Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
11 • COMMUNITY DEVELOPMENT Permit #: ELR2012 -00147
T 1 G AR O 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/17/2012
Parcel: 2S109DA18200
Jurisdiction: Tigard
Site address: 15185 SW SUMMERVIEW DR
Project: Arlington Heights No. 3, Lot 111 Subdivision: ARLINGTON HEIGHTS NO.3 Lot: 111
Project Description: Audio /Data
Contractor: ROOM SERVICE AUDIO & VIDEO SYSTEMS Owner: STONE BRIDGE HOMES
10120 SW NIMBUS AVE C#1 4230 GALEWOOD ST SUITE 100
PORTLAND, OR 97223 LAKE OSWEGO, OR 97035
PHONE: 503 - 598 -7380 PHONE: 503 - 387 -7577
FAX: 503 - 598 -7381
FEES
Description Date Amount
Specifics: Restricted Energy Permit 07/17/2012 $75.00
12% State Surcharge - Electrical 07/17/2012 $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 fort 'n OAR
952- 001 -0010 through OAR 52-001-0090. You may obtain a c py of the rules or direct questions to OUNC by calling 503.232. • • • : r 344.
•
Issued By: Permittee 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 503.639.4176 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 Folz of F lcI -: usr oNl.v
�^
City of Tigard Received
Date/By: 1 ( I Y '4 Permit No. :a an a . O0 1(11
° 13125 SW Hall Blvd., Tigard,OR 97223 Plan Review �(
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Pe t: T
l' I C. It D Inspection Line: 503.639.4175 Date Ready/By: Juris: la See Page 2 for
Internet: www.tigard - or.gov Notified/Method: �W Supplemental Information
TYPE OF WORK PLAN REVIEW
RNew construction ❑ Addition/alteration/replacement Please check all that apply (submit 3 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.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
dwelling Commercial/industrial less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
1- and 2 g ❑ ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ['Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: 5 Ill p Z Job site address: 1 14 S l. S U IvlwlL ���) Six or or more. occupancy.
0 LIf�
13 Six or more residential units. ❑ Recreational vehicle parks.
❑ Hcalth-care facilities. ❑ Supply voltage for more than
City/State /ZIP: T 6H��� O� ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: C/ I m,_ l -A) ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: ^:.•
c 4-F $ciV 7 127 Description I Qtr. I Fee. I Total I •
. New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: AILA ( Of i (, t-` - Lot no.: It 1,000 sq. ft. or less 168.54 4
Ea. add'l 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi- family 75.00 2
AU D ∎ o / ` p residential (with above sq. ft.)
1/ Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/State /ZIP: Temporary services or feeders installation, alteration, and/or
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 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: 12.170 WI s X 11 - 3 - aw t t_= T ie_ - + 0lo&lf s B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: 4_1 tLclrlz-cNc--,(1.c`s I ,� C v branch circuit
Each add'I branch circuit 7.42 2
Address: f a 0,0 9th NI U�S SO t91. C 1 Miscellaneous (service or feeder not included)
Each manufactured or modular
City/Statc /ZIP: 1��-Lp.<i, t � c '� dwelling, service and/or feeder 67.84 2 Fro Phone: ( S'p3) I - 1 Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail:
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
Business name: �.payt , s� - CI — +6"A La, t Z S panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: i CH 230 5 5. 1.) I /WI' l) S 2 U I TI_ E- ( Additional inspection (1 lir min) 66.25/ hr
City/State /ZIP: -P0�-1-� �L q-1 -1..-2_% Industrial
Investigation (t (1 mm) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (% ) o -73 Iry Fax: ( ) Inspections for which no fee is
90.00 / hr
�/ specifically listed (% hr min)
CCB Lic.: 90 Z1 3 Electrical Lic.: ZLf4 Suprv. Lic.: ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required oll' Plan review (25% of permit fee):
Print name:�p i,,r A s J - �/ rc{ Subtotal:
b Date: 7/ 1 State surcharge (12% of permit fee):
1 `' TOTAL PERMIT FEE: z. Qr)
Authorized signature:
This permit application expires if a permit is not obtained wain 180
Print name: Date: days after it has been accepted as complete.
N um b er of inspections allowed per permit.
I :\ Building \Pmnits\E.LC- PermitApp.dac 07/01/10 4404615T(11/05/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined $75.00
Check Type of Work Involved:
)24,__Audio and Stereo Systems*
❑ Burglar Alarm
El Garage Door.Opener*
El Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
El Other:
I COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
El Audio and Stereo Systems
❑ Boiler Controls
El Clock Systems
El Data Telecommunication Installation
El Fire Alarm Installation
El HVAC
El Instrumentation
El Intercom and Paging Systems
❑
•
Landscape Irrigation Control*
El Medical
El Nurse Calls
El Outdoor Landscape Lighting*
El Protective Signaling
El 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