Permit IN • CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
1 ; COMMUNITY DEVELOPMENT Permit #: ELR2011 -00112
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/20/2011
TIGARD g Parcel: 1 S133DA05200
Jurisdiction: Tigard
Site address: 12760 SW GLACIER LILY CIR
Project: LIEBREICH Subdivision: AMART SUMMER LAKE Lot: 74
Project Description: Audio system.
Contractor: LEWIS AUDIO VIDEO Owner: LIEBREICH, HOWARD
2112 PORTLAND RD. 7755 SW WILSON AVE
NEWBERG, OR 97132 BEAVERTON, OR 97008
PHONE: 503 - 538 -1190 PHONE:
FAX: 503 - 538 -5419
FEES
Description Date Amount
Specifics: Restricted Energy Permit 05/20/2011 $75.00
12% State Surcharge - Electrical 05/20/2011 $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 O' - •.•2- 001 -0090 You ma : • ain a cop s or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. IP
Issued By: _ ✓`` �� > • Permittee Signature: /�4
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.
May. 19. 2011 10:16AM Lewis Audio Video No.1796 P. 1
_
Electrical Permit Application
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R.V-C: FOR OFFICic USE ONLY
City of Tigard . li' Received .......
$ .1,S\ N DateJB : j i rAt PeilltitN(/ :. a // - 00)/,
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- rc , ilaiwimm
111 44 13125 SW Hall Blvd., Tigard, OR 97223
1
' - r Phone: 503.718.2439 Fax: 503.598.1960 ,,\ Other Permit:
Inspection Line: 5036394175
,. 'c INC . 0. .•-• • d /B •
FIGAHL) , Os: .4 ' - Y Y- MI 0 Supple Page 2 for
Internet: WWw.tigard-or.gov V, 'Mined/Method: • mental Information
CN ' ‘ 1 l
DE 4171,Vlt0ii -A1--3?'•5...TT:"" . gr.:•: : ;. ..1:; .:.;-.7,T=:' , k_ANit VIRAW:
New Construction 0 Mditionialteration/rcpIaccment Please deck all that apply (submit 2 sets of plans w/items checked below):
ISI
0 Service or feeder 100 amps or more i7lBuilding over three stories,
D Demolition 0 Other: when the available fault current 0 Marinas and boatyards.
' . • .A,:' .: ft - 7-4 lkiteibirirOi COqS : :7 ' : X4•l'' , - .i-,.= exceeds 10,000 amps at 150 volts or 0 Floating buildings.
less to ground, or exceeds 14,000 ID CommerCiabuse apiculture]
El 1- and 2-family dwelling Commercial/industrial 0 Accessory building amps for all other installations. buildings.
El Multi-family El Master builder 0 Other: EFire pump. 0 Installation of 15 KVA or
, -,...e: .. . :.__ : . DEmergenoy system. larger separately derived system,
'i•II 2 ="7 . .:•;i1013 O NPiiliivigibi4 . -. " = "'-' 7 '
. , ,.. li . Eg-:: . 0 Addii ion of new motor load of 0 "A". "E;', "1.2", "1-3",
Job no.: Job site address: 12760 SW GLACIER LILY CIRCLE 100HP or more. occupancy.
ij Six or more residential units, LI Rec,ealiona1 vehicle parks.
City/State/ZIP: TIGARD, OR 97223 ID Health-care facilities- 0 Supply voltage for more than
Hazardous locations. 600 volts nominal.
1 n
Suite/bldg./apt. no.: Project name: 0 A.,
rvi
r c, Sece or feeder 600
i ir amps or more.
.,'„l::. a4..: i0c0Otitittfl
Cross street/directions to job site; Deserlailon ! . =M.' T rat EN
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. add'i 500 aq. ft. or portion 33.92
Tax map/parcel no.: Limited energy, residential 75.00 .00
M.V : . W 1 . ::::::' • fl ' ,.!M.' z,-4., (with above sq„1/) -
Limited energy, multi-family
el
AUDIO VIDEO 75.00 residential (with above sq, ft,
Services or feeders installation, alteration, a ud/or relocation
200 amps or less 100.70 2
r 7 : : :w horil: - : * oi :,:;. ., 5 ,.. TE , 4a ,: : - , . 201 amps to 400 amps 133,56
111
401 amps to 600 amps 200.34
Name: LIEBRIECIT 601 amps to 1,000 amps 301.04 2
Address: 12760 SW GLACIER LILY CIRCLE Over 1,000 amps or volts 552.26 2
- Temporary services or feeders installation, alteration, and/or
City/State/ZIP: TIGARD, OR 97223 relocation
Phone: ( ) Fax: ( ) 200 amps or less 59,36 1
201 amps to 400 amps 125,08 2
Owner installation: This installation is being made on property that I Own which is not
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, p, r panel
Owner signature; Date: A. Fee for branch circuits with
• A.1)PLICAST , t1 4,- - • L._ , = : • • JO CONTAM. pERs, — ,— above service or feeder fee, 742 2
each branch circuit .
Business name: B. Fee for branch circuits without
service or feeder fee, first
56.18 2
Contact name: branch cimuit
Each add'Ibranch circuit 7.42 2
Address: Miscellaneous service or feeder not included
Each manufactured or modular
City/State/ZIP: dwelling, service and/or feeder 67.84 2
Phone: ( ) Fax: : ( ) Reconnect only 67.84 Ili
Pump or irrigation circle 67.84
E Sign or outline lighting 67.84
.:;; ',•-‘..'",, ': . , • . ,g.i : lsii
- .FAcotitcrox .4. 4fg:-.. . 1,--..-.-,--,.,. . Si circuit(s) or limited-energy
Business name: LEWIS AUDIO VIDEO .anel alteration, or extension. Fa _e 2
. Each additional inspection over allowable lit any of the above
Address: 2112 PORTLAND RD Additional inspection (I hr min) 66.25/ hr
- Investigation (1 hr min) 66.25/ hr
City/State/ZIP: NEWBERG, OR 97132 Indusirtai plant (1 hr min) 78.18/hr
Phone: (503) 538-1190 Fax. (503) 538-5419 Inspections for which no fee is 90,00/hr
s. • cificall listed 05 hr min
CCB Lie,: 177627 Electrical Lic.: 36-119CL Suprv. Lic.: 562LEA :Xs:ell ; ' 4110 :.4:1't.
Subtotal: 75.00
Suprv. Electrician signature, required: Iiik.6e 1„
Plan review (25% of permit fee);
Print name: WALLACE E. PROUX Date: 05-19-2011 State surcharge (12% of ptrmit fee): 9.00
TOTAL PERMIT FEE: 84,00
Authorized sign tur . (14 CM PAL This permit Application expires If a permit Is not obtained within 1(0
thsys after It has been accepted as complete.
Print name: PAM ADAMEK Date: 05-19-2011 ---- • Number of inspections allowed per permit.
1,11,,11.G...A0......,...VNT C-Claomtr • wet el., 117/111 /11) 440-46151(11/05/COMAVPB
May. 19. 2011 10:16AM Lewis Audio Video No. 1796 P. 2
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
ilIKOgNII,NvOIWONLY:W _V,,
Fee for all residential systems combined .. $75.00
Check Type of Work Involved:
® Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check'Iype f Work Involved:
Audio and Stereo Systems
. ❑ Boiler Controls .
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
El Instrumentation
❑ Intetcorn and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
El Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems; _
*No Iicenses are required. Licenses are required
for all other installations
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12760 SW GLACIER LILY CIR, TIGARD, OR,
97223
Residential - Electrical Limited Energy
199 Electrical final
06/21/2013 00:00
ELR2011-00112
PASS - No C of O
Violation Summary:
Inspector Contractor