Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2010 -00275
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/09/2010
Parcel: 1S134DC11300
Jurisdiction: Tigard
Site address: 11530 SW GALLO AVE
Project: Mercer Subdivision: CASCADIAN PLACE Lot: 2
Project Description: Low voltage for audio and video.
Contractor: LEWIS AUDIO VIDEO Owner: MERCER, SCOTT D & VALERIE G
2112 PORTLAND RD. 11530 SW GALLO AVE
NEWBERG, OR 97132 PORTLAND, OR 97223
PHONE: 503 - 538 -1190 PHONE:
FAX: 503 - 538 -5419
FEES
Description Date Amount
Specifics: Restricted Energy Permit 12/09/2010 $75.00
12% State Surcharge - Electrical 12/09/2010 $9.00
Type of Use: SF
Class of Work: ALT
Total Number of Systems:
Audio & Stereo: N
Security Alarm: N
Garage Door Opener: N
HVAC: N
Vacuum System: N
Other: N
Other Desc: Total $84.00
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OAR 952 - 001 -0090. You ma obtain a co. .•,fi ru es or -ct •uestions to OUNC by calling 503.232.1987 or 1.800.332.2344. N
l /
Issued By: L� ��� 1 Permittee Signature: � . - 7
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE: Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Dec. 9. 2010 9:48AM Lewis Audio Video No.1099 P. 2
Electrical Permit Application VOR ()Frio:, USE ONLY
, . Received 1.
Ii Cit 131 SW Hall B of Tigard vd., Tigard, OR 9722P ..,,By, ),, , (0 Orr- Permi r) t No,: EFga iL) — a ),)- 5
25 ltt.c."\ \\,, Plan Review
Phone: 503.718.2439 Fax: 503. . 0 ‘09 r■ Dateray: Other Permit; PATIDO (6 oo (55
TIGARD -
Inspection Line! 503.639.4175 C S (LN).-
Date Ready/13y: furiv—, _ Eel See Page 1 for
Internet! www.tigard Notified/Method: 7l--(4 Supplemental Information
. ',. • . . ' - ,- - - Ils , 7 :•::; - ' , — 27 ,7 '. , . .:i0'i4 . -R,.:w,u- • ' ::51'.4.77.7.5.:::
..„ag7.10,:•i.ry.E'.WOD '. .,:f:'41,-7 ,=. -- '4ZAV ' • • ..i.,'7eg41:t1p '`!' • ,'' :'.E'' :• • '., -. 7 a :-.-±7 ': -7 7:
0 New construction [E] Addition/altcratio _ii$ iteldt Please check alt. that apply (submit 2 gets of plans winems checked below):
III Demolition 0 Other: ‘\\\S) 0 Sarvice or feeder 400 amps or more CI Building over Ituree stories.
where the available fault curreor 0 Marinas and boatyards,
=-:•:•,: ,•: .' • ., Aafka Oily • SlOielr . ' Ja' ' ' exceeds 10,000 amps at 150 volts or El Floalioa building* .
less to ground, or exceeds 14,000 9 Cammemiel-usc agricultural
IX] 1- and 2-family dwelling 0 Commercial/industrial ili Accessory building amps for all other installations. buildings.
0 Multi-family ID Master builder D Other: El Fire pump. DInstallation 01 75 KVA or
••'': SITED4611iiXii0 ... '6
• "'":1L7'"' • ' . '' larg parately derived syste
':• ,-:÷s= °Emerge sYst°m• er se ns.
_ ..„.1 N • AND IP ...AT ..:,!; , 1: fl Addition of new motor load of 0 A "1-2" "1-3",
Job no.: Job site address: 11530 SW GALLO AVE 10011P (wrote. occupancy.
0 Six or more residential units. El Recreational vehicle parks.
City/Statc/ZIP: PORTLAND, OR 97223 0 Health fauilitles. 0 Supply voltage for more Man
PHazardous locations. 600 volts luminal.
Suite/bldg./apt. no.: Project name: MERCER 0 Service or feeder 600 amps or more.
• FEEI:sjiiiiint
Cross street/directions to job site: nt..d "FoT . 1 P. 1 Total 1 •
— New residential single- or multi-family dwelling unit.
Includes R Ito chccl garage.
Subdivision: Lot no.: 1,000 sq. R. or less 168.54 4
Ea. add'l 500 sq. fl. or portion 33.92 1
Tax map/parcel no.. Limited energy, residential —_12100/1 2
Limited energy, multi-family 75,00 2
AUDIO VIDEO residential (with above sq. ft.) —
Services or feeders installation alteration and/o • relocation
200 amps or less 100.70
pRopUtytAr4E4...„ : .. 0 .Tiqz, 0 201 amps to 400 amps 133.56
401 amps to 600 amps 200.34
Name: SCOTT & VALERIE MERCER 601 amps to 1,000 amps 301.04 2
Address: 11530 SW GALLO AVE Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City/State/ZIP: PORTLAND, OR 97223 relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps 10 400 amps 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
Branch circuits - new, alteration, or extension, per panel
Owner signature! Date! A. Fee for branch circuits with
7_42 2
. . ' 4010"ANT.. . ;. M-1!t.Z C . .: ..,4:,i, each branch circuit
Business name: B. Pee for branch circuits withour
service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add'l branch circuit 7.42 2
Address: Miscellaneous (serviee or feeder not I: eluded)
Each manufactured or modular
City/State/ZIP: dwelling, service und/or feeder 67.84 2
_
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67,84 2
E sign or outline lighting 67.84 2
=.77,...,..""
. ' :::f..tr;'74, . Signal circuit(s) or limited-energy ...„ a)
Business name: LEWIS AUDIO VIDEO panel, alteration, or e ../„.)
xstension. 1 Page 2 $ 2
, Each additional inspection over allow ble lti a try of the abov
_
Address: 2112 PORTLAND RD Additional inspection (1 hr min) 66.251h
— - Investigation (1 hr min) 66.25/ hr
City/State/ZIP: NEWBERG, OR 97132
. Industrial plant (1 hr min) 78.18/ hr _
Phone: (503) 538-1190 Fax: (503) 538 Inspections for which no fee is 90.00/ hr
— s i .cificall listed 'h hr min)
CCB Li c,; 177627 - p I
y
Electrical Lic.: 36 1195 Suprv. Lie.: 4497LE
q ii --_..--.:7 . ELECT : GAL , PERMITEETt.4 1 ,;' , :.: : •, . "
Subtotal: 75.00
Suprv. Electrician sig a re, required: / I / ii ... „--- -- (____ i _ i _-- 011 I /I
Plan review (25% of pcnnit fcc):
Print name: MICAH MEEUWSEN Date: 12 State surcharge (12% of permit fee): 9.00
TOTAL PERMIT FEE 84.00
Authorized signature: i , • ilIPW ;
This permit application expires If a permit is not obtained within 180
y days after it h RS been accepted as COMpIele.
Print name: TENN LURES' Service I I erclinator Date: 12-09-2010 • Number of inspections allowed per permit.
1:1}3o1idt*PcrmItaLC-1arnitApp,doo 07/01/10 440
0 60 11 ■5 Le..—)-5
Dec. 9. 2010 9:49AM Lewis Audio Video No. 1099 P. 3
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT PEES:
RESIIa, I T 4Ri O1`IW ,f
Fee for all residential systems combined $75.00
Check Type of Work Involved:
® Audio and Stereo Systems*
❑ Burglar .Alarm
❑ Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
,GONX,MERCIAL Wo491I,y.7
Fee for each commercial $75.00
systems
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
n Audio and Stereo Systems
U Boiler Controls
❑ C lock Systems
n D ata Telecommunication Installation
n Fire Alarm Installation
❑ IIVAC
❑ Instrumentation
n Intercom and Paging Systems
n Landscape Irrigation Control*
n M edical
❑ 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: 1BuItdIng\Pcrm1L/ LC- FcrpilIApp,do9 07/01/10