Permit (259) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
" COMMUNITY DEVELOPMENT Permit #: ELR2013 -00175
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/23/2013
Parcel: 2S115AB01900
Jurisdiction: Tigard
Site address: 16200 SW PACIFIC HWY D
Project: Rite Aid Subdivision: 1994 -028 PARTITION PLAT Lot: 2
Project Description: Data telecommunications for TI.
Contractor: BRIDGETOWN ELECTRIC Owner: SN PROPERTIES PARTNERSHIP
5701 N LOMBARD ST 1121 SW SALMON ST
PORTLAND, OR 97203 -4113 PORTLAND, OR 97205
PHONE: 503 - 621 -7122 PHONE:
FAX: 503 - 621 -7123
FEES
Description Date Amount
Specifics: Restricted Energy Permit 07/23/2013 $75.00
12% State Surcharge - Electrical 07/23/2013 $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 OA 52- 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: "544 Permittee Signature: (7/11 6 ®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 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.
Jul 19 2013 12: 20PM Br-idgetown Electric 503-621-7123 pace 1
Electrical Permit A licati EcEivFr
t i
City of Tigard Reccivcd 2 a .3 a - No.:6 --4f O / - 7-5 -
"P.- 13125 SW Hall Blvd., Tigard. OR 972221 Plan Review
• Phone: 503.718.2439 Fax: 503.598.1960 2 2 2013
Date/By: Other Permieu/ Jo i ty.2_,
, , , . , ,... „ Inspection Line: 503.639.4175 CITY OFTIGARD Date RadYillY' jusil ie I iff See Page 2 for
Notiflentaltod:
Internet www.tigard er Supplemental Informed=
Dtv.1$10 i,':0: -!,,,,..: :.•.:,i
0 New construction to Addition/alteration/replacement • Please cheek all that. apply (submit 2 sets of plans Weems chaired bdow):
0 Service or feeder 400 amps or more 0 Building over du'oe 450r105.
0 Demolition 0 Other: where dse available fault current 13 Manna and boatyards.
-.:. •',: ' ;;, .: ..r..,/,,:,Iig- - ,.:t•'::;:,:.., : :,.::.:.,7 , .....::'.. ; i. moods 10°C0 amps It ISO volts Cig 13 FlomM8 "marlin&
less to pound, or exceeds 14,000 13 commercial agricultural
1,3 I - and 2 dwelling IC Commercial/industrial 0 Accessory building amps torah other installations. buildings.
0 Multi 0 Master builder 0 Other: 0 Fire pump. 0 installation of 150 KVA or
: i' ..:::•:-:' :...''.. '.''';::).:. El EAn=n1YrsYslient load of 0 lar "em
Job no.: . 0)- 4 ill II Job site address: I bt 0 nti
oo sw P0.41, 44,t,..„.4,,it 100HP or more.
Six or more resideal units. occupancy.
0 Recreational ve..hick parka.
;ity/StateJZIP: 1 7 0,se a , T q -7/14 /3 Health-care litoifiti 0 Hazarded locations. es.
13 Supply voltage Ear more than
)
600 volts nominal.
i.7 Suite/bldg./apt. no.: 0 Project name: - p , ov Ls 1:1 &Tyke; or feeder 600 mops or mare.
••S;ii '' , ' ' ' — . ' " i?"'`-'-%•`-''r11117. • '''••• 4.
Cross street/directions to job site: .... 41111kViiitiot (...,,,
New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: • I Lot no.: 1.000 sq. ft. or less 168.54 4
Ea. addl 500 sq. ft. or portion 33.92 — 1
'fax map/parcel no.:
Limited energy, residential
75.00 2
, ' 1 '' : ' ''., -,:. ..,)308****0■*,1*,?, ', '.:•.: •„:.•••,, - -:, •,' i '. - ! ';'' :.,::' :•! (with six s q - ft-)
Limited energy, multi-family
4 75.00 1
[ALS Vi5 tA /fa OKTire '`.11V■tt._. ti.LAIV‘taiff....• -kb A 04/14r residential (with above SQ.
:. ileneentitiVriert&':' ! '';:,•!' %,r.' '
4 40.44.■ cps' c. C46■01.11./ Services or feeders installation, alteration, and/or relocation
croorgArr-o***:::'::„..:.., 1 .::::i. ,.. , , ,_ . -GwT,E14. .-.: ..,,.., , ,.:, , 200 amps or lass 100.70 2
201 amps to 400 sunp 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, alteration, and/or
Phone: ( ) I Fax: ( ) relocation
200 amps or less 59.36 1
Owner installation: This installation is being made on property that 1 own which is not 201 to 400
12508 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670. and 701.
401 arnps to 599 amps 16&54 2
Owner signature: Date: Branch circuits - new, alteration, or extensIon,ier panel
• . *001,44iiiii .: .strooiiiii*00 A. Fee for branch circuits wire
above service or feeder fee,
7.42 2 '
Business name: each branch circuit
R. Fee for breach circuits without
Contact name: service or feeder foe, first
56.18 2
branch circuit
Address: Each addi branch circuit 7.42 1 2
Miscellaneous (service or feeder not Included)
City/State/ZIP:
, Each manufactured or modular 6.
784
2
Phone: ( ) I Fax: : ( ) dwaine, service end/or feeder .
. Reconnect only 67.84 2
E-mail: ,
Pump or irrigation circle 67.84 2
:-.,:.•::,, PONE0011 • • .. • : . .• : ' .. . . ..:5■ Sign or outline lighting 67.84 2
Business name: Bridgetown Electric Signal circuit(s) or limited I See ...„..
panel, alteration, or extension. l _ Paget /".-- 2
Address: 5701 N Lombard St. Each additional inspection over allowable In any of the above
Additional inspection (1 hr min) 66.25/ hr
City/State/ZIP: Portland, OR 97203 _
Investigation (I hr min) '66.251 hr
Phone: (503) 621-71n I Fax: (503) 621-7123 Industrial plant (l hr min) 78.18/ hr
Inspections for which no fee is
CCB Lic.: 103824 Electrical Lic;:" . : : 7C I Suprv. Lic.: 41775 _ s . -'. i - .,, listed 1i tir min, 90.0CV hr
...:::..:. '' ''r 117 : ',',ii:''Atl,; i
Suprv. Electrician signature, - • . tiVir Sedass-ra.• Sutu: 15.'°
Print name: Keith Steenslid Date: Plan review (25% of permit the):
State surcharge (12% of permit fee): ¶.
Authorized signature:
TOTAL PERMIT FEE: 814 ,IA
This permit application expires If a permit Is net 'Wald within 180
Print name: Date: days after it bas been accepted as complete.
. 0 Number of inspections allowed per permit.
lABuildirmg\PerrnitaLC_PcamitApp_ELIt_ERE.dac Rev 05/21/2013 440-06151'411/054C01141WER
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Jul 19 2013 12:20PM 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:
1 arc
Fee for ., ,,. ..... ...._� ;.,�Y�.�,,.r � ;;, :•a;. _ . ; .` ;: f' �^.Lt�i1�iAU°�fi1N�(i:fl4 ?�'f •r J�.M f ..v � ,r1 7"i C' nor �`
residential systems combined.. $75.00 Dts040 ow Aar. tie Tehl •
Renewable.eleetrieel energy syatesac
Check Type of Work Involved: 5 kva or kss 100.70 • 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to zs kva 200.34 2
❑ Burglar Alarm Wind eeavation systems In excess of 25 kva:
25.01 to SO kva 301.04 2
p Garage Door Opener* 50.01 to 100 kva • 552.26 2
>100 kva (fie in accordance with 55226 2
Heating, Ventilation and Air Conditioning
OAR 918- 309.0040)
System* Solar generation systems in mess of 25 kva:
Each additional kva over 25 7.42 3
❑ Vacuum Systems* >l00kve — no additional charge 0.0 • 3
Each additional inspection over allowable la any of the above:
0 Other Fitch additional inspection is 66.251 hr I
chimed at an hourly (1 hr min)
Inspections for which no fee is 90.00/ hr
i(//,.y•r ' • • ifical • hated Si hr nun
.... .... ... ; ,.- ,.,u, -, � -.., . ::'a. "`'� ` ? � t•ir . -, ., . ± �...... .�...����..�.�. -�_,.. �. vx.FJ:c�eY �4
Fee for each 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 ■• permit is not obtained within 180
❑ Audio and Stereo Systems Number of mspecti allowed ed � a: complete.
•
❑ Boiler Controls
❑ Clock Systems
® Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical •
El Nurse Calls •
❑ Outdoor Landscape Lighting* •
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
Illuik6nskPennitOF.LC PeratltApp ELR ERE.doe Rav 05/21/2013