Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
a : COMMUNITY DEVELOPMENT Permit #: ELR2012 -00208
T [ G A.RD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/06/2012
Parcel: 2S 112AC01500
Jurisdiction: Tigard
Site address: 7319 SW KABLE LN 600
Project: Solestruck Subdivision: FANNO CREEK ACRE TRACTS Lot: 23, PT 2
Project Description: (1) low voltage for DatafTelecommunications
Contractor: BRIDGETOWN ELECTRIC Owner: PACIFIC REALTY ASSOCIATES
5701 N LOMBARD ST ATTN: N PIVEN
PORTLAND, OR 97203 -4113 15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 621 -7122 PHONE: 503 - 624 -6300
FAX: 503 - 621 -7123
FEES
Description Date Amount
Specifics: Restricted Energy Permit 09/06/2012 $75.00
12% State Surcharge - Electrical 09/06/2012 $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 0 952- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.233444.. -T
Issued By: Permittee Signature: 0/0 4 P 0 . Ue4 I I0 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.
Sep 05 2012 3:05PM Bridgetown Electric 503 - 621 -7123 page 1
Electrical Permit ApplicatioRECEIVED
I N ,,,,y City of Tigard SEP 0 5 2012 Received 9 I S1 l Z 51 • Petmit :g .701 a..- ba..)0
13125 SW Hall Blvd., Tigard, OR 97223 Pl Review
Phone: 503.639.4171 Fax: 503.598.}9611,� y Dare/By: Other Permit L(,4 o2O/_.s 00 it) ,
i , ' • . • Inspection Line: 503.639.4175 !mot I T OF f D Date Ready/Sy: ? Jails' lii See page 2 for
Internet www.tigard {1 1 . .d„ Notified/Method: '1'1 � p 8applemeetar Info Xm . tloa
I
!Iv .' n '•�V' r feegFf J y ' t• tr �a+F . .n. F�a r v{ �,�
j�i'J.•,t�i�l .Y ���'� -I':. ��� !�:� a� � t' +R�: 1 )'�1lf � f� r{� ' � l �7C � � y
Y 1 t � � � t �,��" ��f 0 1 i r: wv ri4MLk c 3 tr_?t .>':. t - ,. �Y at �tlr. �, rH:^ •�1,,
❑ New construction FA Addition/alteratio • lacement Please check di that ' • • satitoit2 sere of Nana w/dein checked below):
❑ D ❑Other: ❑ Sc � or feeder 400 amps or more 0 Bonding over three stories.
. b Y Demolition
¢ ! : 1 �i r r '.r ,'arc , where ale eve)] ablei fact atrrent ❑ Marinas and beaVerda•
I Y1 1� , I . i;Y l . '�6i "' li F V Y,. r j, t �! •i j� ` � .t; I � 1 n 4 i � t ' ,'•a �: '' 7 exceeds 10.000 aeis at.f 50 vole or 0 Floatingbeildinge.
4 t XF Y �� :• Y , :M� revs x1,141;44 . r ' 1i a' " .' leas to ground, or elkoeeda 14,000 0 Commerrclat -use agricultural
❑ I - end 2 - family dwelling Pi Commercial/industrial ❑ Accessory building amps ra all other gedellad0me, both/toss.
❑ Multi- family ❑ Master builder 0 Other. DFire pump. 0 !retaliation o RNA �avel�
LIA \ ?'{ I :11 :1jY ill` 1 ' ":' ' y.�+ ut;.illi;T F� 'Iti1!i1 �'f. "!A}vcj;:4: PiIW.' XIU' lfi 1 �i. DEemegent ! sy5t . tz gcr separately derived syst
irf. 9'iNT j',('IPI ICI � 1 :1'-�4 ` I 3 �i " 1 1 / f I �iNSA, i.1 .1rl.iel'1' gN.
(': �40k• qj ., j'M ; de l i ! �
•`r whllteif5++.`fteilik'sate r:�Vnatr -A ri; �CrMrtra.... 1.& il. tt... w�eis elm:iw,ie:yY.e....4.xi''' V . D Addt t u rnof now ralcorload of ❑"A ", "2 ". "I- 2","1.3",
r /� t 1 - 100BP or more. osamen y.
Job n0.;
I L J ,11b site address: , 1 q Cd l I KO�DtL ❑ Six or more reeideglLl milts. o Recreational retrials parka.
City/State/ZIP: . Q� ^ 1 O Haallb-co s theiitias. ❑ Supply voltage for more them
, 'l 1 I ' L D Hazardous locatforh• 600 volts nominal.
Suite/bldg./apt no.: i e a l ) I P r o j e c t name: e s i m i D Se vice a tip ;• we or mom.
P I N f'4s a ar,t f '_ -, !I ° '! E V V' . '1.6
Cross street/directions to job site: `°'' rvdi i• , : a,t;r w l,:r. ;rinse l i 'fi: - 'r'sr
New residential single- or mull family dwelling unit.
Includes attached iarage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 168.54 4
Ea add' 1 500 sq. ft. or portion 33.92 I
Tax : • I no.: .
Y jWY1lAMJiiTA, n 1 , ro Limited BY. 75.00 2
1 'I' c I l ' r . ; I s , . 1I`r' i ` I I '` j , a'r , •:: r y :ga iy� - (with above sq al
?'P !r4 ' at / atlt ned> etro i1SLAti LY l:rwrr ii . `1't'. 'Y ,'uT ..� •$ , 4N S� , ..! n�; e ■ d Limited energy, rout •- family
LOW V el Art CVw am d , ; . ' residential (with clove sera R) 75.00 2
Services or feeders iostalhuioa and/or relocation
a si • t 200 amps or leas i 100.70 2
;Rfl.[y�'Y',I "y IY.�p. <;r�Y`� 1�'i 1: RilN;y''y� ," •. .-
i • 7 I "J licit %it:t:''.t1;Y�:" "* ;1 i;::ai~ l s 2°1anlpst4400493 133.56 2
Name: . 401 amps to 600 amps 200.34 2
'601 amps m 1,000 eglps 301.04 2
Address: • Over 1,000 amps or felts 552.26 2
City/Stale/ZIP: T�� services or feeders Installation, alteration, and/or
Phone: ( ) I Fax: ( ) 200 amps or less ; 59.36 I
201 amps to 400 Aunt 125.08 2
Owner Installation: This installation is being made on property that I own which is not
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits- view, alteration, or estmedon, per panel
Owner Signature: ! . Date: A. Fee for branch tilde with
44.1 , t'ya tip 72 r lVi , f �ye e .a n'; .r . 1 above service or r
j't 0 ..1 .ire ' p�e L, '. '?A ,. ` ' .°�w IW Y n e L' . ... ` t # ' - +i `d Y 7.42 2
,{,hVR'C rf sb+ M. +li.�' ti u � Y xv ar151t s..a.sa .ems: each lunch ClDCmI _
Business name: B Ike for branch cir tie without
service or feeder fee fi 56.18 2
Contactptrme: branch chuh 6 ,
Each add'I branch ci cuit 7.42 2
Address: Miscellaneous (service or feeder not Included) _
CityBttttell.IP:
Each mmo&ciured filar 67.84 2
dwelling, service an orlbmder
•
Phone: ( ) I Pax: : (' ) Reconnect only i 67.54 2
E- mnil: Pump or irrigation aide 67.84 2
I Sign or outline lighti 1g 67.84 2
A , r 1: hil .r._ 4 1 .... .... t:.... 7 . r:. .F. wn.hlY 1.`:t:!47.i ORNIM14'L^laV n S1 a
Business name: Sai L.£ , y., c t�anel,alteration, or itm. LCbI
each ad:Mb:tat Ioeedon over alt in any of the above
Address: £ 7 01 tv . I-,Q'fit,64e srPE Additional inspectimb(Ihrmin) - 66.25/hr
I.
City /State/71P: epocruoit, 1 , O ( 3 Inveatlgation0.hr ) 66.25/hr
/w '�" ' Industrial plant (1 Iv 'r r) 78.18/ hr
Phone: (Slog ) bail .- '1122 I Fax: (GO ) laj1 7123 Inspections for whit no fee is 90.00/ hr listed ,, min
CCB Lie- : 103 824 f EtpcuiC LiC.. .. �I suprv. LIc : 4 1 7 '.61. ( is r ( :;: ', i.t,.J;.:. ° r . •.f...: :7 i?,��!�l` �, t ',11,"'".. i
i
Suprv. Electrician signature, re Iltr -- %.1„...0.„.,0,...4...;,-e.,, j subtotal 10) d0
Plan rvtew (25% ofpermit the):
Print name: :, )y4A. . 7s P .e.,,s /err/ I Date: State 8 p (12% of permit fee): q 00
TOTAL P ItFEE;. 614,00
Authorized signature: This permit appBn9on expires.ife portritiarrot .eryaed within 180
days at Rhos lien
pe ctioea B Smelted ascnmplebe
Print name: I Date. .
Number of insp allowed per Pamir.
t:lBulIdl acttelLC- Pamitwpp.dae 07/01110 440•46151'(itro5/COMnv®
Sep 05 2012 3:05PM 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:
❑ Audio and Stereo Systems*
❑ Burglar Alarm •
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
•
Fee fot ugh 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
E l 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
IABuildiryilPnmbc ■F1C- PermitApp,doe OVO1 /10