Permit CITY OF TIGARD'
ELECTRICAL RESTRICTED ENERGY PERMIT
°1: 11 .;r : COMMUNITY DEVELOPMENT Permit #: ELR2013 -00155
Date Issued: 07/01/2013
TIGARD' 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 2S 113AB00300
Jurisdiction: Tigard
Site address: 16037 SW UPPER BOONES FERRY RD 175
Project: Zip Realty Subdivision: FANNO CREEK ACRE TRACTS Lot: 38
Project Description: 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
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: M a J Permittee Signature: 545r: Ai
•
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.
Jun 27 2013 9: 15RM Bridgn rinpdecurns- 503-821-7123 page 15
Electrical Permit AnalicatioP '1 it V U i< „ : t ....t ,,,,, ,
City of Tigard UN 2 7 2013 Received 1 i 1,. 1 ,,,,,
r Pe " Na: tLR2 - o
DateDy: e -o)3 ws
-s
111 .,,e 13125 SW Hall Blvd.. Tigard, OR 9'7223 7/ Plan Review
, eo- Phone: 503,718.2439 Fax: 503.598. OF TIGARD DastaY, Other Permit:
S. Inspection Line: 503.639.4175 , Dam Ready/ay: tuns: lit See Page 2 far
Internet: www.tigardor.gov 9UI LONG 01‘/Isicm Notified/Method: ._ Supplemental Information
... ,
gii '';;.: ' '''' : "--: -::: f': 4 -:::':.:, ...i;..:-:1: '
0 New construction ' *Addition/alteration/replacement • Pk.ase check afithat • • • ly (submit 1 sets of plans w/items Masked below):
0 Service or feeder t o amps or more 0 Building over three stesea.
0 Demolition 0 Other: ,
where the mils • • e fault current 0 Marinas and boatyards
-. , . •. • ,-,,,,,,,,, - :... • - . ,:,,,- -,, ,1,:•.•.:1 • , - "•• -.- - - •.. n',:••;u:it-. - .'•i'',"; - ,. - '.. : , ' ' • (' :' • -, .,, . , ,•.:. ':, - :s .•,•F :: . f exceeds 10,000 a • - at 150 yobs or 13 Floating buildings.
':. r :.- l • :-::- - - --: 4 •:•- -'' - , - ' • ': ' s ' .' • ss ' . ' " ' -• ' less to ground, or exceeds 14,000 0 Commercial-use agricultural
0 1- and 2-family dwelling .1 Commercial/industrial 0 Accessory building amps for all ot • installations. buildings.
El Multi 0 Master builder 1 0 Other: El Fite pump. Dial nstlation of 150 KVA or
. , • , , • 0 Eme la
r8encY sYsi — • rge:separately derived seam
R .. 0010#4407 . 00**4:00 - 40 . 0,,,„ . ,.. , ..: i ,, , ::," 0 Addition of new t for toad of . 0 R "1-2e"1,:cie parks
1
Job no.: 1:5.. 453 1 b aNkj Job site address: 1osi e u
# 100HP or more.
0 Six or more rest • -dal units. 0 e24 v
occupancy.
City/Suite/ZIP: ■"1"Z t, rjR_ 001 ea
1,4 CI Hltb-care facili 'es,
0 Hazardous locati • s. 0 Supply voltage for more Max
600 volts nominal.
Suite/bldg./apt. no.: fl s I Project name: li p 1:Z It. j. j 4- 0 Service or Seder • 1 1 amps or mom.
-
Cross greet/directionS to job site:
Description OM , FM. I Two 1 •
New residential s , _ It- or multi-family dwelling unit.
Includes attache. garage.
Subdivision: I Lot no.: 1,00O5, ft or less 168.54 ' 4
Ea. WWI 500 sq. R. or portion 33.92 i
Tax map/parcel no.: • Limited energy, res dential
. - . , - 75.00 2
..;•.;.,..,. : :, - ,4,„:„:- : .. , ;. :,:,„," :i : ;. :•,.:,.:!;,,,i2,', : , , ,vi i , . , .. - : -..,t ; ,**06.:***00i : ;,,* orni :: • : : ... • : : ... , : :,:::;;! ...: , ... Lir ( n rith above 5 9. - t / i • _ family
75.00 2
LIMA/ v 0 t cPCAtAA.A.Are cycsw.L. tium-tnri., -40 -11Pm.4r " .,fIl k wi , ,'::• v:
6 . 1yc1 , -, .K C 1. th pci,.4Le titmice' or feeds ,,' installation and/or relocation
. .. - Y:': - . lig '•E •• '...' :". r.i. -';`;'.., '..4,00RER,N.t .1 i '::: `-. ::::!..;:,7 :in ;Ti,i4444 . Z : '::, ' ::".: ... 200 ele el. less 100,70 2
201 strips to 400 wrps 133.56 2
Name:
401 amps to 600 amps 200.34 2
Address: 601 amps to 1.000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP:
Temporary services or feeders Installation, alters don, and/or
Phone: ( ) I Fax: ( ) relocation
200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 =VS 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
401 amps to 599 amps 168.54 2
Owner signature: Date: Broach circuits - new, alteration, or extension, per panel
; ::,,;: . Fee for branch ci 'cults with
:; : A. eimve service Or :ceder fee.
Business name: ; each branch circLit 7.42 2
B. Fee for branch circuits without
Contact name: serviceiVd er feeder ee, first
c 56.18 2
Address: Each add'l branch crcuit 7.42 2
Miscellaneous ( or feeder not indudedl
City/State/2W:
Each manufacared r modular
: 67.84 2
dwellin tR. service r feeder ,
Phone: ( ) Fax : ; )
I Reconnect only 67.84 2
E-mail:
. Pump or irrigation c rcle 67.84 2
- • . ''}.: - I : s . • '• ; ' ', . '. . - '• • " s" : Sign or White 1ighIng 67.84 2
Business name: Bridgetown Electric Signal circuit(s) orlththed.encigy See ..",... ,
• panel, alteration, or extension. 2 I e t"' 2_
Address: 5701 N Lombard St. . Each additional haspeedon ova-allowable in any of the above
Additional inspection (l hr min) 66.25/ hr
City/State/ZIP: Portland, OR 97203
Investigation (l herein) - 66.25/ hr
Phone: (503) 621-7122 I Fax: (503) 621-7123 Industrial plant (1 hr min) 78.18/ hr
Inspections for which no fee is
90.00/ lir
CCB Lic.: 103824 I Electrical Lic::* 6-887C I Suprv. Lic.: 4177S a . - ' fi call listed Ys hr min
' .V:•"- ••: r*;.fiTit'.
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Suprv. Electrician signature, At-.. , Subtotal:
Plan review (25% of permit fee):
Print name: Keith Steenslid . Date:
State surcharge (12% of permit fee): q , as
Authorized signature:
TOTAL PERMIT FEE: a cl . 04
' This permit a ppNes lee expires If a penult is not "baked withis 1110
Print name: • Date: days after It has be accepted as complete
, • Number of inspectles allowed per permit.
1:113uilding`Pormits1ELC_PaniiiApp_P-R_ERE.dac Re, 05,21 /20 I .1 ' 446.401 s•ri i i fONCOMIWEB
. .
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Jun 27 2013 9:161=IM Bridgetown Electric 503 - 621 -7123 page 16
Electrical Permit Application — City of Tigard
Page 2 — Supplemental Information
Limited Energy Permit Fees: • Renewable nergy Permit Fees:
Fee for all residential systems combined....... $75.00 peserialten Ow. e Tees
Renewable else cal 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* 16331 to 25 kva 200.34 2
ID Burglar Alarm Wind generation systems 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 accordance with 552.26 2
❑ Heating, Ventilation and Air Conditioning _ OAR 918-309-0040)
System* Solar generation systems in excess of 25 kva:
Each additional kva over 25 7.42 3
❑ Vacuum Systems* > 100 kva —no addit octal charge 0.0 3
1=1 Other: additional itspection over allowable in any of the above:
Other: Each additional inspection is
66.25/ hr
charged at an hourly (I hr min)
Inspections for whits no fee is
90.00/ hr
{ I ficall listed 1 ,1 hr min
{!i ..arc ,:,:'� � : K tf. `^'.", t .•- "�.v"r, ,,:;404
Fee for sad commercial system ...... $75.00 Subtotal:
(SEE OAR 918- 309 -0000) Plan review, if required (25% of permit fee):
State surcharge (12% of permit fee):
Check Type of Work Involved: TOTAL PERMIT FEE:
•
This permit application expires if a permit is sot obtained within 180
❑ Audio and Stereo Systems • days after it has been accepted as complete.
• Number of inspections allowed per permit
•
❑ Boiler Controls •
•
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
El HV AC
El Instrumentation
❑ Intercom and Paging Systems
El Landscape Irrigation Control*
❑ 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
I touild:ro PermitskEi.C_POrmeApp_EZ &ERE doe Rey 05R1.2017
• i •