Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
8 . COMMUNITY DEVELOPMENT Permit #: ELR2013 -00073
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/02/2013
Parcel: 2S 113AA00700
Jurisdiction: Tigard
Site address: 16432 SW 72ND AVE
Project: Bridgeport Subdivision: ROSEWOOD ACRE TRACTS Lot: D
Project Description: (1) low voltage for Data/Telecommunications
Contractor: BRIDGETOWN ELECTRIC Owner: PACIFIC REALTY TRUST
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 04/02/2013 $75.00
Type of Use: COM 12% State Surcharge - Electrical 04/02/2013 $9.00
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 95 -001 -0 90. You
may obtain a copy of the rules or direct questions to OUNC by calling 503 or 1.800.332.2344.
Issued By: t'► l.e Perm " ' ittee Signature: �f`+ P� 34 04
((�� 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.
Apr 02 2013 8:35AM Bridgetown Electric 503 - 621 - 7123 page 2
Electrical Permit Application_
SI City of Tigard K Received a_ / sit t�� DOC73
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Other Permit
Phone 503.639.4171 Fax: 503 598.19 R 0 2 Z O 1 3 Dele/By'
Inspection Line: 503.639.4175 Date Reedy/ny: feat is See Pap 2 far
Internet www.tigard ar.grw Notified/Marked 77L ffinppbn -W tafora Ales
A
. T •. ' ' ' , eq' ` o r y . , , d .; .,, .rls ..ly r,.
' (T'���i`V I��C7f�f " ' ' .rr yNr ... 6elaw):
❑ New construct ion [ Addition/alteration, replacement
❑ Service or feeder • 1 amps or more `iBmlldin8 over three Roriea
❑ DtMolition ❑ Other: where the avaihbl fault currant ()Marinas and boatyards.
, r '' r 1 4 1 0X '`,. Nr.`K4i, exceeds 10,000 at110 volts or ❑ Flossing buildings,
less to ground, or - • - - 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling 0 Commercial /industrial ❑ Accessory building amps for all other stallatioos, buildings
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire Pump. ❑ Installation of7sKVAc
�, b, - r Emer eacy syster ' , larger ,e ly derived system
�� ' } r° .: t�►�1 t ❑ Addition of new ••tor load of ❑ "E", "1I 2 "1 - 3••
Job no.: ) 3 Z.1. 3 Job site address: / ‘L/ 3z 5 1 ~ , f '7 Z 4‘ ' A looxr or more. occawncy.
❑ Six or more reside tial suits. ❑ Recrentwnal vehicle parks,
City/State /ZIP: —77,,...-i,/ / 7 Z z 13 Health -case facili • ❑ Supply vokage fee more than
, / El Hazardous beard r. 600 volts nominal
Suite/bldg. /apt. no.: � /` q roject name: ❑ Service or feeder :00 amps or more-
.
,, ,,. .,{q , iii.,- „C.ri .. -::y ..
Cross street/directions to job site: nem mwmoiwr:'sii” +.liT_'1• •
New resldeattal at . le- or multi family dwelling mit.
Includes attached .
Subdivision: I Lot no.: 1,000 sq. ft. or lass J 16854 4
map/parcel no.: ' Ea. add'I 500 eq. ft. • pardon 33 92 I
Tax ma 0/P
YAW> " :_. qw r, c a 75_10 2
, / , Liiaited energy, mu i- family 75.00 2
4-0 L./ Vo / 4 . pre- w,•.. r -,o � fhw` ,� . eK• ?^ residential (with • • e sq. ft )
Services or feed a installation alteration, and/or reloeattou _
S • 0.,4_ A /- 200 amps or less • 1 00.70 2
',.l i • .Q`k11" 201 amps to 400 a , 133.56 2
401 amps to 600 a .. 200.34 2
Name: -
____ — 601 amps to 1.000: , , : 301.04 2
Address: Over 1,000 amps or oils 55226 2
City/State/ZIP: - Temporary eery' . or feeders ittsallatioa, alteration, sad/or
Phone:( ) Fax: ( )
200 amps or less 59.36 I
Owner installation: This installation is being made on property that I own which is not 201 amps w 400 a 125.08 2
401 am to 599 a• 168.54 2
intended for sale, lease, rent, rexchan a according to ORS 447, 449, 670, and 7D1.
1M
irate or S S Branch circuits- • , alteration, or exteaalos, per Noel
Owner signature: ____._,-- _ -.___ . -__ _ Dale: .. A. Fee for bench ci 't0/ with
,' 01 , ' i y+-,, , above service or , er fee, 742 3
W f-. �G each branch sire
I -
Business name: II Fee for breach c' - is wl tJrow
service or feeder - , fiat 56.18 2
Contact name: branch circuit
- — Each add'l branch c uit 7 42 2
Address: Miscellaneous (se co or feeder not included) _
City/State/ZIP: /State /7,IP: Each manufactured .r modular 67.84
2
ty dwelling, service an . or feeder
Phone: ( ) I Fax: : ( ) Reconnect only 1 67.84 2
Pump or irrigation - 67.84 2
E -mail
Sign or outline light g 67.84 2
' :: ;,„ ,,, . +1 F `'4X)11 ` , 4 - .i Signal cirruit(s) or I ited-energy
Business name: "eiR,t9Getbla 0 LE.Crpa c panel, alteration, or tanion _ i _ Puke 2 _ 95 2
Each additional petition over allowable is any of the above
Address: ' 7 01 11/4,1 . L--. C) %Yt 6 •=1-4z0 S 7 e E7 Additional ' - • , (1 hr min) 66.25/ hr
City/State /'LIP: '70Val. l�.twij) OR Qi7 2 , ( )3 _A I Investigation d dal l (1 hr :in) 66.25/hr la
Industrial plant (1 h mini Ti.ltUhr
Pdxme: c Fa I nspect ions for whi. no fee is
( . �3 ) 1 - 71 Z I (503 ) b21 7 1 23 90.00/ hr
5 ectfical listed hr sun
, S r r ; n ro ..,
CCB Lie.: 10 ai'T Ellectrical Lie.. "TC, Suprv Lic a 1 77' 6 :::=71.1. [.....w ....: ,. ,. �'. t ti
Subtotal: S —
Suprv. Electrician signature, requited^" �..,e -4 review (25% of permit fee):
P rint name: / ' ..) /, .5 ins /.- Y [Date: L .1/ Z / 3 S tate sucharge (12% of permit fee): q
Authorized signature: I TOTAL PERMIT FEE: S y
Thls ran a
ti es nit L not obtained while 180
Pe PP aspires ifs
days a 4ter it ass ben accepted as complete.
Pura
Print name: I Date: • Number or inspections ►Pa per Peron.
L1lluildfiglPrmia \ELC- PriniiApp.doe 07/0 I/ I 0 440. 45151(17 /05/COMIWF5