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Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT COMMUNITY DEVELOPMENT Permit #: ELR2011 -00111 ri g 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/19/2011 Parcel: 2S110CB09900 Jurisdiction: TIGARD Site address: 15368 SW ARLINGTON TER Project: Arlington Heights No. 3, lot 87 Subdivision: ARLINGTON HEIGHTS NO. 3 Lot: 87 Project Description: Audio wiring Contractor: ELECTRONIC DESIGN GROUP Owner: STONE BRIDGE HOMES 10120 SW NIMBUS 16869 SW 65TH AVENUE #505 SUITE C1 TIGARD, OR PORTLAND, OR 97223 PHONE: 503 - 598 -7380 PHONE: 503 - 387 -7577 FAX: 503 - 598 -7381 FEES Description Date Amount Specifics: Restricted Energy Permit 05/19/2011 $75.00 12% State Surcharge - Electrical 05/19/2011 $9.00 Type of Use: SF Class of Work: NEW 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- 0. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1: 87 or 1.800.332.2344. Issued By: Permittee Signature: hosi►...1111■AV 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. '° E Permit = Application�� 2 Current Planning 3 Washington County, V. l AV, Suite 350, MS 12, Hillsboro, OR 9712 Approval oQ Phone: 503- 846 -3470, Fax: 503- 846 -3993, In 'I ° Project # G L2 ao //' 00( // ection Requests: 4 www.eo.washington.or.us n � equests: 503 -8 6 -3699 as ;;to .onus f� / / D�0 0 3 6 'RZ .:' fi: ' � t "� *'T,ta�„'+f i�ie, y � . a ;�s.< u ; ..�. n' �,, �.r<>�,;..�;• } ts #°.e*3 a ". : y :,. «„ N �, , T �.-�.- ..,. <•a;+.wx.:, �, +,,:, .,,tr.i i" i fi S-c "' C, f, it " r b # i1 a y - a �. v °+ e . ,,,.....s . , w. ..;,? :e ?,3 s TYPEOFWORK 3.. `, .,r., >xt t 4 .. f1ANREUIEWi a +r.. •W` © New construction ❑ Addition /alteration /replacement ❑ Other: Please check all that apply: ❑ Service or feeder 400 amps ❑ Hazardous locations - 4 ". + ` >`2 . , w R :. E •,,T ,.s..: ,, s.; .. ,:. ,m,; ,: _ a , . or more where the available ❑ Service or feeder 600 amps or more , , 4 - ;I„y , fr ,, ;} CA r TION g ' t ; a ; i, fault current exceeds ❑ Building over three stories DI I- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building 10,000 amps at 150 volts or❑ Marinas and boatyards ❑ Multi family ❑ Master builder Other: less to ground, or exceeds g g ❑ 14,000 amps for all other Li Floating buildings s < ',.� , �° g� e + c ❑ Commercial -use agricultural 0 -. \''. 4 , - ',Y � JOB SIT IRFOFitilf aT,ION�, AIVD ltiat 6h. t C.7 installations buildings • ❑ Fire pump Job no.: Job a ddres s: ` ❑ Installation of 150 KVA or larger �� S3 �� 54-1 � rT � 1 �t ✓vn (¢_ ❑ Emergency system separately derived system City /State /ZIP: �' ` ❑Addition of new motor ❑ "A, "E," "I -2, "1-3" occupancy s � — 2 Z� load of I OOHP or more � Jf__ � ❑ Recreational vehicle parks !� Suite /bldg. /apt. no.: Project name: v � v 141 ❑ Six or more residential units ❑Supply voltage for more than ❑ Health -care facilities Cross street /directions to job site: 600 volts nominal ltYSPRI ITA1gti0*i*WaN�� tert ff Description Qty. . Fee Total Subdivision: /� ges' identiiilsiii le a rmultifamit'dwellin ianits;' ^�,,,R /'��� � �� Lot no.: �"� s; ���a =� ,.g ;- „ y?�.•'.a� - . �'�,:�`:..'� i'- J Includesfattache ara a � :_,:a',��r��,��.�.�r;�.:_t_4. ... Tax map /parcel no.: 1,000 sq. ft. or less 153.00 4 r ' - ..6 .•�'+ n^t: =, i`�''r x +r . > m.�."a.,... ; u �_ ,��:�».x.s�r :;.;� °; °atex. +.. 's:' - ! +k - '° _ ' n ;n' >t EVE + DESCRIPTION OF.�: p � ' " .4.,; • ' `., Ea. add'I 500 sq. ft. or portion 43.00 r ` 9 e....��ea�? �:H x; =,: .��,=P,- .�.wr.�xi �i�.� =, .��, .- .�waz�.•�s,�wn.-- ::'..: & - ��'.,�- :°';='�a ,�,�.���' . , .�•s Limited energy, residential A^);'/-..4'' 61 00 .5 4 / 6--0 (with above sq. ft) 2 Limited energy, multi - family residential (with above sq. ft.) 67'00 2 .'W "W` # ,:. ` e$' .,.. ., _r �. ->7n ^.s. - a�.y : ; , Ayy ?tv.` ": "':'�:; a`:s:"r �" Wait, , 2rzs - -: ,an„-z�._;.- > w4. 4s. cw:, mx��, r:. roa'" ar:: s?° j�.; :•, arr«.^, �v- u., :;s»e:'Rr.+,,�'x..; °= x.�:��:.,m P»'xl:o.�. r,y. :-•.rvr:p, rr ', r � g (iPROP „ EF r tV 6Mi e rt$3<r ° - , >h' E' -''r e-,°V. as Servicesorfeeders>,nstallatton alteration ,�aii/or`ilo #w ot. x. -..,..,.., ,.an -,A-„ a„4,:„,,, ' A:.: 214 ;. r a4 , ,, i1A .. - T ",,NAND. • 4;i � aii . --- t� . _ - "_ - ��. , " _. _ "s,.... __ ,_ --- w_ • e (_ r , ` J N1 ` 200 amps less 92.00 2 Name: S`T - `''��-(� �- jRw - . A �'F 1 r•.) 201 1 to amps to 400 amps 122.00 2 Address: Li /50 G wl�.. ,,j-,no ek -T -- 3 1 0 -0 401 amps to 600 amps 1 84.00 2 / - 601 amps.to 1,000 amps 275.00 2 b City /State /ZIP: rA,L.e� a �� OS 4 n3 Over 1,000 amps or volts 514.00 2 Phone: (503 ) —1 _ - Fax: (503) `Tempoi•ary'se`0c w feei3ersMin4Esllatioii' alteration aridor' relocation, < lia , : <` tT'+ =, t -,kr:. Owner installation: This installation is being made on residential or farm property owned by rile or a member of 200 amps or less 79.50 2 my immediate family. This property is riot intended for sale, exchange or rent. (ORS 479,540(1) and 479.560(1). 201 amps to 400 amps 1 10.00 2 Owner signature: Date: 401 amps to 599 amps „ 2 -a`'<- ”; : • �� .�,..p�..,r.' ° ' °5 °t V:: s - - - �t . =.a^�; r +:-r :i:n ra : R-. "iu,�eu ..:,�, �.. r,..x,; - sst • .:-C`' :; e " ::”. ®"; P a `, r " ".a t X5,;'3 " 'NP' ,.. ».i E s �' .6�, " ".i•��:. .� f :, ». r r.p�..P. 'i„ rF � _� t ,LICANT� . ���rru�F ��� , � ®�CONTACT�wP�ERSONa�q�����,��wr B?'anchsc>rcutts� -,new alteration orextensioit, r`< a <�•`��; " A. Fee for branch circuits with Business name:Electronic Design Group above service or feeder fee, 8.75 each branch circuit 2 Contact name:Joshua Nichols B. Fee for branch circuits e tb feeder 61.00 Address: 10120 SW Nimbus Ave Suite C1 fe first branch circuit 2 City/State /ZIP:Portland Oregon, 97223 Each add'I branch circui,E 8.75 Miscellaneous (ser. ice o 'feeder not - `in >; - a Phone: (503 )598-7380 Fax: (5503 )598 -7381 Each manufactured or modular 104.00 2 E- mail:jniehols @goroomservice.eom dwelling, service, and /or feeder Reconnect only 79.50 I •, aL' r" .,: ., r , , .s:::- ,.. n m i l e x = ., :4� rr CO TRACTCIR '' "'``° r� '` v`: r,., -�., fl. __� .x- .:���p�s�� �'"a ., . .. �- ,�!�.,�,,,,x,...�r `.;zc,fi;� i= ��_ �� ���M Pump or irrigation circle 61.00 2 Business name:Elect Design Group Sign or outline lighting 61.00 2 Signal circuit(s) or limited- Address: 1 0 1 20 SW Nimbus Ave Suite C1 energy panel, alteration, or 6100 extension. Describe: City /State/ZIP:Portland Oregon, 97223 2 Phone: (503 )598-7380 Fax: ' ( )598 -7381 Ea f onaif nspect onE'o4(,1 all _ 'owalile , in any the,above Per inspection 90.00 E mail :jnichols @goroomservice. cCBlic.no.:90213 Investigation fee (see compliance) 2885 LEA Electrical lic. no.: City or metro lic.: Other: Supervising electrician 4 ,. _ E LECTRIC A LP E FtIVIITF E ES g J.• " „,S V signature, required: ( f Subtotal '75 Print name: Plan review (25% of permit fee) ' Jason M Go D ate, Ill i I Authorized l I State surcharge (12% of permit fee) 9, 67) signature: ,l TOTAL PERMIT FEE y, cre This permit application expires if a permit is not obtained Print name: ✓” , Josh M Nic hol D ate: ft l� ' �t within 180 days after it has been accepted as complete * Number of inspections allowed per permit. Revision 6/08