Permit v
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
s : COMMUNITY DEVELOPMENT Permit #: ELR2013 -00085
T t GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/16/2013
Parcel: 25101 DCO3702
Jurisdiction: Tigard
Site address: 7185 SW SANDBURG ST 201
Project: Rose City Personnel Subdivision: ROLLING HILLS NO.2 Lot: 44
Project Description: (1) low voltage for Data Telecommunications
Contractor: BRIDGETOWN ELECTRIC Owner: ARNSBERG, JOHN S
5701 N LOMBARD ST BROWN, LARRY H
PORTLAND, OR 97203 -4113 % MODUN, JEFFREY K
9700 SW HARVEST CT #180
BEAVERTON, OR 97005
PHONE: 503 - 621 -7122 PHONE:
FAX: 503 - 621 -7123
FEES
Description Date Amount
Specifics: Restricted Energy Permit 04/16/2013 $75.00
12% State Surcharge - Electrical 04/16/2013 $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 a obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. �y
Issued By: ` -4- Permittee Signature: r Q ,�LIc 23 1 4. u�
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 15 2013 11:21AM Bridgetown Electric 503 - 621 -7123 page 2
Electrical Permit Anaii �>IRrEIVED
al City of Tigard (I (I 3 �
I3125SWHall BIvd.,•1'ignr&OR 9722. pg 15 2013 1'Ian R.iiew gther Permit
Phone: 503.639.4171 Fax: 503. 98 n.IdHy
Inspection Line: 503.639,4175 tripe Ready'1 Aerie Pam: far
Intern et: www.tigard -ar.grn CITY OFTIGARD tJelillad/Met w1: T7e..7 mow•- ••dam --w-
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/ gyp N r
Titp Fri- * .G DIVISION
usf5 �' r ..w
❑ New construction cn Addition/alteration /replacement ' &hack ail ttt.t apply (submit j seen of plans Willem S:
0 Service or feeder 400 amps or more ❑ Buttdiag ova' time amri+s.
❑ Demolition ❑ Other: where the available Htult marmot ❑ Marinas sad beatysrds.
. - u r exceeds 113,000 amps a ISO vas or ❑ Flaming build** '' • kW to ground, or exceeds 14.006 ❑ Commercial-up agricultural
❑ 1- and 2 -family dwelling (21.ConmmarciaVindustrial ❑ Accessory building amps for all other inutalist:on& handbags.
❑ Multi-flintily ❑ Master builder ❑ Other: O Mira porno. O InspUeion of 73 KV A or
❑ Emergency system larger aapmastr Peeved system.
... JO 4 Afl W AND CA11 ; ❑ Addition of new motor load of ❑ "A ". "E ". °I,F', "I
10011P or more. ece y
Job no.: l3 - Z C I ,lob site address: 7 I u S L San' ' 1,4- (] Sia a store reside unite ❑ Recreational pinta J D 1 teauh -ear& facilities CI swab +else. for Imam than
Cily/Statd7.IP: T . .7 ow ( t 7 Z I Z Z _ -- ❑ Hazardous kkanum. coo volts nomfal.
Suit efbldg, apl - '� ❑ Service or feeder NO amps or store.
G4-s- 'Lai Project narr,e: s �� ' �'>a -^� 1 1111111111111111111111111 °°7 r
Cross street/directions to job site: Descripsi . per. ram. Tsui
^_ �_._ __._�_.. __ _ Nem residential a e- or mulli-famlly dweMlag nail.
denudes attached
Subdivision: l Lot no.: 1 000 sq. n. w imr 16431.34 92 4 1
Fa sdd'I 500 R. portion
Tax map/parcel no.: I Limited above Xi Q imittd energy, res 75.00 2
pIIlf1V OF WOOL Limited energy. mufi}family 73.00 2
residential (with strove sal. R 1
�✓ tb (4 ''�C ? .- W -^ "" Q - _IA.. - Services or feeders InntaWtlo alteration, cad err relocation
200 amps or less 100.70 2
4/ cp rt.1(.rt� - Ste$ 4._
El PROPIEwry OW 4 1 D TJNA$ ' i 201 amps to 400 133.56
401 amps to 600 � 200.34 '-
Name:
_.�.. . 601 amps w 1,000 ai 301.04
Address: - — _ .._ _____ . Over 1.000ammpsor 552.26
_ -- - --- --- _.. -... -_ -_ .....__._. Temporary services or feeders installation, altatradoa, lad/or
City /State /ZIP: relocation .
F ( ) 200 amps or has 59.36 1
Phone; ( ) --,- -- 201 amps to 400 amp4 1 125.0E I i 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 339 - 165.34 2
intended for sale, lease, rent, or exchange. according to ORS 447, 449, 670. and 701. Braga ►hegira , alteration, or ell5ell51aa. Tr mow
(hvncr5rgnature:.._.__. ._ _-_.__._....__._... .. Date: _-- ._.-..._..._._..___._ A Fee for branchcirt5lits 1
AEM1 £At11fT 'CI CONTACT 1TiA4°tY shove service m feeder fee• 7.42 2
{ '.,' .;as b reac h circuit
Businessman: B. Fee for branch cirduits wrtkaus
-- - --- •- -_ -- -- - . - - -- service or feeder fee. first 56.14 ^ _
Contact name: branch circuit
- --- -- - - -- •— — Fach add branch circus 742 , 2
Address: MioceHaaeoan (aerl'ice or feeder not included)
Each manulhcused or modular 6734 '-
C ily/Statc/7.IP: dwelling. service and/or fonder
— _...._ Reconnect only 67,44 2
Phone: ( ► Fax: : ( _ _— —�_ Pump or irrigation cieck 6714 2
r
E -mai I: Sign or outline lighting 6714 2
CONTRACTOR Signal circuit(,) or limited -energy
,r�-t� � panel, alteration, or erosion. 1 Pant 2 -4-r
2
Business name: �L�l �3 CU C Each additional iolpeefiole over allowable is say of the above
- Address: , $ 7 01 N . 1-0 (K. B 4 0 S 7 - t2( - T" Addis Tonal inspection (I hr min) 1 66.25/ Its
T Investigation (1 hr min) 66.25/ hr
City/Stater/JP: )D OR oil Z 43 "`� 3 _ __ tmleutrial plant (1 brrein) 74.14/
Phone: MO )41.- 7122. I Fax: (o4 ) 42.1 7123 Inspections for which no fee is 9000/ rr
s ifical listed 55 stun
CCB Lic.: 103 B2-4 1 Electrical Lic.: r •- fi Suprv. l.ic,: L 7 7 �v 1� .7
1 L.
. Subtotal
Suprv. Electrician signature, required . (�� c - `�^ ,� ? 6?i f .E'er Plan iew (25% of permit ka
1 S� �? Scales (12 %of potmit Beek q
Print nanw: r • 7� /i -s`f f' 0-.4„s /.'Cr _ Date: Y l-) i - -- - TOTAL PERMIT FEB r? q
Authorized signature: TMIs permit a expires Ufa parson is art Aulaad wMata 150
`— —� days a it has bees accepted as anaaS10m.
Print name: Date_ _ : • N aces of inspectl pns allowed per permet
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