Permit 111. n CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2013 00069
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/21/2013
Parcel: 2S112AA00600
Jurisdiction: Tigard
Site address: 6713 SW BONITA RD 270
Project: ServPro Subdivision: MILLMONT PARK Lot: 49
Project Description: (1) low voltage for data /telecommunications
Contractor: BRIDGETOWN ELECTRIC Owner: WALTON CWOR NELSON 13 LLC
5701 N LOMBARD ST BY CTMT - WALTON RE TAX
PORTLAND, OR 97203 -4113 4678 WORLD PARKWAY CIR
ST LOUIS, MO 63134
PHONE: 503 - 621 -7122 PHONE:
FAX: 503 - 621 -7123
FEES
Description Date Amount
Specifics: Restricted Energy Permit 03/21/2013 $75.00
12% State Surcharge - Electrical 03/21/2013 $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 may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800
Issued By: A/Alb/ �C Permittee Signature: 00 4PPL C 4
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.
Mar 21 2013 8: 29F1M Bridgetown Electric 5 0 3 - 6 2 1 - 7 1 2 3 page 2
i a EIVED
Electrical Permit ADDlicati 1 t 1-
City of Tigard , 1 1 2013 ItIceivod IIIIM1331111I . Permit Itch: ej ....e_.)01 3 —000(05
13125 SW Han Blvd., Tigard, OR 97223 Mut !Levi 1
il l 1 Phone: 503.639.4171 Fax: 503.598.19. I Datc/By: Other Permit:
Inspection Line: 503.639.4175 CIT OF TIGARD Date R . .■ 21 See Page 1 Ow
Internet: www.tigard-or.gov ; A. NO DIVISION Notif . - : • -:: -. lorwedoji
mim
,0 ,,,, , ,. m.. i., .. .. V. I,- ,y:r., '•••
a.:Ii. , ,,,,10 , .. ::' 4 . ,,,:,..'....- ..,, -5,, ...lovi.:.,..,.:,.--..,..:._;.!...,.....s.e.r.iikil '.3 IIR',•.•■•....; :7, l'•
13 New construction INAddition/alteralio • replacement nesse check all did : :. - (ddittit X sets • , piked wfikau checked below):
0 service or feeder • . amps or more 0Ruildirigover three stories.
0 Demolition 0 Other: . where 0ss a 1.. :: fault manse 014orinas aod banyarth.
ICPA 'f' i - . -...1:. : .' - ' : : . j , '''- --1 •111 "me" 10400 . ''' II 1" wilts (IT a l 'ns b ""*"'
ic.i, to ground. • -Icceeds 14,900 1:1C-onunarcakule agrioultund
0 1- and 2-family dwelling R Comrnacialfindu - dal 0 Accessory building . maps for rdi o -,itlidallalii4)11L buildings.
0 Multi 0 Master builder 0 Other: • itt Fite pun*. , 0 Installaden of 75 KVA or
vv.. rt.
A .1 :;.:Li:' 4, iii". : 4i 7 : 4 .'''. - ii' , Arr . ,ork:P A . sal R am:agency - - lance swat* derived tryst=
Addition sinew , • - load of 0"A". "R", "1-2". "1-3".
100HP a mare. ocapimcy.
Job no.: 1 _7,1% Job site address: 611; V./ 3,,,,,,,,..4,,, tt i 1111
0 six or more - ' .: ,... - wits. 0 Recreational vehicle pada.
City/State/ZIP: 17' an.) 0 ' q . 22. di II 0 Hoalth-caro r - : 0 Sop* ordtage kw mare din
' 600 volts nominal.
Suite/bldg./apt. no.:* ci Project name: . 1111 Service or feeder ; 6 • amps re moan,
7 -`, "•:' :.;;;
Cross street/directions to job site:
■ , ..11, EiMMIE.1111.1&M.,:i MI •
New residential a • ,_ e- Or multi-finally dwelling oak.
Includes attae • • garage.
Subdivision: Lot no.: 1,000 sq. ft or less 168.54 t 4
4. ald'I SOO sq. fk.i.. rarlion 33.92 I
Tax map/pared l no.:
,
Limited energy -.1..- .41 7500 2
2. 03; :FS a :4!;c;, ' with above . • .
..„, , ..,,, ,,„ .; „,, , k.,„ 1, ,$,„..,.„, , - ...,,,,..... .‘ .. 4 • - " '''• •• •••• • .. .... h....." " ' '''. "- . - - Limited energy, m . •• -family III 75.00 2
Low' ti . _ ,...., . I residential with ft
• • ve .
'.. • en or feed Installation altera • • • and/ar Mom
-4 •.... 4— C . amps or less III 100.70 2
-,,: ':;•'..' ;', ': ..' ia ?. : .0,1 194),Itatzrp,rnr, 0,1pA7. 1 1■ I '. v• ' ' ' ::•:it'f5 ''.,;:•;.• 201 amps to 400 '. 133_56 2
II 1 tows to 600 :. ••: 20034 2
Name: Sft . „ 04.... .8 . / ,,,, 0%
601 amps to 1,000 , , - 301.04 2
Address: 09er 1.000 amps or ohs 552.26 2
Temporary send -;- or feeders installation, alteration, and/or
City/State/ZIP:
relit:anon
Phone: ( SO ) C9a... ce z q Fax: ( ) . 200 Mpg Or less 5936 1
1
Owner installation: This installation is being made • property that I own which is n • 2c amps to 400 em • 125.08 2
t
4di 99 • .
intended for sak, lease, rent, or exchange, according • • ORS 447, 449, 670, and 701. amps to 5 .- 168.54 2
Blanch circuits- l, 9 alteration. or astesolon. par panel
Owner signature: Date: A.lee kr branch • OS wttA
, lineP 4 xi : 775.2zi.0 :‘,.:, , , , ,- i .. , , , ,, , ,mata gA , , y obove sente 7 - - fee. 742 2
Business name: B. Pee tbr branch .* • is wilknit
semi= or fader • -, fiat
56.18 2
Contact name: branch circuit
Each addi branch ci -• *, . 7.42 2
Address: M teeflaneous ( ..., cur: feeder not Included)
Each masuillowed • modular
City/State/ZIP:
dWellitm, service . . • • feeder 67.84 2
Phone: ( ) Fax:: ) ReComtect only ' 67.84 2
Pump or Irrigation c le 67.84 2
E-mail:
. Siam or outline l':: •• '• g 67.84 2
i '' .702..TSZADY.Ig:Vi..n.1 ;) - ffrg aa i drags) or ',.„ -
•0 .. , InlItill -4 !r - 2
Business name: Igtik P I. - e, A uh. __, _ „ Kt 1 .
Rath adalonal - • - Bon over allowahl i• : , oldie Mime
Address: S7 0 / 1‘) . L. 0 rn. 8 . r 0 sres AdRitional ins • - -•••• ., (1 hr min) MI 66.25/ hr
ImiPsugation (I hr " MIIIIII= 66 . 25 n•
City/State/ZIP: TORTLAhlt) ,0 • qii II --4 41 1 3
Industrial plant (1 hr , 'n) 11 78.18/hr
Phone: (Sly; )62 712 z. 1ffe 2 , ) l4.1 1123 Insivetions tbr wh ' no fee is
•,,.,' 10 -: listed li min ' 90.00/ hr
CCB Lic.: lo3si4 i Eltectrical Lic.: . -9 ;,' ,I 7C, Suprv. Lie.: 14 f 776 . ftifilgwrait
subtotal 4 ..- -
Suprv. Electrician signature, ,, • •1 -.• , ' . 5% Of • - ,: fee):
Print name:7e://-/- ...C-1 - o-ss /. Ill Date: 3 2 / 3 State • - arse (1254 ofpermit As): S -
TOTAL PERMITfEii; $ 1 4 -
Authorized signature:
This permit spotter ::. erptraHa pie:Fitts setebtelsed wIt/de ISO
days : ' .• it bait bees accepted la aerobes
Print name: Date: • Number of in . - 1— allowed per waft.
LWOW% \ParaltatELC-PenaitApp.doo 07/01/10 44046M(11/05/ • • B
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