Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
I COMMUNITY DEVELOPMENT Permit #: ELR2013 00154
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/01/2013
Parcel: 2S113AB00800
Jurisdiction: Tigard
Site address: 15995 SW 74TH AVE 150
Project: Excel Orthodonics Subdivision: COUNCIL VIEW ACRES (LOTS 21 -44) Lot: 30
Project Description: Low Voltage for Data - Telecommunications
Contractor: BRIDGETOWN ELECTRIC Owner: DUNCAN, JOHN ARTHUR & JANICE LEE
5701 N LOMBARD ST 9929 NW UPTON CT
PORTLAND, OR 97203 -4113 PORTLAND, OR 97229
•
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: PAS Permittee Signature: JEA. A.p,.sr AT'
3`t�n/
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: 14AM Bridgetown Electric 503-621-7123 page 13
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Electrical Permit Applicati II M "'"' C B F 1 i ■ p, i -,E :,\
I . . .,
City Ti a rd . : Pemit
. -,, ', , ' Received
Dare03 11, II r
a No.: , , ... A / -
IN ._ , 13125 SW Hall Blvd., Tigard, OR 9722g N 2 7 2013 Plan Review
Phone: 503.7182439 Fax: 503.59&J9 . l ,
Daterely: Other Permit,
Inspeation Line: 503.639.4175 r , o - nr ?le Date Ready/By: Juno III See Page 2 Sir
Internet: wv^v.tigard-or.gov 4.11 yr I !LARD Notified/Method: Supplemental Information
',;„. f i q , i 1 VA .,,,' ,Al -,41■, 8R,e; : .l i ii 1 4-gtar4 ,.., 44'; ', 1 , 44k*: ' :,.„Llr. ,, ::,, .:=!....•,.,.„,:11\ ... ..
0 New construction Pg Addition/alteratio replacement Please check all that apply (submit 1 sets of pleas w/items checked below):
0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition 0 Other: 1 where the avails le fault CUITChl 0 Marinas and boatyards.
k ` . 14: 1 Ang l, : . .. ' i .. .: , 7ilr i, ';‘''''* IP- . ..''r '. ' ,'' 'i', ...,.: '',.: '-',,..,,l':: '-'',, exceeds 10,000 amps at 150 volts or 0 Floating buildings.
lens to ground, exceeds 14.000 0 Commercial-use agricultural
El I. and 2-family dwelling '. Commercial/indu- 41 0 Accessory building amps for all oth installations. buildings.
0 Multi-family 0 Master builder ; 0 Other: • OFire pump. El Installation of 150 KVA or
larger separately derived systen
Addition of now uioIor load of 0 "A" '1*". "1-2","1-3",
100F1P or 1310319. occupancy.
Job no.: 1 Job she address: 1 5qci , cm 14* h ic .
a Six or more resi ntial aunts. 13 Recreational vehicle parks.
City/State/ZIP: '17 (g 1k Q 1 3Z q 0 Health-care facili 'es. 13 Supply voltage for more than
p Hazardous looati s. 600 volts nominal.
Suite/bldg./apt. no.: 150 1 Project name: "V- i-t.l.■ORCROtlalie-S 0 service or feeder amps or more.
',,!';f70.177:2iMaidelanglyk
Cross street/directions to job site: . Description QM Am Tad •
New residential Basle- or multi-family dwelling unit.
includes attachec garage.
Subdivision: I Lot no.: 1,000 so. ft or 1ess 168.54 4
Ea. addi 500 sq ft. or portion 33.92 I
.
Tax map/parcel no.: ' Limited energy, res &Wel
75.00 2
1,y - ,i . . - , 1 ' .::: -.' , .:, ,'::::..' " , : . ':',' :--: :.};:.. ''.:::-.! (with above sq. I1.)
75.00 2
toaVa Vei rulAittez • ! 0LAMAJAN't■ it) 4 residential (with sq. ft.)
Reatiiiiii*Ellirilli - .
$ 1 ; 0 9 4 . 1 . . " t b f " - C A S W L - 1 , 4 4 4 + C 0 3 4 6 4 . . , ' Services or feeders installationalteratIon, and/or relocation
..-:. -, 2°° am °r less loam 2
201 arms to 400 turps 133.56 2
, ,
Name: 401 amps to 600 an 200.34 2
Address: ' 60i amps to 11,000 amps 301.04 2
Over LODI amps or volts 552.26 2
.
City/State/ZIP:
Temporary servkes or feeders installation, alteration. and/or'
Phone: ( ) I Fax: ( : ) relocation
■ 200 ainps or less 59.36 1
Owner installation: This installation is being made • ni property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease. rent, or exchange. according ORS 447, 449, 670, and 701.
401 amps to 599 amps 168.54 2
Owner signature: • Date: Branch circuits - new, alteration, or extension, per panel
,
A. abFeoevrecrsembraingcehorcitddiserwf::
7.42
Business name: each branch circi it 2
, B. Fee for branch circuits without
Contact name: , service or feeder fee, Ufa
56.18 2
' branch circuit
Address:
Each adel branch circuit 7.42 2
C Miscellaneous (service or feeder not l•cluded)
ity/State/Z1P:
Each manufactured or modular
67.84 2
Phone: ( ) I Fax: : ) dwelling, service and/or feeder
Reconnect only 67.84 2
E-mail:
Pump or irrigation c role 67.84 2
, ::::: . ''. ,. P.: I lg ," ilt.0$00401 7 ,-0C: ' -:,' ' " ' ''''':' . '' '': Sign or outline lighting
67.84 2
Business name: Bridgetown Electric Signal CiMIlig3) Of 11117113Cd-efletgy See
...,.
panel, alteration, or extension. 1 Page 2 ("7,"' 2
Address: 5701 N Lombard St. Each additional inspection over allowable la any of the above
Additional inspecti. (1 hr nth) 66.25/ hr
City/State/ZIP: Portland, OR 97203
Investigation (1 hr . n) - 66.25/ hr
Phone: (503) 621-7122 I Fax: ( ii.) 621-7123 industrial plant (I h min) 78.18/hr
inspections for whic no the is
CCB Lie.: 103824 I Electrical Lic::' ..,6-887 1 I Suprv. Lic.: 4177S n.- ificall listed hr min 90.00/ hr
Suprv. Electrician signature, . • teta, ier ,. :.,.0., =I
Subtotal: , 00 •
,
'
Print name: Keith Steenslid Date: Plan ow (25% of permit the):
- State so - : go (12% of permit fee): et ,015
Authorized signature:
TOTAL PERMIT FEE: N.D. 1
This permh applies' , n expires Ifs permit 6 ant allasiced MM. 180
Print name: Date: days a cult has bees accepted m complete.
• Number of inspecti ins allowed per permit.
Dldirepormits1ELC PareilAw_,ELD_EIRE.dec Rev 05/21/2013 4 I 1405/COMAVEI3
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Jun 27 2013 9:15AM Bridgetown Electric 503 - 621 -7123 page 14
Electrical Permit Application — City of T gard
Page 2 — Supplemental Information
Limited Energy Permit Fees: Renewable : nergy Permit Fees:
ffirMITtrt7:2,71.0IM =Milt
Fee for all residential systems combined... .. $75.00 Decagonal oft: Tea Total •
Renewable elec • 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*
15.01 to 25 kva 200.34 2
❑ Burglar Alarm Wind generation ystems 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 (foe in oldance with 552.26 2
❑ Heating, Ventilation and Air Condit fining OAR 918-309-0 )
System* Solar generation in excess of 24 kva:
Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva — no addi charge 0.0 3
Each additional inspection over allowable In any of the above:
❑ Other: Each additional inspection is 6625/ hr
charged at an hourly (1 hr min)
inspections for which no fee is 90
x :cal listed n hr min
7c._�,.,,.0 °w%'sC. n ", i. i� , .:' �, '' .. , , A � � ..�.� ' ' '�dyLY. tF t i u r0f ET0' +i
Fee for esc� commercial system .. $75.00 Subtotal:
(SEE OAR 918-309-0000) Plan review, if required (25% of permit fee):
State su 'charge (12% of permit fee):
Check Type of Work Involved: TOTAL PERMIT FEE:
This permit application wires if a permit Es not obtained within 180
❑ Audio and Stereo Systems days a her it has been sceepted as complete.
* Number of inspect ma allowed per permit.
❑ Boiler Controls
❑ Clock Systems
® Data Telecommunication Installatio
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ 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
1 :1auildmatPamit LC PermitApp_ELR ERE.doe Rev 05/21t5013