Permit V CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
11- o_, . COMMUNITY DEVELOPMENT Permit#: ELR201300216
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/28/2013
Parcel: 2S 113AA01000
Jurisdiction: Tigard
Site address: 16570 SW 72ND AVE B9
Project: Stay'n Power Subdivision: ROSEWOOD ACRE TRACTS Lot: PTS C,C
Project Description: Low voltage for data cabling
Contractor: BRIDGETOWN ELECTRIC Owner: PACIFIC REALTY ASSOCIATES
5701 N LOMBARD ST ATTN: N PIVEN
PORTLAND, OR 97203-4113 15350 SE SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-621-7122 PHONE: 503-624-6300
FAX: 503-621-7123
FEES
Description Date Amount
Specifics: Restricted Energy Permit 08/28/2013 $75.00
12%State Surcharge-Electrical 08/28/2013 $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 throu -001--0090. You may obtain a copy of the rules or direct questions to OUNC by 1987 or 1.800.33 2344.
Issued By: C_x�lcP P rmi Signature. �' .1 ,' U�
y —yir7 nc--h a flee Slgnatu
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.
Aug 27 2013 10: 10AM Bridgetown Electric 503-621 -7123 page 1 Electrical Permit A Hestia ECEIVED , 1•. ,,: ", ; „ , . `, ,,,., �,
INCity of Tigard nato/B : 'Effiliffitil% PetmitTto: !-/1�?0l3 e Oa/0'
f• 13125 SW Ball Blvd.,Tigard,OR 97223JU G 2 7 2013 Plan Review
r Phone: 503.718.2439 Fax: 503.598.1 Date/By: Other Permit. � &
in Line: 503.639.4175
. ` i0m www.tigard-or.gov CITY OF TIGARD Noti Notified/Method: tuns: S Page t I Ier
Internet: www+tl v 1{ A� Notified/Nlethad: Supplemental Wermatloa
i:•i.'rw!}>-', �Yyi�tr/, ��•r".Y,�7ij�:'iP; }.�i�til�ty�i'i:�;'F, ,,,,, A IO.I;V' - ,r,,..., 7�i",ti�r�1:y�Auia. Cdr - •q+1, '� •
6141,jru:-k.4`.li�.'.�ti^frOlkili .•.'i;•.'n°Ri'K.itiiii iliC!?3 TY�.•,��.''.. .-�t:.M-;..`�'>•. '14N.. .... .r ,dry. ��y 4 ��w''I py�j'��pJ7I,,,�,,�ay'gg�
', .1:, u'ILL:�Y«Ur...lil.��.11"�'V� �ln\5Wi'�r.lti'Yt4�4,'.`:".5�ttat'.
❑New construction tell Addition/alteration/replacement Please cheek all that apply(submit j sets of plans wfitems decked below)
❑Demolition CI Other: 0 Service or feeder 400 amps or more 0 Building over three stories.
,,,-�, ... where the available fault current 0 Mains and boatyards.
u Y ;r�eF�i.,; t I , }." w ,,, ,... .., ., , -,_.,,. ,u . :,:.:." at�„;`�" . ' t ,,;. � 5 i, •'. �" - •:o: � `-, r..� .,;.,}....•.. ..p,.� ..,,,i.. .;.:.,.1..•i:: r exceeds 10,000 0 Floating buildings.
j } ml'S..bi .�laZik7elilhr.7n_Zswil�2C •"G r� ry ! .. ry:[1•"- e
❑ 1-end 2-family dwelling ►:e Commercial/industrial less to gromd,or exceeds 14,000 0 Commercial-use agricultural
❑Accessory building amps for all other ions ladoes. buildings.
❑Multi-family ❑Master builder ❑Other: 0 Fire Pump, 0 Installation of I50 KVA or
•th` "' . � 4.;e 'i•,+v,a 0> r ` � '-'�', ; i i ' �°0Cy sYg • large separately derived system.. "�,.� a 4 , � l ? , •:..'r1;.::;..; (' -rY
0 Addition of new motor load of 0"A","E',"1-2","1-3",
p Job no.: %-;—C c 7 Job site address: lip 5j10 5 f Tl � 1001ip or moire. occupancy.
r�((/ 0 Six of more residential emits. 0 Reematiotml vehicle parks.
U City/StatelZIP: n■ OR q1/L2 011eahb-ca e facilities. 0 Supply voltage for more than
' 0 Hazardous locations. 600 voha nominal.
Suite/bldg./apt no.: ei Project name: N I %mix 0 Service or feeder 600 amps or mere.
cd4;D EI . y v. ,:11:: ' ._,t.vI Cross street/directions to job site: wvipd ee lei.
Pse, Tout •
New residential siesta or sou Ill-fatally dwelling nett
Includes attached garage.
Subdivision: l Lot no.: 1,000 st-ft oriels l 168.54 4
Tax reap/parcel no.: Fa add'I son e4•ft or portion 33.92 I
limited energy.residential
'r' ;�jT.s ' ',i1.-"' : '' :;fir°."" i ,r�y(i ;a._�(^{ (with above .ft.)
75.00 2
Low VO i4Dy, cent Art ;'1,6M/L, Jo) Al Luresid meal( ith ab ve 73.00 2
residential wide above N.R
Co-mut/at WAR, Services or feeders, :T..: 4 rel,
install* alteration,and/or relocation_
Sl:n ,;1 >itiV�., ' I, + `uu W•i ::✓T .'?,' b0:.'sj.p1j� • i,,4 200 amp8 O r less 100.70 2
201 amps to 400 amps 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: Treloc o ry services or feeders Installation,alteration,and/or
Phone:( ) I Fax:( )
Owner Installation:This installation is being made on 20o amps or less 59.36 t
� g property that[own which is not 201 amps to 41;0 amps 125.08 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 599 amps 168,54 2
Owner signature: wti; • ' Date:
Branch.eh circuits-new,aiteretioa,or etteasloa,per panel
u,te i ��of )3;;r jY,"r ,:1„,'1:1'; � r�;6 :
A.Fa for brands circuits with
above service or Reda fey 7.42
Business name: each branch circuit 2
B.Fee for branch circuits wrtoar
Contact name: . service or feeder foe,first 56.18 2
branch circuit
Address: Each addi branch circuit 7.42 2
CitylState/ZIP: Miscellaneous(service or feeder not Included)
Each manufactured or modular 67.84 2
Phone:( ) l Fax •( ) dwelling,service and/or feeder
Reconnect only 67.84 2
E-mail:
' <
Panp or irrigation circle 67.84 2 i. i ` ARta ii9 :sti : 414Z.r iir #w00 ''' . . � . :. ...
Sign or outline lighting 67.84 2
Business name:Bridgetown Electric Signal cirrult(a)or limited-energy See
panel.alteration,or extension. ( _ Page 2 S 2
Address:5701 N Lombard St. Each additional lnapeedoe over allowable In any of the above
Additional inspection(1 hr min) 66.25/hr
City/State/ZIP:Portland,OR 97203 Investigation(I hr rein) • 66.25!hr
Phone:(503)621-7122 I Fax:(503)621-7123 Industrial plena(1 hr min) 78.18/hr
Inspections for which no fee is
CCB Lie.: 103824 I Electrical Lic::',6.887C Suprv.Lic.: 4177S s.,- ificall listed l4 hr min
:t
: ... : . "tia` i.i.:�c._ _ y t
S :ii47*11-t'5';
Suprv.Electrician signature, . " Subtotal: 75,40
,
Print name: Keith Steenslid Da1e: Plan review(25%of permit fee):
Authorized signature: - State surcharge(12%of permit fee): q.00
TOTAL PERMIT FEE: 91.1.00
Print name: Date: nits permit application capital if a permit is not obtained within 130
days after it has been accepted as complete. (,
t:te>rimingeermit,�t.C_�1Aep •�_tR.ax Rev 05;zu2013 440-461 • Number of inspections allowed per permit.
,T2.•/
srCllrosTOrwwss
Aug 27 2013 10: 10RM Bridgetown Electric 503-621-7123 page 2
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
,,r n.,N.: ..�� ,. �:.9.i?•11'.'%��`f�.: ;:Y:�:;:E., ',� �,,..:i M;,' .'�W.?'.?'.y'�'1..v..n......'.u..,. Mr s1�IV3)":
+ - - 'T,:t:�ji�G�'`,`--�"�?'S;fa'i�ti: �%'•. ``� .:......:�..� A
Fee ford residential systems combined. $75.00
o�s.tsor. �. Fee reed •
Renewable electrical energy systems:
Check Type of Work Involved: s kva or less 100.70• 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 Iwo 200.34 2
❑ Burglar Alarm Wind geoeration 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 918-309-0040)
•yst
System* solar geaeradon systems in excess of 25 kva:
Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable In aay oil the above:
❑ Other: Each additional inspection is
charged at an hourly(1 hr min) 66251 hr 1
Inspections for which no fee is
,;. T.._.. ....- ,� M.'c:i!•itif�:�.::::";�q:•u:'•r"r'�x.` �`.':.1�?�.xM'l min 90.00'
hr
•-ifical listed Shr
A _T2l7i�::Y7_' 571M_w
�7SYl .`°
Fee for suit commercial system....................... $75.00 - subtotal:
(SEE OAR 918-309-0000) Plan review,if required(25%ofpermit fee):
State surcharge(12%of permit fee):
Check Type of Work Involved: TOTAL PERMIT FEE:
❑ Audio and Stereo Systems �`p°'�` has d m 180
Number of inspections allowed per permit.
❑ Boiler Controls
❑ Clock Systems
® Data Telecommunication Installation •
•
❑ 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
I:tllui ding1Permld\ELC_PermitApp EU FRE.doc Rev 05/21/2013