Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2013 -00081
T [GA RD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/11/2013
Parcel: 1 S 134AA01800
Jurisdiction: Tigard
Site address: 10120 SW NIMBUS AVE C4
Project: Infocus Tigard Subdivision: IKOLL BUSINESS CENTER, TIGARD Lot: 2
Project Description: (1) low voltage for Data/Telecommunications
Contractor: BRIDGETOWN ELECTRIC Owner: HANSON, RONALD D
5701 N LOMBARD ST ROBINSON, CONSTANCE A
PORTLAND, OR 97203 -4113 ROBINSON, CHESTER TRUST ET AL
203604 EAST FINLEY RD
KENNEWICK, WA 99331
PHONE: 503 - 621 -7122 PHONE:
FAX: 503 - 621 -7123
FEES
Description Date Amount
Specifics: Restricted Energy Permit 04/11/2013 $75.00
12% State Surcharge - Electrical 04/11/2013 $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 1.800.332.2344. , \
Issued By: 11 + " "Nl'Q� Permittee Signature: At( /fiI /L /e 0/V
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 10 2013 2 :40PM Bridgetown Electric 503 - 621 -7123 page 2
Electrical Permit Application ' : EIVED
Sli City of Tigard �' 3 Pma,mxnNo. : �Ll� vi 3 - O D���
13125 SGIr Halt Blvd., Tigard OR 97223 A a R 1 0 2 013 . Plan Revia Other Permit: 503.639.4171 Fax: 503.598.1960 Dmre/BV:
Inspection Line: 503.639.4175 CI I OFTIGARD Notified/Method: Dike xeadyl8y: -rice .. a g.p Sae a. mfl.t7maaaNe
Internet: www ug�Notified/Method:
p ,. x7gx?Ili 1 V t - x = .I r^ 'r p .Z e `iio e ��+ s , e. ` t 11;i rat
l Pte cheek an that • • (subuifit sets *spline wilt 'Was cinched balm t):
[3 New construction Vs Addition/alteration/ e�lacetnent ❑ ice or 400 or More II Building over Ikea mow.
❑ Demolition ❑ Other: here the available fault gamut O Mariam msd boatyards.
a' ITaa+1 ".9.71,1177.411"7117,':. s peeds 10,000 as at 150 volta or ❑ Floahegboidlug.
amps
to grosed, or exceeds 14.000 ❑ Cousneead-use agricultural
❑ l - and 2- family dwelling 4 0 Commerciallind , • I ❑ Accessory building pa for all other jubilations. buildings
❑ Multi -family ❑ Master builder i ❑Other ❑ ire pump, ❑ iartail tic* of 75 KVA or
1:1 ergenoy system. larger saparatdy derived system.
xN71d:T, A -
j 1 , - ' ` 1 y r ' " c t , - ❑ 'don of now meson load of ❑ "A", "8", "1-2", "I-3", witturt 00HP or more. O
!lib no.. y . Z R !lib site address:
) S W N. j►') b u s ANA.. ❑ Sic or more residential units. ❑ Recreational vehicle parka.
❑ ' lealth -care facilities. ❑ Supply voltage for mow an
ds
City/State/ZIP: l j5 # " I Z. P ZL 3 ❑ pus locations 600 volts nominal.
JJ � ❑ arfiader600 or more.
Suite/bldgJapt. no.: C� I Project name: cc `� , jl ,��
�Vi 1 ;�A/ r�.,i � .rx' l. '. ; !"'F!"r r....L:.� r wo [[ .y�yg�
Cross street/dira� ions to job site: iiiii- ~i ce •
N residential Slagle- or atal6- family dwe rag unit.
In dudes attached prase.
Subdivision: I Lot no.: 1, m0 sq. ft. or less 168.54 4
add' 1 500 sq. it or portion 33.92 1
Tax map/parcel no.: Li itod energy, residential 75.00 2
r N n with above sq. ft )
�iYtr ' °' �` L' , 'ted energy, multi- family
1.-e. .� t" mw C. K ♦ ► sidential (with above as. ft.) 75.00 2
w V 1+,44._ �r� //�� — ' � Sc ea or feeder inetallatiokalterst kn, and/or relocation
s) A ! C / 4- �� i' es P , s ` •\ 20 m amps or lens 100.70 2
! y /� 20. amps to 400 am" 133.56 2
11 amps to 600 amps 200.34 2
Name: . m I amps to 1,000 amps 301.04 2
Address: a - 1,000 amps or volts S52.26 2
T mporary services or feeders installadonl, alters and/or
City /State/ZIP: re ation
Phone: ( ) I Fax: ( ) 2 amps or less 59.36 I
2 1a to 400 amps 125.08 2
Owner installation: This installation is being made • n property that I own which is not 1 an to 400 168.54 2
intended for sale, lease, rent, or exchange, according a ORS 447, 449, 670, and 701. B ads circlets— new, slteratil or esiceslea,-narnand
Owner signature: Date: A Fee for branch circ.aia with
1rs7 , , h above service m fender tie, 7.42 2
oath b eirouit
B. Fee for branch circuits wither!
Business name: service or feeder fee, first
branch circuit 56.18 2 •
Contact name: F add'I branch circuit 742 2
Address: • etlaneous (service or feeder not included)
manufcturod or modular 67.84 2
City/State/ZIP: • raft service artier fbMer
Phone: ( ) I Fax: - 'nnect 67.8 2
) • mp or irrigation circle 67.84 2
E S gn or outline liglrirnl 67.84 2
x r7, , v ; ' t . _ S : circuits) or limited-enagy Z' S 2
% ' E it t e, a
• 1, alteration, exte hioo. Page
Business mane: W - Q colt additional hupecdoa over allowable In any of the above
Address: £ 7 01 F. , , L O m. t3 • - ,J ^^ S Trzeb -7 daitioaal inspection (1 hr min) 66251 hr
� r., „� : '
ligation (I hr ,min) 66.251 hr
City/State/ZIP: L A}d C'� 3 Atli i mostrial plant (t hr min) 78,18/ hr
Phone: ( Vol. , — 'r 12 2 Fax: i p4 ) 4Z i 11 Z3 spections for which no fee is 90. le
,+ s Meal listed 1y hr mm
CCB Lic.. 103 az.4 Electrical Lie.: -. ,, ;! , Suprv. Lic, • 4 17 7 % „#, ' r°l. V. ::7. _. 7i7n : �, :.. �'
_ subtotal: f
Suprv. Electrician signature, regttilt '" -r -, review (25%ofpe mit ice):
Print name :4, )LA- Si #-ss fee.. Dale: II / f 13 State surcharge (12% of permit lbe): d'
TOTALPERMIT:Fly; S q
Authorized signature: This permit applkadoa emplr*If.s permit la. cat abMaai within tali
days after i1)ar boas acoelikd as camping,
Print name. Date: • Number of uaspotions allowed per permit.
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