Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2012 -00259
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/20/2012
?1GAR . g Parcel: 2S113AC00103
Jurisdiction: TIGARD
Site address: 7244 SW DURHAM RD 900
Project: Foremost Forwarders Subdivision: COUNCIL VIEW ACRES (LOTS 21 -44) Lot: 25 -27,2:
Project Description: Low voltage prewire for data telecommunications from demark to tenant space.
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 11/20/2012 $75.00
12% State Surcharge - Electrical • 11/20/2012 $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 $84.00 •
Other Desc: Required Items and. Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal 'Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 - 0010 through OAR 952- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: O ��G /C`/ 4. O4/
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE: Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 603.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the Job site until completion of the project
Approved plans are required on the job site at the time of each Inspection.
Nov 16 2012 3:37PM Bridgetown Electric 503 - 621 -7123 page 1
le-
Electrical Permit Application RECEIVE 1
C' of Tig rd Received If �� . :-
IN 1311 25 SW Hall Blvd., Tigard, OR 97223 NOV 19 2012 D p,,W /2- ��-'" E '420 • �fJaS�
r Phone: 503.639.4171 Fax: 503.598.1960 - p g • I Permit}
. ... inspection Line: 503.639.4175 CI TY OF T in � od T � ��a • m i�armaUar
intern[: www.tlgardor.gw CITY 1 Vrr lu
it l ;
f,, l f ( t� i � . l i �V Vl 4A R`' a� ('i p: '. • . 4 S, . _• ' p l�•l.F di r.,..tr 0 , }' ,E,V { i1 , i r c ^F% r ✓ x:11 a 1, V -.{ _„
+ ' i l,�, �I k.,jf1. i1 ,,, . , l4 ::w,.,. 'k ' I . { :1� 1 • ,,. t A, ' !. !' +12W t: {!1 ! -. x- . ti „. .: , : ,. :. :7..t. � � , i2,.., F t i . r - t �:x1,,ni�;
❑ New construction M Addilion/alteration/replacement
' ��� r• ? • .N"i'`.��".S:l'�{.�:t!!$!CAG2�� � .,w} ,«c.w. n.c.,. T.r'i: b YI =.rsJ 1.�.. d1- �. ? 1 t� 1 ca,
1 - . _', . '... '7' g a; � „ ' # _: • balm): .
❑ Demolition ❑Other
[Navies or - amps er e• - b Btii diair three aeries
wine the : . - fault oatrsnt D M a r i n a s and • . • • •. •
tat 'i , i. ,,�;1i' Or•6In 4-c 4r: 7r n 721'77••1': N p'. n nr{ ,t Y - •0 :$! ` 4 vxr exceeds 10,000 1 ,. : at 110`vcltaor 0 F .
ref i !:7 t! s i!. 0 nr:,snrlr awS:eehii , ° r e. r :F, • ; i:',∎} r�' <A
r••:a. -.Y ! � , .K le > g t d s . �: .,{,.c,..lw.__ti+ `•la IeN t08ralOd. • , - • . _ , . • . . 14,000 ❑ •.•. -. : ,.a4a1
❑ 1- and 2- family dwelling r_4 Commercial mdustnal ❑ Accessory building amps for all . imxmllations. banding&
❑ MUlti•famil ❑ Master builder ❑ Other: D Fire primp. I D tnsmllatioo • f7S KVA or
r 1 ' z -; 4or { , 1 aT a n 1.Y ,e m 1°rr= i ,. . QE • • derived en
IG4. r,t LA '. (�i� r ,r i. : 11 1 ' d 1 . rC c 11 1 - , . i 4311% :1 A'113' • l y{ , . ' 'ti
eA, . � e:li ' .d:uLrt�B{rJawi:.� c..�aa.,i�.,e h .,n.r . .,,...: xa.+`� '7� , .. +rr w • D Addition ofnow '• toed of D"A ". "V', "1 2 ", "1•9',
Job Ito.. Job site address
72 �1 "Div oVu( ,11M, 100HP or more. 1 aat�ita,
- �Q D Six or more rat • :. ®¢a. D Ree eadmia1 vehicle parts.
City/State/ZIP: 1' 4 ,A, • .icy • D Health esre faeil i. e& D Supply •.' . - for mote than
•
D Fla>e�1mn 600 wla . • Suite/hldgJapt. no.: I S Project name: ■ ∎ Dsrervioe or heeler • ■ or mom
•...r . .vl of......_.7e�_�!1 MiL a Z - ` •+ r . r v T wp'ur , nn{[, r
Cross street/directions to job site: 11111111illia !C _' i!ii tld1 tli >• •
'Neer residential ' 0 Or mielti4ientlY dwelling tilt:
Iodides attach -: garoae.
Subdivision: I Lot Ito.: 4400 sq. B or less, 168.54 4
P.a. add'I 500 sq. ' •, or portion 33.92 1
Tax niap/paroe1 no.: Lbuitod etm� rat
C.'I AS.? n + iR i 1 }�tc� '! ?� 1
}r7� , .nr for Y u�.s{uti7 " ri'r.r s• 'r 1 u ± r 73.00 • 2
,.. XX .�p.a let 1., I1 i n, , A +
} �' s , } . !p L11..z ..s . i4 - ,..,...:4[4 �i .,,,.• . f r r J j�c� 11 ( , � . I �- �M a�yp � rr��
'd �'a' iliCi? 1`F�,.. ,.,,Y_,..: ,,`5:{u . or ..ra,o,t�..a..:8».a. c� .r,s - L7�...'•. � : r :h J dr v. '1Ea! United-energy.. ) llllffT , • I� 1 •
Law vitti-D. t. at,,nn.t -fir, residential( ' - sal. ft.)• 75 1
S �`'�' Services or - • t allatb° alteration, ae61. >rslocation
�,►._ . ,, . i s t t... 200 amps or lets j 106:70 2
ii' : Tk ms's - e?'„ i'.4e :: ' ', , , ..rt. r V .: 'iri it ,I a.6' d ! nli Z' `' ;fin }s A 2f01 to 400 n1.1111111111111 13156 1 - 2
Name: 401 moms to 600 '. ", • • - 200.34 2
•601 amps to 1,000 ; • : 301.04 2
Address: Over 1,000 amps, •,! gulls • 552:26 2
City/StaterLlP: Temporary ... or feeders installation, : r .• .. • • and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or kss I 3936 I
Owner Installation: This �tallatlon is being made on 201 amglato400 :' 1 • .; 125.08 2
g property that I own which is not
intended for sale, lease, rent, or exchange, according to ORS 447,449, 670, and 701. 401 wn�tie 999 �' 1 68.34 2
Bram* details - : I i . alterlstioa are teodoa; ' -Dead
Owner signature: Date: A. Fee lb't'ranch yl 'Is with
i uS s _
1 ! rff9 ., q ti k . i• try 4, v tv , ,. *x 1 1 , . 1 each 3ClYice I • rfee,
. �i9 x ...w•
. _ 1. .t.
,.,...1 : . il . 4 11 , ti art,} u- ..; �1 4 1 1ip . al e' r , { { y
., dxr.{ :� w. L • .;� 'tai :::t3 all l -.di cub branch - , t ` 7.42 2
V.
Business name: B. Fee fbr branch, ., ;to wi tout
t}tx ale of :...:. :cyst 2 56 .18
Contact name: btaridl dread I
Ea Ch add'1 blanch uit . 7.42 2
Address: Miscellaneous( • or'tbteder Not Included)
City /SiateJZ1P: Each ': p ,;r • ; modular 67.84 2
dwelling, peruke feeder
Phone: ( ) f Fax: : ( ) Reoomectonly I 67.84 2
E Pump or irrigation ` - 67.84 2
Signor outline ligr •_ 67.84 2
, �° , � i , 1 7 , 91r, 1 ,r •}' *"'�'?(,"S1s Y : } 1 r. AL�dlyg4rf' 1�w7w "yP 1 � Ate. ,w.,i�_.�,_,
'ri:, iQI:YMI IIt,I.M lkrn,�� tjd` 0.r �. 1' 1 au..! ' }r .. , `;:6d111'cfi t j:,y '^n: - (: s i •c ) „•^�' -.- i s� 2
Business Mlle. • 8 ` 'P ."..1-z1,4:,..: .. e •• ----Ion.
10: �l1.V / • , Each additional ' .. i over Blows •' Iran , of the above
Addre s: ' £ 7:01 N L..O Oi $ 0 S ! e B7" Addidormt ... - _..-• (l to mid) 66.25/ ■
Itmestl�ntlaall.hr I ', „ 66.29!
Cit3' /SOBRe/L7P. ' j 1 3 , I todinolel pan t° ... min 78.1
(50 ,)'.;! - 1121. g F � ax: ( ) 7 i 23 alas for • . no fee: e . • .
• 103 • IA . . ` yr (. Suprv. 14 i 7 746 ` • ' F, . ;5 9400E
CCB Lic.: s al Lic : r S Lic.: t` r,,: , ..._ ± :.1. ° t. t ... .' .., r.s , nM1
Suprv. ,Electrician signature, requ 1 . hO `
P . reviaNr� 7Xxotgatirdltan)%
Print name :4', �!° g s /tea/ Date: State arge'(12%ofparnlitfbe) . ' ,a . • .
Authorized signature: I . -•IP 'AP.0 - ; 4::_; --
Thin permit • • oeplrie itil a ±bt5a,tiot;.. _ .dtbdeeIa0. .
Print name' dm :•''rBhi .brie app s .
I Date: • 14'mmberof -. alioiedpepemh ._ ..
C18io7 oii'amestattirmmiapp.deo 07/Olno 440.46Ifl(lL X:01LM'5H
i •
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Nov 16 2012 3:38PM 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 Systerns*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other.
CQl l " V,°.. • ! i 4 `;,
Fee for lack 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
❑ Intea+com and Paging Systems
❑ .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
•
I tis„ua enriap,.d c 07w1/10
•
•