Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2011 -00191
TtGAR.D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/09/2011
Parcel: 1S 136CA04100
Jurisdiction: Tigard
Site address: 11140 SW 79TH AVE
Project: ENK Subdivision: FRIENDLY ACRES Lot: 7
Project Description: Audio system for patio.
Contractor: OWNER Owner: ENK, CALEB
333 S STATE ST #V411
LAKE OSWEGO, OR 97034
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Restricted Energy Permit 08/09/2011 $75.00
12% State Surcharge - Electrical 08/09/2011 $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 OAR 9 -r 11-0090. You may ob - - - = •f t - ` direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. 7 ,
Issued B . s / �� Perim ee Signature:
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.
' Electrical Permit Application � FOR OFFICE USE ONLY
i
Cit of Tigard �0 Received
1 /4 a 13 125 SW Hall Blvd., Tigard, OR 9722 � % 1 Date/B : I ® Gr Permit No.: - L ii q'
r Phone: 503.718.2439 Fax: 503.598.1960 t \ ) e . Other Permit. 11
TIGARD Inspection Line: 503.639.4175 1^ < A V - ,,S 11Li. Ready /By: Juris: VI See Page 2 for
T �� Noti fie d/Method: Su
Internet: www tlgard -or gov ( Q � p Supplemental Information
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❑ New construction ® Addition/alteration /rplacement • Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
. � VIR A EaAC QF ON ` ttiV 1 J & * �' exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 0 Commercial-use agricultural
❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ® Other: Patio Roof ❑ Fire pump. ❑ Installation of 75 KVA or
r T Y 5 ❑ Emergency system. larger separately derived system.
� "JO vSlTE�INFORIYIAITI A ID1L y x { ❑ Addition of new ❑
r r . __ - z s , , ,, ,......- ...- �.,,,, .: w �. .. p " „ . i / , a o o motor load of
Job no.: Job site address: 11140 SW 79 Avenue 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: Tigard, OR 97223 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: Pati ereo T 4,` ❑ Service or feeder 600 amps or more.
'G'V : k; .`v! W 'SCFIFsDUL'E ` ` ' ,''" ?3 °"l:•3
Cross street/directions to job site: Pfaffle and 79 Description g = F EF �.� e
] D I Qty. I Fe .
I Total
79th New residential single- or multi - family dwelling unit.
Nortbound on 79 Avenue from Pfaffle to 11140 on right side Includes attached garage. •
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 • 4
Ea. add'l 500 sq. ft. or portion 33.92 I
Tax map /parcel no
Limited energy, residential
t "' f ," V t d,iuS @CRI QF WO '* " '' ' m 5 { ` (with above sq. ft.) 75.00 2
Limited energy, multi - family 75.00 2
Speaker wire being run from stereo to mounted extrnal speakers. residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
, a , ` ' ` 3 a '" a i 7 , a . " 7 ° „ "1 amps to 400 amps 133.56 2 a m
�► /5 ' 1 'ROPERT,�#0�'�����w °i�'. ,�*��;..�TEA �.�..� �x�rs 201 am U P P
Name: Caleb Enk 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: 13500 SW Pacific Highway #516 ( I t', I lA(y) Over 1,000 amps or volts 552.26 2
City /State /ZIP: Tigard, OR 97223 Temporary services or feeders installation, alteration, and/or
relocation
Phone: (660)864 -9622 Fax: ( ) 200 amps or less 59.36 I
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, ren or change ac rding to ORS 447, 449, 670, and 701:
Owner signature: � � 401 amps to 599 amps 168.54 2
Branch circuits — new, alteration, or extension, per panel
Date: 7 9 — A. Fee for branch circuits with
above service or feeder fee,
, ' PI IG T " ; i ° I + , CON APSY M
�. .,- 4 I J /. 5 tr r -r ._.. ? .. »: each branch circuit 7.42 2
Business name: �`2 a �(/t/ �- B. Fee for branch circuits without
�� C(� service or feeder fee, first
Contact name: branch circuit 56.18 2
Each add'l branch circuit 7.42 2
Address: . Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: ( ) D ag:: ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E Sign or outline lighting 67.84 2
1 _ " 5 r � 'r R 'CONRAr TOR " ' g .,
: , t' Signal circuit(s) or limited- energy
Business name: panel, alteration, or extension. Page 2 7 2
Each additional inspection over al owable in any of the above
Address: Additional inspection (1 hr min) 66.25/ hr
City /State /ZIP: Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr .
Phone: ( ) Fax: ( ) Inspections for which no fee is 90.00/ hr
• specifically listed CA hr min)
CCB Lic.: - Electrical Lic.: Suprv. Lic.: 4 ' ° '° "' Sw
P ��: .:_ �.��.., „ � EI�rECT�RI( �A� �
Suprv. Electrician signature, required: Subtotal:
Plan review (25% of permit fee):
Print name: Date: State surcharge (12% of permit fee): ei
TOTAL PERMIT FEE: ( ti
Authorized signature:
. This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
Number of inspections allowed per permit:
1:\ Building \Permits\ELC- PermitApp.doc 07/01/10 440-461 5T( I 1 /05 /COM /WEB
Electrical Permit Application - City of Tigard
• Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
N'
RESTDE M- W®R
� �,.-
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
Fl Audio and Stereo Systems*
n Burglar Alarm
❑ Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
n Other:
C®1VIMERCIAL W& UNxLY ` 1
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
•
❑ Audio and Stereo Systems
❑ Boiler Controls
n Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
❑ HVAC
❑ Instrumentation
n I • ntercom and Paging Systems
. n L andscape Irrigation Control*
❑ Medical
❑ Nurse Calls
n Outdoor Landscape Lighting*
n Protective Signaling
❑ Other
Total number of commercial systems:
No licenses are required. Licenses are required
for all other installations
I. \ Building \Permits\ELC- PermitApp.doc 07/01/10
Property Owner Statement
Regarding Construction Responsibilities
Oregon Law requires residential construction permit applicants who are not licensed with the
Construction Contractors Board to sign the following statement before a building permit can be
issued. (ORS 701.325 (2))
This statement is required for residential building, electrical, mechanical, and plumbing per mits.
Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not
submit this statement. This statement will be filed with the permit.
Please check the appropriate box:
I own, reside in, or will reside in the completed structure and my general contractor is:
Name CCB# Expiration Date
I will inform my general contractor that a II subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
or
I will be performing work on property I own, a residence that I reside in, or a residence that I w ill
reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction
Contractors Board. If I change my mind and hire a general contractor, I will select a contractor
who is licensed with the CCB and will immediately give the name of the contractor to the office
issuing this Building Permit.
I have read and understand the Information Notice to Homeowners About Construction Responsibilities,
and I hereby certify that the information on this horn eowner statement is true and accurate.
C4/6- k
Print Name of Permit Applicant
Signature of Permit Applicant Date
Permit #: Clf)�) � 1 rl ( •
Address: /1/ yv J/-„' � ;F: ���ul%
Issued by: / / ' Date: r 5 // f:
This Copy for Permit Offices