Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
a.. COMMUNITY DEVELOPMENT Permit #: ELR201300150
Date Issued: 07/01/2013
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 26102AC00700
• Jurisdiction: Tigard
Site address: 12540 SW MAIN ST 120
Project: Fish Field Subdivision: BURNHAM TRACT Lot: 1
Project Description: Low Voltage for Data - Telecommunications
Contractor: BRIDGETOWN ELECTRIC Owner: DOLAN & CO LLC
5701 N LOMBARD ST BY FLORENCE T DOLAN
PORTLAND, OR 97203 -4113 4523 NE DAVIS ST
PORTLAND, OR 97213
PHONE: 503 -621 -7122 PHONE:
FAX: 503 - 621 -7123
FEES
Description Date Amount
Specifics: Restricted Energy Permit 07/01/2013 $75.00
12% State Surcharge - Electrical 07/01/2013 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: 0 Boiler Controls: 0
CCTV: 0 Clock Systems: 0
Data & Telecommunications: 1 Fire Alarm: 0
HVAC: 0 Instrumentation: 0
Intercom /Paging: 0 Landscape /Irrigation: 0
Landscape Lighting: 0 Medical: 0
Nurse Calls: 0 Protective Signal: 0
Security Alarm: 0 Other: 0 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: FAA J Permittee Signature: S &6. Afpr_�c /LTS
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 603.639.4175 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.
Jun 27 2013 9: lORM Bridgetown Electric 5 03 - 62 1 - 7 1 23 page 5
Electrical Permit Aaalication
City of Tigard " !IF Received paniiit isk... _
"1■1,/ V
A
13125 SW Hall Blvd., Tigard, OR 97223 Plait Review
i.- Phone: 503.718.2439 Fax 303.598.19 JUN 27 2013 DateBv: Other Permit:
Inspection Line: 503.639.4175 Date Ready/By. Suns: gi See Page 2 for
Internet: www.tigard-or.gov
.. !TY OF TIGARD NotitiecVM whod: I Supplemental Information
''.:•.!ir',..',.::.',..5-1.,•',.:Nlii:::!,',?,V,ile,f,;::;.''.:N!1:1.7!.-'N.•:'.414-gtOktOt:',. : '. r Dgvisioikt ". ,i_..,';',::,.•-: ,g'.•,`A:iEll,i4.:40';!Via.E72.:4'''cIA-.Z.M16112MITICZiF
I .
0 New construction a Addition/aheratio 13liceMent Please chedc an that apply (submit a sets organs w/items checked below):
0 Service or feeder WO snips or more Q Building over three stories.
0 Demolition 0 Other:
whore the availab.e fault current 0 ME1111110 and boatyards.
',1"::- . 7. JX4 9 . 1 5.147%41,?4:i.ir„. •1,1' ,',. r;11' ' ''' ;' ' .,.., ' *;;01$1**** . "'.•::';'-' :: :-:' 1 • , : ,f :,..': -: .:-..' - ' exceeds 10,000 amps at 150 volts or 0 Floating buildings.
less to ground, or steeds 14,000 0 Commercial-use agricultural
0 1 - and 2 dwelling ■14 Commercial/industrial 0 Accessory building amps for all other insialiaiions. buildings.
0 Multi-family 0 Master builder , 0 Other: 0 Fire pwnp. 0 Installation of 150 KVA or
0 ErnergencY Wolin. larger separately clerked system
.:-.-..,', ''.. . ‘P A lt., VRIF 4 .4 , 4n1MtAnkr..****.*D, 13/4/40. : . : : : '. I . ' ;.: '.. .--..',';'' ['Addition orrie„ motor load of 0 "A "E'', - i.2", '1
Job no.: 11,-411 I Job site address: I-L,546 4, Ak I 001-OP or more. occupancy.
1 0 Six or more residential units. 0 Recreational vehicle puha
City/State/ZIP: 1;c OR ci-12.1,$ 0 Health-care facilites. El Supply vohage for more than
0 Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no,: 11.0 I Project name: ci Vi'aR 0 Serviee or finder 00 am . : or mare.
,0,..;e:,:i,) :.. 7,i c; t jalli141f4/*31,ik„,1.4:
Cross street/directions to job site: Ngl. 0 :
netc;iaoan Om 7.. 4
Y - 7;•... . '1;
New residential single- or multi-family dwelling unit.
Includes attatbed garage.
. -- Subdivision: . [ Lot no.: _ 1,000 sq. tt. or less 168.54 4
En. add'I 500 sq. ft. or portion 33.92 , I
Tax map/parcel no.:
United energy, residential
75.00 2
' •;',,.':,: i .... . :,', .,...', '-''-:'''.-•.::..f,:•w-,M'',4i,C,.•;":40eSCRAWA90',4*-1511'f* ' ' ." ' '. .
Limited Sq uiti ft j_fam dy
75.00 2
touuo V a‘lnuelf. rinetAA kAottiv■.., 01-SAAA..ckm 41: 41.M.44/iA+ residential (with above sq. ft.) ,
R:. CrikeePhiMil.;,z. :---:, ,•:-:.
iii)4-4.1- 2,4- ecx&A.4tief Gakta, Services or feedlert instsdlation mitlior reloadoll
z.1::q640 it,0401` F A::;.,5: . : , .';V:.;,,:. -; V -. : i ti !TEN'ANT: --. - ..: ',.: - -. :1 ' 200 amP's or less 100.70 2
201 amps to 400 amps 13156 2
Name:
•
401 amps to 600 amp 200.34 2
Address: . . 601 amps to 1.000 amPs 301 04 2
Over 1,000 amps or lolIs 552.26 2
City/State/ZIP: .
Temporary servie s or feeders installation, alteration, and/or
' relocation
Phone: ( ) [ Fax: ( )
200 amps or less 39.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amni 125.08 2
intended for sale, lease, rent, or exchange, according tr QRS 447, 449, 670, and 701.
401 amps to 599 16834 2
Owner signature: , Date: Branch circuits — g alteration, or extension, per panel
=;...,.. A, a Fee for bromi uitsw
7.42 2
Business name: . each branch circui
B. Fee for branch cur 'ts without
,
Contact name:
service or feeder $e, first
56
- branch circuit
.1S
' , 2
Address: Each suld'I branch cir9uit 7.42 2
' Miscellaneous (se or feeder not Included)
City/State/ZIP: '
, Each manufactured or [nodular
67.84 2
Phone: ( ) I Fax: : ( I ) dwelling. service and/ r feeder
'
Reconnect only 67.84 2
E
Pump or irrigation cir e 67.84 2
'!. '. r, • •,- , ,, . •,..:. signor outline lightin
67.84 2
Business name: Bridgetown Electric Signal aj
circuit(s) or i
(s) or li ited-zergY i nge 2 See 1
panel, 1. 2
Address: 5701 N Lombard St. ; Each additional Inssecdoa over allowable in any of the above
Additional inspection 1 hr min) 6625/ hr
City/State/ZIP: Portland, OR 97203
Investigation (1 ht milt • 6625/ hr
Phone: (503) 621-7122 i Fax: (503)621-7123 Industrial plant (1 hr in) 78.18/1w
Inspections for which o fee is
CCB Lie.: 103824 I Electrical Lie::' 6 Suprv. Lic.: 4I77S s . - Axil listed '4 h min 90.00/hr
' '-' "J l ',L ':- . itr ==.7. 7 . 1 ..n.1 77 Mae r -On: ' '
Suprv. Electrician signature, _...-.C4e-purst..,r Subtotal: Is. 00
Print name: Keith Steenslid Date: Plan 'ew (25% of permit foe):
State sum ; .■ (12% of pennit fee): ci..d
,
Authorized signature:
TOTAL PERMIT FEE: 8q, 0 0
This permit a ppilcaft . . empties if a permit ts not obtained within ISO
Print name: Date:
days afte It has bees accepted as eempkte.
• Number of inspection : allowed per permit
HEuildinelerrn itsELC _Permit App .51.5_011 doc Rev O52112013 440-461 ST(1 INVCONME.13
Jun 27 2013 9:11AM Bridgetown Electric 503 -621 -7123 page 6
Electrical Permit Application — City of Tigard
Page 2 — Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
... .• ;.. °� ,;:,:`! •:: .,:, _: ;. „_':?',•, ,.•... . >��. •.,:,'�' 1. iii:
Fee for all residential systems combined.. ' $75.00 Description F " e ' i `• ' Mal •
$ 5.00 Ob. I pee 'rmat
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems*
15.01 to 25 kva 200.34 2
Et Burglar Alarm Wind generation a :, a in excess of 25 kva:
25.01 to 50 kva 301.04 2
❑ Garage Door Opener* 50.01 to 100 kva 552.26 2
•
• > 100 kva (fee in with 552.26 2
1=1 Heating, Ventilation and Air Conditioning OAR 918 -309 $1 I)
System* Solar generation ., stems in excess of 25 kva:
Each additional kva .ver 25 7.42 3
❑ Vacuum Systems* >100 kva —no addit .nal charge 0.0 3
Each additional '. 'Mims over allowable in any of the above:
El Other. Each additional ins. Lion is 66.25/ hr 1
charged at an hourly (I hr min)
Inspections for whic no fee is 80.00/ hr
/fits// listed ' hr min
' i • �.. r� . g , p3w• ��: q �.. , r F`" F. F-.r..0
Fee for each _ : r � ��. �:L , � >., �a�;,� ., _. .,�,
commercial system $75.00 Subtotal;
(SEE OAR 918- 309 - 0000) Plan review, if - quircd (25% of permit fee):
State rage (12% of permit fee):
Check Type of Work Involved: TOTAL PERMIT FEE:
This permit a pplica . • • empires if a permit is net obtaiaed within 180
❑ Audio and Stereo Systems days a , 4 hints been accepted as complete.
• Number of inapecti • ns allowed per permit.
❑ Boiler Controls
❑ Clock Systems
® Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
•
❑ Landscape Irrigation Control *
El Medical
•
❑ Nurse Calls
•
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems: _ '
*No licenses are required. Licenses are required
for all other installations
IABuildirglPermisMELC PermitApp_13.R ERE.doc Rev 0521/2013 •