Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2012 -00144
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/12/2012
Parcel: 1 S126DCO3300
Jurisdiction: Tigard
Site address: 9900 SW GREENBURG RD 230
Project: Dr. Layport Subdivision: LEHMANN ACRE TRACT Lot: 4 -5
Project Description: (1) low voltage for TI
•
Contractor: BRIDGETOWN ELECTRIC Owner: ATHERTON REALTY PARTNERSHIP
22732 NW GILLIHAN ROAD 2100 S WOLF
PORTLAND, OR 97231 DES PLAINES, IL 60018
PHONE: 503 - 621 -7122 PHONE:
FAX: 503 - 621 -7123
FEES
Description Date Amount
Specifics: , Restricted Energy Permit 07/12/2012 $75.00
12% State Surcharge - Electrical 07/12/2012 $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: N 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 Not cation Center. Those rules are set forth in OAR
952- 001 -0010 through OAR 952- 001 -0090. You m obtain copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
C .332..23344. /
Issued By: tj i_g, co Permittee Signature: ,9 k ! 'I 41 - 6,0
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.
Jul 12 2012 9:57RM Bridgetown Electric 503 - 621 -7123 page 1
Electrical Permit Application 1,:, , , I : i : ,.•., ,
gi City of Tigard RECEIVE II' - •• ' •
13125 SW Halt Blvd., Tigard, OR 97223 R °I r "" /�o %I/
Phone: 503.639.4171 Fax: 503.5911.1960 p ,, Other Permit
Inspection Line: 503.639.4175 JUL 12 2012 pue Rmdy/By: El Page 2 far
Internet: www.trgard-or.gov ma y ;
l T: 1 z F �,. i r ra �m}a n.fir' • 1�. ant . �.r. v I r I _ . • � p . � .1 Supplemental telormrtlau
I 7 .ky.tv�E�'l�Pd d I � jl,cnu n tia0 eJC, - ' � ' vhF .� � ,. v dh a s . q 61 'SNIT . k�1W�X,1 .�� .i}{'� a x h ,� .iza a
t Ms � r �.W �3�'Wr.«!vF'��j(��'�' rivr i� I �;;t44 . FmfV 11�. :.... ' I ' +�. ' ���I't �'i
❑ New construction ' �• .dition/alterah.' j �'•''�• r�i..•I'r;, wl a
• Plane eAeell all • � apply ( �� � seta • pins vagina checked below'
❑ Service or 00 amp, or more i7 aui�ag over throe
❑ Demobltios ❑ Omar ,
}���5� where the a - . • current O Mad= and � boatyards.
i �'• it 1 5 l47 •S'11 6 ` 5,7, l J SSr• Y ta lr l 1►'i y 1 a `Tooth* bldings.
',�'� ! ' F!l��;�r'�`�t
.�w� .. �: i u a �K ..,�� Nr��: a .': ` I ,� 1 �.+`: n�;l exceeds 10 , � at SOwtb or .7 � h• _.>;.. . .r.is . raver ,.� ;t }�Gi��.P1�:'i.�,.��:• °�•d ��.� 1
❑ I - and 2- funnily dwelling • el/indtls�rlal ❑Accessory building less to ground,: •,meaeds 14.000 O Commend-um agnouhurai
awe for all Installations. !wad ng&
❑ Muld-famil ❑ Master builder ❑ Other: CI Fire pump. aInstalWionof 75 KVA
' ' '1 ,'!g,� 9 f t ,�k, "I rc' j 7 �[' f t {, a is- I:w .>'.'P•n r� ❑ m�geocy e
^- t " ` 0. 211, i' � ::311: ": s iai.� '.n t:,: i ll. '� �w.T.n: ' r�iu i-,,:a : � •l i Y^ - 't:...lL tie. .0 QAddminon Ot .. . • ,.. bed of O larger separately 2" L ived rye!
Job no.: 35 Job site address: i q 0 6 SCAJ �' _ J1 100HP or .• . - occupancy. -
['Six or more nu • • • units. 0 Remaationat vehicle parka.
City /State/ZIP. / • O Healthcare tho , ties. O sup ee !er
ply wr aware slim
❑Hamedeus ', 600 volts nominal
Suite/bldg. /: no.: , 3 r.jectname: • 5 DServioecr. . -. ma
• 1 00 . ., arre.
Cross sheet/n'I .�r:l 10' ' trl4.1 J .r 4 i I nr :poi y �.
Newresldenditli I t' ■ e- made- fandty dweili jg utslt.
Includes attach ;r garage.
Subdivision: Lot no.: 1.000 al. ft. or 1 168.54
Tax map/parcel 110.: Ea. edd'l 500 sq. , or portion 33.92
SQ. ft.) ,
,;•;=N u r�� itr �r F ���`�`5 7 7y :+mp its D err , � rii 'I3 1. r ITe I I Limited t I
,, . , � , i9!;l , l f r1 1 pS ki �e�I 1 Pi";
rr �� � , ti.s�.4 r�u: � a 1 lt � t,:r..� 1 �iit 5 ; 1 � ler� F, e' t�v� � ' I (with shaven [[ • 73.00
l�Q"ZN l.Q_b.t Llrnimd totetgy, T, .{fly
/ 75.00
restdemtiai { � ' . ��: hove
� a p s 0 ,• ; Services or k,. berallatioa dteradon, and/or rdoeatlen
(- 200 amps or less : 1 100.70
tr `, ,"I�IN� t ar�ct� '1 � �rt�tv�u.� xr l } rr � y.��h� •. hitiaYf'�Y°jrE1:t{r, �y,��f 4
t .�..'+tlrr'LC a ... •A.ata';., �tlitY11!d „tl'� t i. F i �'r:.kc;tC:•,5 ti.'"i'1M �Ij'.C"1�.` 201 amP91° 46h 133.56
Name: 401 amps to 600 i '. 200 . 34
Address: 601 amps to 1 ‘.1;!" 301.04
Ova 1.000 amps �' • b 552.26
City/StaW2tP: Temporary eery or feeders installation, alter and/or
, Macedon
Phone: ( ) I Fax: ( ) 200 amps or less I 59.36
Owner installation: This installation is being made o a property that I own which is not 201 amps to 400 , . < 125.08 •
•
intended for sale, lease, rent, or exchange, according tc ORS 447, 449, 670, and 701. 401 amps to 599 "' b..: 168.54
Owner signature: Date A dren118 , altt:radon, or artendoa, palnel dF ' 1p p A Feee with
'} yf IL Tf er �� kWJ. J Y' k r i s 1�•.�] 7��j lui:JN "i�1.i WrJ I i f V�"yl,, " (WV7G UW �IKr fe�
•r,1 "••': "t '1� dn.•Pk O.n.p xelv..e:,.e4. i( ' lilz:ia.a1W.,�'tw46.u..f�i ��a�'a�i p r+.d:,t: �_ ...r.:t L>,'1�1�9Ji,i1: earn branch 7.42
Business name: I B. Poe for branch . : , without ,
service err - first
Contact name: branch circuit 56.18
Address: - Bach. adddelha•ancit .
ra. t. 7,42 , 2
Miscellaneous ( ., a or feeder not lnduded)
City/State/ZIP: each ma:suflictured l modular
dwelling. service : ', or feoder 67.84 2
Phone: ( )
Fax: : (; ) Reconnect only 67.84 2
Pump or irrigation •• - t ° � � � l ii" t4 i i;.;2; } t,�:.` ti� +�" �� 1 fi ►i� Signal e 67.84 2
Business name: �1Q ma circuit(.) or r ited a ergy
Ua�o i FGE 4ce mmel,at�tioa,m, .,_.: .. 1± _ > Oe2 7s 2
-7 N O Q I S -rsue, ,.r Emil addidpaa � �' - don ewer allowable litany of the above
1 .V ! s�%� / Additional : (1 hr min) 6625/hr
City /State/ZIP: fpoccCI.rAI4D oR g72.03 -to (3 Investigation (I hr `) 66.25/hr
Industrial plant (1 78.18/hr
Phone: co veal - 112 Z J Fax: (spy, ) eV 11.23 Inspections Ion ' „ '. no fee is 90.00/hr
B Lic.: I Beall li sted min
i/ C
103 B�4 E cal Lic.: 1 9uprv. Lic.: Li 1 0 I' 1 i? 1 S ∎i L. r I ° t� r
Suprr. Electrician signature, roqulted'-" I I I , Subtotal: , 0 '''
J Plan!! iew (25% of permit fee):
Print name: Lo, ',L%, S, ..slid Date:
i �'c7 -• State - : • (129'e of permit fee): r
Authorized signature: TOTAL PERMIT FEE: -
This permit applies ,.. expires If a permit i not obtained w thla 180
Print bane: I Date: day. - It has beta accepted as complete.
• Number or' • - allowed per permit.
l AseddiegTermitnELp•PermhApp.t 071011 10
4 e046I37(11pSICOIla/grpa
■
Jul 12 2012 1:08PM Bridgetown Electric 503 - 621 -7123 page 1
I l i
Electrical Permit Application - City of Tigard q �'00 j Sco
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
W �ih,;.L • _G Z,:r I 1 t ' � �;•�51111i,9'i. §i''
Fee for i 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: Il
• u:..k�„d..F.^..�l��.a_..aiWh I `� -l:u .r1'" 2 -1 '�i.IIAI �, - t�; i II : - Il
Fee for gags commercial $75,00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved: i l l
❑ Audio and Stereo Systems
� II
❑ Boiler Controls
❑ Clock Systems I'
® Data Telecommunication Installation
❑ Fire Alarm Installation I!
❑ HVAC •
El Instrumentation it
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control* I!
❑ Medical
El Nurse Calls
❑ Outdoor Landscape Lighting*
I'I
D Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1 1 ButldingWamitgELOPeresItApp.doc 07/01 /10
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