Permit a CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
:11 COMMUNITY DEVELOPMENT Permit #: ELR2013 -00026
T L CARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/04/2013
Parcel: 2S101AB01501
• Jurisdiction: Tigard
Site address: 7555 SW HERMOSO WAY 200
Project: NW GRASSROOTS Subdivision: HERMOSO PARK Lot: 21
Project Description: (1) low voltage for Data/Telecommunications
Contractor: BRIDGETOWN ELECTRIC Owner: LIONEL LLC
5701 N LOMBARD ST 7555 SW HERMOSO WAY STE 010
PORTLAND, OR 97203 -4113 TIGARD, OR 97223
PHONE: 503 -621 -7122 PHONE:
FAX: 503 - 621 -7123
FEES
Description Date Amount
Specifics: • Restricted Energy Permit 02/04/2013 $75.00
12% State Surcharge - Electrical 02/04/2013 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems:
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: N 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 0 952 -001- 090. You ay obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 f or 1.800.332.2344.
Issued By: Cy� (X(�/ Permittee Signature: OM f+( Y t . j G fin/)
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.
Feb 04 2013 11:02AM Bridgetown Electric 503 - 621 -7123 page 2
Electrical Permit Application l ' ECEIVED
13125 SW Tigard
e l ga . ri�ara, o3. 97223 _ ' 7 , , o sy: 1� �' 13 �T °ef 1� �L ao ► 3 ' 0 Dv� (o
3 4 x. 0 :3 � • .
Phone: 503.639.4171 Fax: 503.598.1960 ! -° p�ygy; Other emit:
II [.inC 503.639.4175 ) TIG � tee a .. myr 811 Ste wp: .11>ba
bltemet: www.tigard- ar.gov
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❑ Demolition ❑ Other: ! who.e ese awi .... Mull current D Menem and boetyuda.
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❑ Multi- fbtnily ■ Master builder 1 ❑ Other: Q Fix pump. D tomuafson of 75 KVA or
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Job no.: • _ v i ( Job site address 7. S gin or more m D aeaeatimat tde past..
Ctity /Statc/ZIP: T �' I 4
Hestth.aS faoitt ' D Supply Wage ge Por mane than
p Hsoordoae 600 mats aomiad
Suite/bldg./apt no.: /Jfr Project name: /:, ) . Gr r H 1 Serviao er hedge ' • armor*.
Cross street/directions to job site: C : , 1 " •
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Subdivision: • Lot no.: 1 sq. & or16U I 168.54 4
, ' add') 500 sq.1t or portion 33.92 1
Tax map/parcel no
Y s' . "' •, nF�a«,wn� w+r r�y�sra, : nm i n„ -, n ?�? t )}`y , .r , .. ! ;. -• • • 75.00 2
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acct ■ 75.00 2
POIMIIIMEMIIIIII ! , 46 as or les 100.70 2
. ' , sa "r} —t^t. vi4.. j. s '1 ID 400. ■ 13336 2
1 amps to 600 20034 2
Name: I 1 amp to LOCO :,•.,. 301.04 2
Address: 1.000 amps • Wits 552.26 . 2.
City/StateJ7.1P: T , a e
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Phone: ( ) Fax: ( ) 21 i amps or lets 59.36 1
Owner I adon: This installation is being made - n property that I own which is n . t 't to 100 125.08 2
intended for sale, lease, M, or exchange, accord
TORS 447, 449.670, and 701. 1 ampere 599 :a,•;. - 168.54 2
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. branch -. 7:42 2
Address: L-..,L Orr • _L_:1_, City /State/7.IP: 67.84 2
Phone: ( l Fax:: ) only 67,84 2
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E-mail: �� aye q j or outline 67.84 2
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Address: . S7 01 � i - L::0 /)'t6 • 50 S ' le •Ithinel .. '., • (I hrmie) ® 6625/br . � �
Ci /StnterzrP intestiodclia :Iir . 6625ikr
1>lan4 (I , cam} 78.18/ hr
Phone: (So;) ,{ 122. 011 $ )42i ii 23 - -' : air ' . , aaibe is 90.00/ 1st
cal Lie.: %O3 :2 `_rfl Su pry. Lie.: 7� < <� t'' r 3 i L '. " , , 4 : ,a7?
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Suprv. Electrician signature. rep i - • 4� S
Print name: ";704-A, -A .'eo - ns /,,• Date: . 2/N f /7 i d ( 'of - " fee): . ' _
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Print name l Date: dap • • -• IOW . bial eats il4a
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