Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2012 -00222
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/20/2012
Parcel: 2S 101 AC01600
Jurisdiction: TIGARD
Site address: 7100 SW HAMPTON ST 126
Project: EBS Associates Subdivision: BEVELAND NO.2 Lot: 18 -19, P
Project Description: (1) low voltage for Data/Telecommunications
Contractor: BRIDGETOWN ELECTRIC Owner: NEIMEYER, JOHN
5701 N LOMBARD ST 15 82ND DR STE 210
PORTLAND, OR 97203 -4113 GLADSTONE, OR 97027
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PHONE: 503 - 621 -7122 PHONE:
FAX: 503 - 621 -7123
FEES
Description Date Amount
Specifics: Restricted Energy Permit 09/20/2012 $75.00
12% State Surcharge - Electrical 09/20/2012 $9.00
Type of Use: COM
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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)
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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 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.
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Issued By: d Permittee Signature: Off! ,'PP1 t±C4fload
• OWNER INSTALLATION ONLY
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The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE: Date:
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CONTRACTOR INSTALLATION ONLY
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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 19 2012 2:36PM Bridgetown Electric 5 0 3 - 6 2 1 - 7 1 2 3 page 1
Electrical Permit Apnlica 1 4 V ; , . i: i , i I ,. t , 1 - : ■ --, !
City of Tigard - r 1
, Received -
,.. Permit No.: FbC 0001
N 13125 SW Haft Blvd., Tigard, OR 9-p "1 1 Plan Review I
. - Phone: 503.639 r- 9 2012 .4171 Fax: 503.59g? Date/By: 1 Other Permit:
Inspection Line: 5D3.639.4175 Date Ready/By: I la See 2 for
II Arlo
■1 -Tic,"
fiamplemea •
Internet: www,t1grard-mr.gov CLI i7 i''''L 'V' 1 . - r '' Notified/Method:
laforeudien
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- ri■ ..... ,,..• „,,,,,'„.,, 0.''',,,11111 . ' - • • , u.,, - ...,,v)sigx,wr r. ire 1 43:411P7MV. , , n •• . '
- '413V.P . In . 1. Me" ti. . .1: ,. ,%C. , ,,, , , , ii . • "kit, , . • • ,. Ofilp4:1 i qe„. .-... . ." • . . • : • - .ev . '
. :Fr? cwil, ...a,:,,,,T,',..7w., ; ; . ._, , ,.:,...,,,,,,,titi . ,,F1 , 1 ,,.? , e'l -,;:.-,V2k u, .4,,, .1- • ;;;... 1.111avil.,1:-.3040..11.M.' IZ.!.., .,,,,,..4,. . ..,....1,,,,,,,,,ou.i...:4-,.
Please aback all null : • ( . •,•., 4;54 OriAilas V. -- - ' . b°1410:
El New construction IX Addition/alteration/replacement
()Service or Snider; ii amps or more 011uildinne - three stories.
0 Demolition 0 Other: whore the avail.) . fault current 0 Marinas and • • ards.
4,441.1, - .ifrAAMTV11',.5rrll'..Z.•;•",.T.q47,r, ,"•1,1414; r - ,TiteltD , ,,y,S• • •) 01 . 2 . 1, $C. , i 4 •,.,:11 . ■,1*-.4% oxen& 10.000 . . at 150 vein or 0 Mating hol • .' • . .
-,- ,••••.,,'-'', . ' .. • ',.x..Y.L.Arorprawat.a,r :.;,.:s‘, ealualrgsiw,sc-,1 1 . -,. `L.• ,t+.. i: ,." -,, • ;, less to ground, • .• • - • • 14,000 0 Corn .• - agricultural
El I- and 2-family dwelling 14 Commercial/industrial 0 Accessory building mops for an el. - :estallations. buildings.
0 Multi-family 0 Master builder 0 Other: 0 Fire pump. ; 0 hattallation o 7 $ KVA or
• •-• • ':"WW
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. , , Thrt'''''T;:',; ".'' ir 0 nneff gen Y "5 '''l . larger derived system
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; 4/ .. 'I) 41R. '..14 ■• i..:‘ ri'',1.-....th4.11,!inlarli'....11,5-' ;■...te.... • , •t• s " , .`17kr , , , ,1 • 4-? ••■ .7%:.. Addition of new • • • load of
100HP crr more. I occupancy.
Job no:: lit-Cptek Job site address: -1 t Do elAN 4.k64 0.
0 Six or more maid. • nal turas. Onoblolapaik..
I I • ID Suppiy vol for more than
City/State/ZIP: '170 i 0\--2_ coti..5 . Health-cam faoih' , s.
0 Hazardous load .,' . 600 volts 6 . .
Suite/bldg./apt. no.: ID Sesvka or feeder •■ . amps minors.
ils, t tip I Project name: V.-% tefedaak44 - e...ma...r.sel .- ., , - , ,- -- ,, •-,.,,,- ..••••,,,-,,...-- - .1. ' ' r --
Cross street/directions to job site: rhmo-toiks Total •
New residential ...le- or matti.finaily dwelling . . it.
Includes attach. L garage.
Subdivision: i I,ot no.: 1,000 sq. ft. or less I _ 168.54 4
Ea. add'I 500 sq. ft.I . portion 33.92 1
Tax map/parcel no Limited energy, r--,. - .'. 75.00 2
j )- • . ';'). 71 1-, 1 0 ' '''' 'ZifiPi r444:ior, ( ebtvewith se: ,. )
:.,' :: .0.'' '' ,),,..".; -u' ,,:' AD.: In' ..:11.1i,uniu;:nii,i24•64:,,?wiNibi . 1U,"0,rt . 47' ''''''' '1 • ,,' -0 . • :311a4uYAK• ' •
Lion' ted energy, m ;,.. -amity
I 75.00 2
clili \h4.411._ty _. gi:l'ilCIAAAN8f. .t.4f1AA. el tAxa pi/AC AO residential (with ! hove eq, ft.)
Services or f ilsiddlatlim, alteralboo.aaWir rdocalion _
, 200 amps or less 100.70 2
.,.- .1-..........._
l4i4....t.'!.; \ Wilf: '..,•.';'. 201 amps to 400 - 133.56 2
' '..' ', fr " ''' ' .1 al..1...:- .:1.,, ;1 zi.:Zoil irtilletialittSArzatImgiutiat- . , .
401 amps to 600. , .. 200.34 2
Name:
'601 an to 1,000 I ,.. 301.04 2
Address: Over 1,000 amps . .Its 552.26 2
Temporary servi , -. or feeders installation, alteration, and/or
City/State/ZIP: relocation ,1
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Phone: ( ) I Fax: ( ) 200 amps or less I, 59.36 I
20] amps to 400 . 1. 125.08 2
()wilful installation: This installation is being made on property that I own which is not
401 amps to
intended fbr sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
linnehelreolte- I - alteration or manakin. per panel
Owner signature: Date: A. Refer branch c' , .,. 'ts with
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;,,, • , . * . r •ltrr i: ? . ' , 5'.r .,- .T - T:T+WAtiVIA025197452ViiiI 1 7 .1 V1 - 72 5 Ar 'i • .. ).„10,, ■ above service or • - - fee,
7.42 2
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B. Fee for branch ',' . in without
BusineSs name:
serviceer feeder I ee, first 56.18 2
Contact name: branch circuit
Each edd'l branch c; .. 't 7.42 2 I
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Address: Miscellaneous (a ; , e or feeder not:Included)
Each manufactured : modular
City/State/ZIP: dwelling, service ,. 67.84 2 I or feeder
Phone: ( ) I Fax: : ( ) Reconnect only 1,
; 67.84 2
Pump or irrigation c le 67.84 2
E-mail:
Sign or outline ligh., .g 67.84 , 2
44. igliVIRMIVAPOWINZIEZ7,9 4 KALL- , :le t": Signal eircuitOor :
Business name: airamvtip4, EL or EctiAce panel. alteration, : . .... '. , 1 Page 2 , 15.( 2
Eatli adtildolial . . don over allowable in any (Witte above
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Address:- S 7 0 i /0 4e0 71?eb
. Additional ins. - ; .. (1 lir min) 6615/hr
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CitY ?ClitrtA14b OR (Ai 2. 03 - Lt . )! 3 Investigation (I In . a)
Industrial *It (I I ; ; in) • 6615/hr
78.18/hr
I F ( SO/ ) 62t 1123 Inspections-for whi .., no the 46
... listed ke. hr min . 90.00/ hr
CCB Lit.: 16362,4 I Elctrical Lic.: -98701 Suprv. I.ic.: a i 771 .18ii,..t;iitZ
1 $tibtotal: . ,
Suprv. Electrician signature, requ "44/" ‘... .........„40,4„;e Plan . 'ew 055 of perntit fee):
Print name:‘; i )4-1,.. ...cs e .... 4, I Date: States : barge (1296ofpeimit.fee): ,
1 11 Toranapiirrs.ap .
Authorized signature: flit penah a - '.- , .tlesairsairimptipi4isseS,
.. taw bcci "mnefied is
Print name: I Date: • Number of ".. L. - drys "L . allowed pee pirriiii. ' ,
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11Buildiesearnits\ELC-PeradtApp doe 07/01/10 440-t6157(1 1/05OMAVEB
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Sep 19 2012 2:37PM Bridgetown Electric 503 - 621 -7123 page 3
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
Fee for all residential systems combined ... $75.00 •
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Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ _ Garage Door Opener*
❑ : Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
Fee for cach 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
❑ :FiVAC
❑ Instrumentation
❑ _Intercom and Paging Systems
❑ ;Landscape Irrigation Control*
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❑ : Medical
❑ _Nurse Calls
❑ `Outdoor Landscape Lighting*
❑ Protective Signaling
❑
Other •
Total number of commercial systems:
*No licensee are required. Licenses are required
for all other installations
1:1.13uiIdin \Pannit ELC- Peniupp.doo 07/01110
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