.3:7l,1y. �. ,4w�� , 4,II.a4r,i/.•+..•kunn:a� �•. 'rc =: y; OAddidoaof: - mot 1086 of 0 "A" "6","1-2", "t -3"
address: 7 5
Job no.: 12. E Job 9161: '7 gl11N � 100HPew . J occupancy.
13 §/{V � Six or more - unite. 0 Recreational wane/. poke
's
City /State/ZIP: Grit 4 0 Hsahbcare feet dies. i7 Supply fi
voltage r more than
^- 0 Harallous I 600 volts nominal.
name: Suhe/bldgJapt. no.: 0 506 J Project name: Cagriegt- 08ervise 4 , mops ormorn
11 s {i rat Fj - . ;;Z•::/1':•-''; 1 s Wfi 3Y .w
street/directions to job. s ite: 3 r ii6lki t e 1 , f i c. { r., r ,._ V� y�
Cross Slft'ef/ f itR " i i 7
{ Newrselden : ■ I ; or aeulUFlamtly dtrrenh g unit.
1 Iarludes attach : garage,
Subdivision: ' I Lot no.: 1,000 N. ft. or • - 168.54
Tax map/parcel no.:
Ea. edd'1500sq. ;orpottion 33.92
°t - tr v 1 a w s d u r 4 tyt d� Z irr l�f ti4wxrtd��tJ' l tG Y, r r r 1 y IJNI[OQ mere', • - .• 75.00
r ,' 'P. + i,. _ • a � Y%�`' � I - atl 1 J ,���� �. �,.,y1 ✓((�1K �f ry4 a��
It,lr(11C1N .n. I-I1.u.,.4
Y,i.b (��.:.i.Y�iYeNrl➢.Uih'fiiYS2lP •15 'LLLRiatzh.�i!i•Y3�t6�7 } ,:Y _ 71 ( ids above •
Limitedener . famil
Lt l{w I 1- =� :. �. . residenu ( , .. sq. it 75.00
)
altera
services or : :lnstallnNanitloo,,�a,/m�mo. motion.
20
�RMY9 3/ 0 MFG or less 1, 100. I0
' F li3 t� � 5rr �..,.' { 1a t�"� ! a �iCJ' I }.L ��� � �waun�^p'"' Y
' y 1„, .,i :,. , :: :L .Z11:k1,,..w+e;1�!iil%'f , `1. Milif 1212 l..f. 1.r' -.•r; ,.�.ak1- 201armsto400 . 133.56
Name: I 401 amps to 600 • 200.34
Address: I 601 amps to Lilo 301.04
I Over 1,000 amps b 552.26
City /State/ZIP: Temporary sue or feeders Installation, attention, and/or
relocation
Phone: ( ) I Fax: (1 ) 200 11171pil or leas 59.36
Owner Installation: This installation is being made 4 property that I own which is not 201 to 400 '�' ` 125.08
rent, exchange, according t¢ ORS 447 449 670 and 701.
Branch elrerlb she
� a"' t° s99
intended for sale, lease, ten or exc I • - 168.54
O Owner signature: sheath/140r or 4 • • .: • , - l
p ii 3 n ,,� a �� t � ure t 1 i v i ku iP a'�? PrS} I dY ru rs,�v 1 v n A. Fee for branch with
;�� y"; S7 ?, �l i ' it "• E ' f� `,' above service o i . fee, 742
• r : y I, l each branch
ar:�;. a.:a.:- il;dr,t• , � eJ Fi.;�C .iLti fl.. ..;1:reeL'liE4 i �,{
Business name: B. Fee Re branch •s .- ::.. without
Contact name;
service or - - . - I -. first
branch circuit .
Beckadd'I branch i • it
Miscellaneous ( •• "; • or feeder notlnduded) _
City /State /ZJP: Each maniacal , •: modular 67.84
I
•
dwelling, service • • ortreder
Phone: ( ) I Fax: : (I ) Reconnect only 67.84 •
E-mail: _ or irrigation 67.84
e `t, ` I E� 1& fc ' T't r 9x pa7� w o" Q s ' a r y Sign or outline h ., : g 67.84
'' E • ..i* rf31''iwCL iF� {mil •. ,1 u -. "..i..:..... - �ni� I!'I` 1`4''r',f', ,1 1 r sly J? i ,�,.,,, a .., ,• ' . . :+':. -,x - Signal ctuuit(e) or ! , edeinagy
. , t►aael altetatitn, ' I
Business name: la % t►! s g l Paget 75.
d O ` Each additional b . . -. • a over allowable In any of the above
Ad seas: /..., Q (� $ • / / $ �7 Additional in . • (1 br min) 66.25/ hr
Citylstatdz,P: j II C) (3 - 1n� (1 lef ) 66.25/ hr
141 - 712 2 Fax: ( In spec i s plant
for (1 • o 79.18! hr
Phone: (90 ) I ) 1021 7123 inapedlon/ far wb m fee is
CCB Lie.: ) ,, tt I s :.�L.J� betel 3 min 90.001 hr
. 1038 t 4 E�ectncal Lic.: • -$ -Suprv: Lic.: a i77 ' ;rik1171fiet• , s!. r �
,.... ,.: • ._t.: :r.T - :t .rtn: •l'•• qt.
Suprv. Electrician signature, � Subtotal: • 40
P1 sew (2596 of permit fee):
Print tarts.: o �'1G`a .5i /� Date: S 00
h.S � i I tube e b -:: ge (12% of flab): Q,
Authorized signature: ! TOTAL PERMIT FEE: Piti /
'fhb permit a ,.. i - espirea K s pensh Is sot obedned wlibin ISO
Print name: I Date: dos r it has been accepted es complete.
• Number or.... • .. • • • . allowed per permit.
l:Wulkbutioe tdOELC- PermhAppdec 0710rno 440.4615T(It1Ul/COMAVE8
1 i
Jun 21 2012 11:09AM Bridgetown Electric 503 -921 -7123 page 2
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT : ES:
* .rt n — �E.:
Fee for a residential systems combined....... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Condition i g System*
El Vacuum Systems* !
❑ Other:
Fee for each commercial j $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
0 . 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 regwred
for all other installations
I: 1Bu +ldmiperrnin1FS.c- ramiulpp.doc 07101/10