Permit •
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CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
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COMMUNITY DEVELOPMENT Permit #: ELR2013 -00007
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/14/2013
Parcel: 1S 134AA01900
Jurisdiction: Tigard
Site address: 10115 SW NIMBUS AVE 400
Project: Too Cute Subdivision: IKOLL BUSINESS CENTER, TIGARD Lot: B
Project Description: (1) low voltage prewire from demark to tenant space for comcast cable
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Contractor: BRIDGETOWN ELECTRIC Owner: ROBINSON, CONSTANCE A
5701 N LOMBARD ST BY KILLIAN PACIFIC LLC
PORTLAND, OR 97203 -4113 500 EAST BROADWAY, STE 110
VANCOUVER, WA 98660
PHONE: 503 - 621 -7122 PHONE:
FAX: 503 - 621 -7123
FEES
Description Date Amount
Specifics: . Restricted Energy Permit 01/14/2013 $75.00
12% State Surcharge - Electrical 01/14/2013 $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 P may / obttaain �'
��'f//A11�. a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. !,
Issued By: .� a'" / `xu�` Permittee Signature: D^ 3 1 PPUC" ' 3 "( l vd
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.
Jan 10 2013 11:31RM EridAp 5 0 3 - 6 2 1 - 7 1 2 3 pace 1
REvir .•. _••• , .
Electrical Permit Application
City of Tigard JAN 1 0 2 013
• 13125 SW Hall Blvd., Tigard, OR 97gari A n n
• PnviP4
e Plan Revw
l
Phone: 503.639.4171 Fax:
Inspection Line: 503.639.41r G DIVISION Date Rdy/By: See Page 2 tor
Internet: www.tigard-or.g GraW Recei •
Date/By: vii S I ' ait 1) '' 1 - 1 -+P-A9 , 3 - ( 70007
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Date/By: Other PernsitAii, WO, , 0 0 t)-((4.
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Natified/Mothod: TO I Supplemental Information
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0 New construction Et Addition/alteration/replacement Please chock ail that apply (submit /sett of plamw/iMors checked below):
0 Service or feeder 440 amps or more 0 Building over three stories.
0 Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
;:ttkis.!",Cli;1-4;:itlii , r.-
-' '.: ; i./' 10.000 aunts at 150 volts or 0 Floating buildings.
less to ground, or exceeds 14,000 0 Commemiakno agricultural
1:1 1 - and 2-family dwelling 51Cornmerciallindustrial 0 Accessory building cusps for all other installations. building.
0 Multi-family 0 Master builder 0 Other: 1:1 Fire pomp. 0 astallation of 75 KVA. or
0 Emergency system. larger separately &dyad 'yam.
;i 44,404041101,0*40,0( 0 Addition of cow Motor load of 0 "A", "E", "I 4°, "14",
100HP or more. occupancy.
Job no.: r3_ Job site address: 1 on 5 s \ M;e% b A.,s s 14, osix or mom mid twits. a Recreational vehicle parka
City/State/ZIP: --r, . orz , 9 ? 0 Health-care facilities. 0 Supply voltage for more Man
D Hazardous locations. . 600 volts nominal.
Suite/bldg./apt no.: goo I Project name: --1 e 4..e._ 0 Service or ibeder 600 swam more.
A"
Cross s to job site: Deserted= : Oh , . I Fro' 1 Teta I . •
New residential °logic- or inaltMiuntly dvvelnieg unit.
Inclades attached garage.
1,000 sq. R. or leas 168.54 4
Subdivision: • I Lot no.:
Ea. addi 500 sq. II. or portion 33.92 1
Tax map/parcel no.: ' , Limited energy, residential
r:ii',..',,W,1-;i';r9V,',0 ;i'i'Mli'l.;',:lk,' (with above sq. Et ) 75.00 2
t tt - titi t ; tt-It t'tttr.a littitnlirmmraittem••entrIttmtn tortottr.9•..... -.,,t tt : t-t ',!. , t -.. .-.,- ..tt•,, .: t,t1, ,
Limited energy, mul &finally
75.00 2
L. t 4- \le 44. o. "Pi - 1. I ... 1 : ev. PrO" del'al oe it 4 lle 1 residential (with chow sq. It)
Services or feeders installationolteration, and/or relocation
Spae.4,„.. , 11 ,0c revi- ., . c....„Lic 200 amps or less 100,70 2
. , .
IL , ..Ally..3 , 11 , :: :' ' - ' • . •- • koviplo,; hIrptp.-:- ':-.L .7'..: i 20 amps to 400 amps 133.56 2
N 401 amps to 600 amps 20014 2
ame:
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City/State/ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
201
Owner installation: This installation is being made on property that town which is not amps to 400 amps 125.08 2
401 amps to 599 amps 168.54 2
intended for sale, lease, rem, or exchange, according to ORS 447, 449, 670, and 701.
Branch details - new, alteration, or estension, per panel
Owner signature: , Date: A. Fee for branch circuits with
;:`.: s.V-tfiitklhOlctkr****Iff104"*.1 above service or (ceder fee,
each branch circuit 742 2
Business name: B. Fee for branch circuits witimu
service or feeder fa, first 56.18 2
Contact name: branch circuit
Each aild'ibranch ci 'mit 7,42 , 2
Address: Mivedbmeoos (service or feeder not Included)
Each manufactured a modular
City/State/ZIP: dwelling, service anefor feeder 67.84 2
Phone: ( ) I Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation .:Ircle 67.84 2
E-mail:
Sign or oudiae lighting 67.84 2
7 , ... ?; ', ''.7;' - t''t . Signal amigo) or limited-at er8Y
Business name: celiVtiN t' r. i C., panel, alteration, or extension. Page 2 _ 1 2
Each additional inspection over allowable la any of the above
latrel
Address: S 7 0 i A./ . L _ootr f eo rtr. Additional inspection (1 hr min) 6625/hr
City/State/ZIP: e PO'N'TLAt4t> OR cli 2. 03 - 1 3 ' Investigation (1 hr nin) 6625/ hr
Industrial plant (1 t rimin) 78.t fll hr
Phone: ((O )i I - 7127. I Fax: ( S03 ) �2.I "7123 inspections fur whb no fee is 90.00/ hr
CCB Lic.: 103 8i4 [ Elretrical Lic.: • _ &pc, I Suprv. Lic.: y i 776 ezth.1:-.-
Subtotal: '7Z' —
Suprv. Electrician signature, requ: ...0 ',4,c-,/,_. ‘ . ...,,,,,..,,, , , # .4 .. , - ,;e . ,
Plan review (25% of permit fee):
Print name:4, . ye—A. ....cr . ,, //re Date: State surcharge (12% of permit fee): 6 1
TOTAL PERMIT FEE: S
Authorized signature: ,
This permit applies dos empires if a penult is not obtained within 180
clays atter if ha ban aceepted as complete.
Print name: Date: • Number of insect me allowed pre pernni.
I VuildieB1PavntitsSELC-Porni1AFILdoe 07/01110 440-40117(1 rrosicownans
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Jan 10 2013 11:3119M Bridgetown Electric 503 - 621 -7123 page 2
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
Fee for 211 residential systems combined........ $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
E l Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
El Vacuum Systems*
❑ Other.
COIVIMERglai',w(7)RK oNz; ; . -
Fee for 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
El Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
0 Protective Signaling
❑ Other
Total number of commercial systems: _
*No licenses are required. Licenses are required
for all other installations
1: 18uilding\Retmitc\ELC- PrfmitApp doc 07/01/10