Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
• a .• COMMUNITY DEVELOPMENT Permit#: ELR2012 -00212
T [GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/12/2012
Parcel: 2S 112AC01100
Jurisdiction: Tigard
Site address: 7301 SW KABLE LN 900
Project: Subdivision: FANNO CREEK ACRE TRACTS Lot: 21, PT 2
Project Description: (1) low voltage for Data/Telecommunications
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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:
FAX: 503 - 621 -7123 .
FEES •
Description Date Amount
Specifics: Restricted Energy Permit 09/12/2012 $75.00
12% State Surcharge - Electrical 09/12/2012 $9.00
Type of Use: COM . •
Class of Woik: ALT
Total Numberof 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)
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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 2- 001 -0090. You may obtain a _ or
copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332
Issued By: C V f JfL Permittee Signature: D&i `PP�/'�►tl i [•T/(i
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.
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Sep 11 2012 2:34PM Bridgetown Electric 503 - 621 -7123 page 1
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Elec rical Permit AnDlication , V :. , , , I: , ,, . ,. , '
City of Tigard f SEP 11 2012 e q ll a-1 a- . - erm* No,: ei:. de(. - 00.3.0_
13125 SW Hall Blvd., Tigard, OR 97223 Plan Revie
c. Moo; 503.639.4171 Fax: 503.598.1960�e � °gyp 1� Gf�nu � Ocher Perndr.
Inspection Line: 503.639.4175 N11 1 / O 1 t Data Raalr/By: I RI See Page for
Internet: www.tigard- or.gov ;i �n� Notif>edlhtathad: 1 1 Ssppkmaa. loftum.ae.
C 4 k . s,_1 1t1r IYt r Fr:" NN ! 97S 1 ' t s ca r • . I '" r
i ,(7, � a ', it v ,t� , i ; r , t' J '� i ry� . ���y�� {a stH' �M . - sS t tit ,� ,,� �r � v, +�
r i1} "3{btj t l,' 1 o,V i .1 I � A. ,�'„" :'.I,,, ,„r � � '2.. . J I,. x '''.:011 i%it' ..41: , irnd f?
m∎oliN „9 .k1.W 14:14 i :frArn_ ,s . 4 1;if 'k r u..
. 4; f. , �
Sb •. • (.M.SI Y.. ..
❑ N construction ■:' Addhion/aheratian/rplacement Please checkslita (aibfldl Vote • plans seems • .- below):
❑ Smvloe or feeder i amps or More laEttulingovei - - stories.
0 • ..., .lition ❑ Other. where the avaaaw Each current q Marines and • • . ,, • • .
M , t M14 g tm�re. rs T: n t r� Fra t. vg 1§:•;,, *.' ,, r9• exceeds 10.000 •. at 150 volts or 0 Floating � 'i . 6 iw i x: . u,s!r. s:itai;�Nt ..ar.a rwd+r.,.;..i " .x:A ! {a: t�F 5 -+, .. ,. t i■i Si f: W ;'1,1,4 lesam ground, gro or - - - 14,000 Q Cgmaieretel "- egucullaral
El 1 - : 2- family dwelling ® Commercial/industrial ❑ Accessory building a m p s f o r all o t h e r .. • • quudiage.
❑ Mut '- family ❑ Master builder . ❑ Other. DEng pump. 0 installation co 75 KVAor
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r i t-Ok it Ii 4 't. F i ' ` n ,pr gym, /T � as �. s :t Y'Ie Z.0fIrrpV,x� t ' • ( !x 0 Emergcoey � . . , °Addition of new • • . larger y derived mom �i1] ,:allo ;' l .S .i i l-reo_ ...B1 742.4its ✓_,aig; anee`i a414;:,4k1 .1 ' .' .11:P.:l'2 • load of Q °A . `E^, rrl- .1 _3
It - N Z, 3o gW Kyb1A.- tv� 8? or mere. occupancy. Job no.: �i lob s ite address: ' � t °S&or miner -. , :1 waits, 0 Rearemioml - •t.. parka,
City/State/ZIP: 1 p. , co_ -li VA 1311aaml.calre fail + -.. 0 Super vo , far mane than
❑Aavmdm>a l 600 volts no
Su ite/bl dgiapt no.: 100 I Project moms: I] s rrioe or feeder • . er more
'yam R t y..,..
Cross st ect/directions to job site: arse 1 *,,,
I New residential :Ic or aaltl . t
. laeladea attached':
1 ,000 sq. f . or less
Subdivi .' • n: Lot no.: I 168.54 4
Tax : r • . I DO.: Ea. add'1 500 sq. f2.' . portion 33.92 I
Limited enegy.
G+r.p F _ �. _ t , 3 J Lt d y ><, ':0 t t•� {T,4` u ... ,.., , 75.00 2
r
'VS!: .4 ' .1. Y I h - ill 1 � �; l i i 61 .� lei ; 'sµv°1. 'IratTkllt (with doleful. ,a• OYfV_LlY1r rri„ m,it,'i.+r.o n. trge)r�n ?.1 a,try t
(' Limited energy, m + „ ay
L.ow Vol iuG . QNrlfr ln�me Lm.... itJk l Orki, � f b)Jten residential (with � • • ve sq. R) 7900 2
Servkes or feeds bWaWttbmolteratlon, and/or} retoeatioo
',14 r, . _ 200 amps or lose 100.70 2
,, --x t rft r c u ; a. 'S4� K• ° /r." �;t'7 „t , . 1 . I
'lf i a t 1 f `it a � r w , 4� r t o i. i < `' ZOl to 40o 13356 2
z �, . ,w<u. _ :� li�Lte,t,isi S., Lt.. S+;.,,r area 4'��:tiv't �'S , r.���.:w���,', r� �.. $to. '.alrx;iiia : .. s �} �' y. k�' � ��
Name: 401 amps to 600 0 200.34 2
601 amps to 1,000 :, 301.04 2
Address: Over 1.000 amps or bits 352,26 2
City/State/ZIP: Temporary serum -'- or feeders inandlatlory alter , and/or
relocation
Phone: '. ) I Fax: ( . ) 200 amps or less I 59.36 1 s
Owner installation: This installation is be' made on that I own which is not 201 sops to 400 , 125.08 2
pnY 401 amps to 599 • - 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670. and 701.
Breach dteraits - ' t atteratllon, or extension, panel
Owner signature: Date: A. Fee for branch j is with
iSi'k - ^� •- . � wart nn .n t _ t n,•.. �.i .. - r,':,I'a�s t •7s „!..,. , , aboveservlceor fee.
frn 'Ea?t•' ,I�RE�a sM.x�.r�rleKua4, 'lh.CEr.G�M16rc,ytlGxY.r!+, -. e>c11brands ° I" 7.42 2
Busines 3 name: B. Fee for breach II • Is Wilms
service or feeder first 56.18 2
Contac branch circuit I
j Each add'I branch ••e' - u 7.42 2
Addtec`: Miscellaneous ; , or feeder no4'in
Each manufactured :: modular 67.84 2
City/State/ZIP: dwelling, savior : • • or feeder
Phone: t ) l Fax:: ( ) Rocormect only I 67.84 2
Pump or itrigeribn . 67.84 2
E -mail Sign aroutlineli: I�,. 67.14 2
„)ti, ' 3 . {+ n ti t. + MY", °..°„ r K17„;, , 7, �mayy� aq . • • ,tt ...� t1 l
,..., t l �,. P4 � o :' p , l �° Si'" S " �► is Y , t Si • oon I • i tad -energy
n Eti..., i u,_,. , Wit,. „:u, G. ,n ,r., 1�,t.t"Y. v1 ti:Sik a.r C a of l
Business name: "eigapCtvwi . 4EGT$i iv n'av'el. alteration, or , I , , •• Ion. - I Page 2 7 5 2
Each addWow{ ' • • , r , n over aQowaide 'Rani the above
Address: ' S 7 0 / tJ _ O r$. 6 4Ql) S 7-12 err Addkiaral ,, . • ! ( hr min) 66.25/ hr
City/S te/ZIP: P T1J JD OR � J Zr03 -'t i 3 investigation (1 Iv , ") 66 251 hr
. Industrial pleat (1 .i ) 78.18/ hr
Ph ne: (o3) i • 7 � 2 - I Fix: (t 4) ea, ii2,3 Bona f '., is 90.00/ hr
CCB Li..: 1 03 82.4 I • E r1c LIc.. -' c I Suprv. L ic.: a i 7 7 b Y . � ir;i✓St . 1 !N _ �t ' :. � ,tt _ ..__ -.. :a " s; tr fa 'tmi
Suprv. Electrician signature, t+aq ':{04L Plan - law (25%ofpermit fee):
Print mote: ,')L` S d eo rss !-'S I Date: State ., j • . (12% of permit Bee): ' I TOTAL Raw PE>3: i
Authorized signature: ms permit awl . i on expir p f a'.permie b mu : within NO
Print name: I Data days What bese aoeeeted as -'.. - .
• Naaa itar of inspaoa �I , , allowed per permit.
1:18ulldiva PamiNpp.doa MAUI 44046IST(l1/ce/CO[WWEB 1
Sep 11 2012 2:34PM Bridgetown Electric 503- 621 -7123 page : 2
Electrical Permit Application - City of Tigard
Page $ - Supplemental Information
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LIM#TED ENERGY PERMIT FEES:
Fee for all residential systems combined........ $75.00
Check Type of Work Involved:
❑ I Audio and Stereo Systems*
❑ I Burglar Alarm
❑ I Garage Door Opener*
C]! Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑FOther:
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CQM841 '"I. ° WOIRK C 10.4.. .. :. ..,
Fee for each commercial $75.00
system
(SEE OAR 918 - 309-0000)
Checl kType of Work Involved:
❑ Audio and Stereo Systems
❑ !Boiler Controls
❑ !Clock Systems
IN Data Telecommunication Installation
❑ Fire Alarm Installation
❑ iHVAC
❑ !Instrumentation
❑ iInteroom and Paging Systems .
❑ !Landscape Irrigation Control*
❑ !Medical
❑ !Nurse Calls
❑ ; Outdoor Landscape Lighting*
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❑ !Protective Signaling
• ❑ (Other
Toth number of conunercial systems:
*No licenses are required. Licenses are required .
for all other installations
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