Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
•-.- COMMUNITY DEVELOPMENT Permit #: ELR2013 -00102
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T [GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/08/2013
Parcel: 2S113AB00300 •
Jurisdiction: Tigard
Site address: 16037 SW UPPER BOONES FERRY RD 100
Project: Simpson Property Group Subdivision: FANNO CREEK ACRE TRACTS Lot: 38
Project Description: (1) low voltage for Data/Telecommunications
Contractor: BRIDGETOWN ELECTRIC Owner: OREGON STATE BAR, THE
• 5701 N LOMBARD ST 16037 SW UPPER BOONES FERRY RD
PORTLAND, OR 97203 -4113 TIGARD, OR 97224
PHONE: 503 - 621 -7122 PHONE: 503 - 620 -0222
FAX: 503 - 621 -7123
FEES
Description Date Amount
Specifics:, Restricted Energy Permit 05/08/2013 $75.00
12% State Surcharge - Electrical 05/08/2013 $9.00 •
Type of Use: COM
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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: � 4 . /./y oYL1 Permittee Signature: ,O/L 4/3
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.
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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.
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Na y 07 2013 3:52PM Bridgetown Electric 503-621-7123 page 2
Electrical Permit Application
City of T.igard
Si
13125 SW Hall Blvd.. Tigard, OR 97223 Mg 07 , '213 Received
Drne/Br
Plan R. '
Phone: 503.639.4171 Fa: 503.598.18ft ov TIGARD Dat Darell3 B - :
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Inspection Line: • 503.639.4175
Internet: wvActigard-or.gov e , . : y: , Other Permit 3 3- d 0 0 q3
Nw ' ' • "' 45-15 15 ''
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' Prniiiitilu: ; 81169 P:Pieal161
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BUILDING DIVISION illargitafer°M° d):n
1
, 4....Int".."-; 1 :i`..IJ s ='';44 ,-. z;;.: " 7:Wr7 'L L;c.'-i'44.t,:t.---,- *...' ' ePArittt
, 11'.4, •■ .*:..;.1 .-,-. • s -..?e4sq•-yv,,r.t.... ., , . .,....... y, ,., :.,. ..46.:1,., ......
0 New . construction ffi Addition/alteration/replacement Please ahech'sll Vim .. • L (rnibilitt Lietaof plans vifaurna checked below):
0 Saralee or fheder 4 .'■ amps or triiire 0 fluililliiiever three stories.
0 Demolition 0 Other: .. .
. where the available • .- .. . currone 0 Madras and barnyard&
mouv—majs , exceeds 10,000 .... at 150.votts or 13 Flowing builthogi.
.. . :4 ': hoe to ground, or • ... .. 14.000 0 Commia
trel-use aglicalaral
0 1 - and 2-flintily dwelling ro Commercial/industr al 0 Accessory building amps for all other ...• , Ilstiom. buildings.
0 Multi-family • 0 Master builder , 0 Other: 0 Fire ranP. (3 bunallation 0(75 KVA or
0 EracrilettcY actalt.' larger separately dmived system.
' ' ' . ' 1 ' . . 4 i i l e 4 t . 0 . . ) 4 ; l i q ' T e r i a l i : T i M I T X : 1 1 ! : 0 1 1 4 , : Z E M A P I r t 1 1 : f i t . 4 1 , * ' M OdOWilknofnmv.00ricrndof O A ",, "E "1-2"„ la
'100HP or more. ; occupancy.
Job no.: 13 - 3 -t , Job site address: i 61)37 9.4 p - F, F- - CI Sit at more redden . al mks. Cl Recociabmel vehicle pada.
0 Health-care famliti -. OS volisge for more than
City/State/ZIP: . - 7, — ; ,9 „,, I5 e q 7 2 TAI
4 g 0 Hazardous Wail . . 600 volts nominal
Suite/bldg./apt. no.: 4g. joi, Project name: S.,',..,ps ,, 14 v s ; 0 Service or feeder . e ■ am' annum.
meirtfera:wcr ep$ on
Cross street/directions to job site: 1 • .....t.,
" 1111■ - iiiii - IlentillIlllerl. 1•111111=11M11131
New residential... .!.■ e- or'imulti-tentily'dwelling unit.
Includes attached 1, rage.
Subdivision: I Lot no.: 1,000 sq. ft. or less ; 168.54 4
Ea. add'1.500 sq. ft. .1 portion 33.92 1
Tax map/parceino.: 1-. 751)0 2
ri ;=..;;0.f:N with ft
ttiV irr:14 .._ , .Willtataleg4 , ,I , ,
' ' • '
Limited energyonu .-tinnily
79.00 2
? •(.. AO r 0 ......4 A IT> A PI residential waits , , ve actj ft.)
Services or feede . instal do , attire , and/ar relocation
-
I , / C-z•r-c.s4- c.e. i 200 sop or leas IIIII 10070 . El
!, 'v .
- 0 ...w y ,.., ...,.., . ri <,- i44; '3 ;v .', = •;, . ''.• ',4.-. ' . ,4„,..1:', . ..,,;•,.., 201 am ,31.III.
'!Fin:: ' ,.::. 3 1 . .' 1 . ' 44■Wc_ ..,' '.4P '',': . me _•,' ', • '..; J.: ': ,' , • - : , ,',.;3•1. - '41-ca4:1•.:: , :s. steps t 400 . MI 133.56 El
401 amps to 600 am . 20034 2
Name:
• 1
• '601 amps to 1,000 z "pa 301.04 2
Address: Over 1,000 amps or , .Its . 552,26 2
Temporary serve -IL or feeders installation, alteration. and/or
City/State/ZIP: . , relocation
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Phone: ( . ) I Fax: ( i ) 200 amps or less I 59.36 1
201 .,.. 123:08 2 to 400 , ,
Owner Installation: This installation is being made on property that I own which is no amps
401 amps 599 1
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. to , ., 16814 2
Brandedradb - ' , alieration. Orectensloa, perraind
Owner signature: ■ Dare: A. Fee for blench ci - Is with
I
BIEWM2M %441 1.WZ.M.SE=riat . L a -i'J above service or -.:, file. 742 2
. each branch circ •
Business name: B. Fee for branch c' 'ts without
se,rvioeorfrsde4e. first 5618 2
Contact name: branch circuit
Each add'l branch c' , it 742 2
.
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Address: ' Miscellaneous (w41 orfeeder not isainded)
, .
Each manullicaued d modular
City/State/ZIP: • dwelling, servfee or feeder 67.84 2
Phone: ( ) I Fax: : I • ) Reconnect only 67.84 2
. Pump or irrigatiou c*:', to 67.84 2
E-mail:
a Sign or outline lig -
ht' ', g 67S4 2
. -
ii' WiniltIWOOikt nii iteIN:Mkeigrigii Signal cfrcuit(s) or 11 ited-enenry MIN
- ?S`
Business name: t pe a v i g h a laca g&'
SR .. el altered . or . tension. 11,MEWO II
Each additional , needon over allowable In arta dm above
Adthess: S7 01 ,j , 4.. at- 6 Ater) srreeL, Additional ' - - - (1 hr min) 66.25/ hr
investigation (1.lir , in) 6625/ hr
City/State/ZIP: 'VOgajtiajb CR - .C11 2 03 -4 11 1 3 Industrie' plain (t , in) I
Phone: (Sol )1dm - 1172. I Fax: (603 )4j$ /123 inspecticen•for whir . no fee is 90.00/ hr
CCB Lic.: 10'3624 I ElFetrical Lie.: -- Scric. I Suprv. Lie.: £4 177 datniliNg.P.,":171";...;! ••;, '
Suprv. Electrician signature, 4/...."‹
re ' ' I -we/
Rao, 'my (25% of permi fee): .76.- -
Print name: -Cie APP.'S 4•171. Date: State - barge (i2%Ofpermit fee): C)-
. . : TOTALITRACT;FEA: .g q -
Authorized signature:
nil permit ap - . a° cap elf. ±11'11F111#400049frnsivoldsla ISO
days Il
. ea o, lionned its eisinisits. '
• PriM name: Date: * Number of inspectiima allowed per peanut.
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' . masiiinag‘Perinirn44-r dap 07/01/10 . : •440.4615TM/0 as
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Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
16037 SW UPPER BOONES FERRY RD 100,
TIGARD, OR, 97224
Commercial - Electricial Limited Energy
135 Low voltage
05/24/2013 00:00
ELR2013-00102
PASS
Violation Summary:
Inspector Contractor