Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
lig s: COMMUNITY DEVELOPMENT Permit #: ELR2012 -00215
T I G A.R O 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/13/2012
Parcel: 1S134BC00200
Jurisdiction: Tigard
Site address: 12194 SW SCHOLLS FERRY RD
Project: Comcast Subdivision: WINDSOR PLACE Lot: 32
Project Description: (1) low voltage for Data/Telecommunications
Contractor: BRIDGETOWN ELECTRIC Owner: GREENWAY CENTER LLC
5701 N LOMBARD ST ANA KALAKAUA CENTER
PORTLAND, OR 97203 -4113 2155 KALAKAUA AVE #602
HONOLULU, HI 96815
PHONE: 503 - 621 -7122 PHONE:
FAX: 503 - 621 -7123
FEES
Description Date Amount
Specifics: Restricted Energy Permit 09/13/2012 $75.00
12% State Surcharge - Electrical 09/13/2012 $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. I
Issued By: 1 Permittee Signature: Of� 'F! Poo oo r)oK1
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 13 2012 2:22PM Bridgetown Electric 503 - 621 -7123 page 1
El -' rical Permit A li ati r i V . ,
City of Tigard DatelEtr 4 1 z )y ye.- , I :t finis:: ' .a:0 /. ' - 002&1 '
13125 SW Hall Blvd., Tigard, OR 97223 S E P 1 3 2012 Men Review
' Phone: 503.639.417! Pax: 503.598.1960 DateStr. Other Perraa'
.. , ' inspection Line: 503.639.4175 "i 1 I R- � ' Y S � „Z 2171 men Et m od: c RI B Ike e Pap ter
Internet www.tigalyd -r.gov
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❑ TT - construction :1 Addition/alteration/replacement . e ' �" r'Y - •:... ' • ;� gr, -- - `
Q Sm georfeedee' I eropi'o s epta' ' rl'giiiIsor - , elonea.
❑ De. Alban ❑ Other a4mo Ilm avails • ' gnat carrot II Miriam and •
r e i ri G t1� *i < J..` 9 `'.. !' U3. t1 C n P ,. , , ' al
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:1 .,K• r ,Y^.4 1 i t . `a :1 � km to 10,000. I • m 150whs or Pl • bml'
1R'nai� �Li� Illl. rr� r,t{ •�'� N,r';f�� ....L..; I,�.�z M.u,d7;rk _ �. •.a.c. :.;a.�..n �: 1 a � to ground, or .... � .14,000 al • • ,. ... - ag7ieGQlffl
Eli- ., 2 dwelling %' Commercial/industrial ❑ Accessory building amps for all other , 1 ... one. • buildings. I '
❑ M • -famil ❑ Master builder . 0 Other: 0 Fre pump. • II le on ..175 KVA er
t P iii g;q &4r ! . , z IY '. Ic.: 3,4"Ki.04 3, 'a01f1I ISfIt'iti t ii ... s .. 1 P OGn° inoY BYO '� . • . • d.i asystem. • timt hi' 1 . u11,,,�TU3 t?:i;' _.::11 , r.. kdl,_ l arYHi. i.: L. V.:11..r1_M1.7.1e.:�.f.lit..tir 1 0 I .h Q Addition of ne •• •' • toad of. II "Aw.,.6 , •1- . "1 •3•..
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Job no. V Sob site address: i 21q $yN ��na1lS c �w. i�,D. 100HP ar mare.
O Six or acme ms • I Y.
mitt. II al - • p
C110S .... zap: ' rasr•�9V (YrZ MI/3 o fetili • ° ,mot. *ar�re than
Suitedb , giapt. no.: Project name: , - �i y 0 service m cedar ' < I oraoo ea
.... r 1 • Iu' u'. i 1 72 Ii' I� I ' 1 sit 1 •M.I 41Pir
Cross - - directions to job site: �r�•;d .. ,...,s.N+ ...4F If,..0 I�. S �. r },_ F�i`'Fi�l�i.
�v __ _.� l�ilfa Nli."ll•1111•Ell •
• New residential : ' , - or multf • , .7 , - Ws . 1
laetades , . -" •, wage.
Subd on: I Lot no.: 1,000 nit or tom 168,54 4
Be. add' I SOO sq. ft. I .. portion 33:92 I
Tax . � � too.: �;
y 4 ym tvk; l a� I urea k e rncr c c� r a e= s �I 1 �lntr atF,t ' ( , 150 2
p',g I y c } 1 4 . r . 1 1 4 r l n,,.4it pi 4 ¢; I i t R rti. 1 - gibesein - �
. .M1 r I ' r_ A ti fgi K.- .l4ll.l,' /. c .�i,....Y1d..t.a RIre..7las., I. ,J.. -SSA arka4�,..4...1» -.
I. c �_ -- I LiinfiEd-0sler83, 1lleoiiy . 75:00. I 2
1/ 0,„.... yL. ,,„. & N !• ''�`� .. "'L T (with ' I .I .' - w. S.j a .. re
locddoa
E 1► 200 amps erless 1 • 100;70 [ 2
f
C I h P .1 1 1 C j`•si41 ? � t r i , ' -
. 14 ri LiFitIN N T Ll 1• 201 to400 i 133:56 2
Iti t ii L��. 14.:. � :P!,E,rd i i,rl..:., 1 13V - , e.'. ^4..e I ,:. ' ∎,. isti•PLi t.A `;;Ju. SA.. 6 `
Name: 401 amps to 600 I ! 200 :34 ! 2
601 amps to 1.000 301.04 ; 2
Ad. V Ow e 1,000 amps: ' I 552.26 2
City /' . 1 I. ry . , I,I .. or .. , i , . , a . , ; on,
Phone: ( ) I Fax: ( ) 200 amps or less I 59.36 i I
Ow , installation: This installation is being made on property that 1 own which is not 201 amps to 400 .!, : 125.08 j 2
late •. , fbr sale, tease, rem, or exchange, according to ORS 447 449. 670. and 701. 401 mppnto 599 ; 168:54 2
Owner signatures: Date: A. Fate ,ttaoch ., taws&
1 1'S Ij � t '4.' lace I 1.. ' ' 1!� /1!. 1A J{tl / fie 9h ° I ff�. ky Jdl�l {'rktr '1t] r!I Ftt r 1 ? ..
£ , ct iA l rs .1 c ; N 4 1 f 1. .
rrti 4i I . -, 1 i H+.
II 4 f. I t r i, .
, i t l abavo aaviebor I fee' 7.42 2
�•t.., .,61,1:�4.-,:.w. . 1 .„ „F.,.
,n....H ..
iti,f' .. 41 it .II. 1. t._- .It'IL. en .,a. n. w.r. ..,0 ..,. 1. 4�1fir . ... nth- d .
• :. pain B. Feeiiorbranch ;... without I
service or ruder: - - first 56,18 2
a branch cittadt j •
Eaci add'I lttanch -', . _ .1 7.42 . 2
Addre : Mhoelbtteol s (' - . or ... iinelnded)
FacfiMsnu Oared , . modular 67.84 2
City/S ZIP: dilllelling orteedts
Phone: ( ) I Fax:: ( ) Reralmect only 67.84 2
Pumper Irrigation •;. - 67.84 2
Fein 'l 1 i�� i a 11`h'e ! I , yA1 ti �
'iy'yI;t�� its *¢,,: Kt . 184'u .J 'l r an Signoeuti rI,;., 67.84 j 2
Ixr�..i; aHa'1§•r'-.. 1 �_ •1,..t. , y ,, .;1. { 11. _! r•f.,.�fcsTZ.4a cc Strife (d si ,"/' pe I: •..s �'
Bus'' name '1 + � : Baelraddltlr�mll aloe over uh' Maein , of the I • 2
Adders.'. • £ N. I -00.84e0 s -T Additiaitai. •(l taMfg) 615.2.
city .. r_ ztp: ' p U- cisk . '7Z -1i3 ^(lir.:. 1 6625/b
Industrial ;dent a .,! min) t • 713.18/
Phone: Sge,y4te 711Z I Fax: c . 1113 ' ''! Ill I
Lk,: : Y 3u rv. Lie. '�� ,1 lj r -1 !listed IT ^ u , rir : :
tiO384 .1
CCB L I P 41 ,J..
Suprv. an signature , �... - �+0i -.+P� ' a - '. °
Paint e . , 'i/4 Sete. rksI'd I Date: State. =E2==ira II ` j
,out; , signature: ' • TCPTA t:`'..: F ..;
This pars*. ' II .. ■ :: !!k° ;; r .f" 8
Print mile; I Bate: via t - #liu 4 at • .. • , 1'• .. .
Namber o - epoirtiid pa: ,
•
..1!.B' �ga m/ovao 440461 STt11/06ICOlGUws3 •
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Sep 13 2012 2:22PM Bridgetown Electric 503 - 621 -7123 page 2
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
•
•
•
•
Fee fot .l1 residential systems combined........ $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
•
❑ 'Burglar Alarm
❑ I Garage Door Opener*
❑ II- leafing, Ventilation and Air Conditioning System*
•
❑ !Vacuum Systems*
❑ !Other:
Fee fo gArl commercial $75.00 •
syste
(SR . OAR 918- 309 -0000)
CheckiType of Work Involved:
❑ EAudio and Stereo Systems
❑ !Boiler Controls
El bock Systems
•
r gi Data Telecommunication Installation
El !Fire Alarm Installation
❑ IFIVAC
El !Instrumentation
❑ !Intercom and Paging Systems
❑ liL andscape Irrigation Control*
❑ Medical
I •
❑ (Nurse Calls
El !Outdoor Landscape Lighting*
❑ }Protective Signaling
• ❑ ( Other
Totl number of commercial systems: _
*No licenses are required. Licenses are required
for all other installations
lAeuaa u cfam;iamaoe 0151 /10