Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
a " COMMUNITY DEVELOPMENT Permit #: ELR2012 -00223
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/26/2012
Parcel: 1 S 125CA11800
Jurisdiction: Tigard
Site address: 9245 SW 74TH AVE
Project: Coryn Subdivision: 2007 -083 PARTITION PLAT Lot: 1
Project Description: Limited energy residential for Data, Telecommunications .Audio,Security and Telecom
Contractor: DIGITAL THEATER SOLUTIONS LLC Owner: MCGEHEE HOMES LLC
2373 NW 185TH AVE., #239 9245 SW 74TH AVE
HILLSBORO, OR 97124 TIGARD, OR 97223
PHONE: 503 - 757 -2818 PHONE: 503 - 292 -9344
FAX: 503 - 941 -9659
FEES
Description Date Amount
Specifics: Restricted Energy Permit 09/26/2012 $75.00
12% State Surcharge - Electrical 09/26/2012 $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 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.80
Issued By: a�� Permittee Signature: D� fiPPi_ e A-(/0k.
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.
09/21/2012 11:03 5039419659 DTS LLC PAGE 01/02
Electrical Permit A lice " is'
UP E it i i ) FOR OFFIC:F. USE ONLY
City of Tigard ReC01V0d 9 y ��p �� .. • Datc/By: / _ q- II � Permit N o. rt.3
7 13125 SW Hall Blvd., Tigard, OR 9gE3P 2 20 12 Plan Review
' 1 :''' Phone: 501718,2439 Fax: 503.598,1960 Onte/By; Other Permit: S TaO0..- oat 27
•r• t GA R t.) Inspection Line; 503,639.4175 C I ( Date Ready/By hula: 121 Sce Page 2 for •
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S tj F�1;`� Notlfled/Method, mental lnfermat:on
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® New construction ❑ Addition /alteration /replacement Pleaw check all that apply (submit a acta of plane wfttetns checked below): 1
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other:
where the available fault current 0 Marinas and boatyards.
. •,,. : •� itit '; ' ; ,1 i tOST'311J r11N. exceeds 10,000 amps at 150 volts or ❑ Floating buildings,
leas to ground, or exceeds 14,000 0 Commercial-no agricultural
® 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building Amos for all other installations. buildings,
❑ Multi - family ❑ Master builder 0 Other: ❑ Fire primp ❑ Installation of 75 KVA or
El tCY
: .• i :: • : 5111'12:; 11Nt'ORMWAtit)tw 'itNl): to A'FIO Addition of new motor load of ❑ I A "E", separately a l -3 ",
l"i ' � T4 stem
❑A
Job no.: 1 Job site address: 9245 SW 74th 1on or more. occupancy.
❑ Six or more residential omits, ❑ Recreational vehicle parks.
City/State/ZIP: Tigard, OR 97224 ❑ Heallh -care fnoilitiea. ❑ Supply voltnae for more than
❑ Hnrnrdons locations, 600 volts nominal.
Suite/bldg. /apt no.: ! Project name: McGehee Homes 0 Service or Feeder 600 nmps or more,
.F'EE>'; '�i+1s •
Cross street/directions to job site: Deuerlpd°o I Qv. I Fe% ' I coral
New residential single- or molt!- family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: _1.000 sq. R or less 168.54 4
Ea. add' 1 500 Sq. ft, or portion 33.92 1
Tax map /parcel no.: Limited energy, residential '
:... ',: ;,,, - .,.:: , ..: ,.`:. S ,' u'.i: P*,.....! air: W.01t1t • (with above sq. 11.) 1 75,00 75.00 2 • Limited energy, multi family 75.00 2
Telecom, Data, TV, Security, Audio residential (with above eq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or Ices 100.70 2
+:Q ;:PRb , u :'rli! : :1 !! ..;.:;;I: '1•` ..... 201 amps to 400 amps 133,56 2
Name u cj 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
Temporary services or feeders installation, alteration, and /or
City/State/ZIP: relocation
Phone: ( ) I Pax: ( ) 200 amps or less 59.36 I
Owner installation: This installation is being made on property that I own which is not 201 amps to 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
A(1i reiA F: ; ".::. . CD: : 'COl'1t/Sit l •r: P1;ir8ON. strove ranch service or feeder fee. 7.42 2
each brunch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name; branch circuit
Each add'! branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular G7 84 2
dwell ing, service and/or feeder
Phone: ( ) I Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail. Signor outline lighting 67.84 2 • o : : Signal circuit(s) or limited-energy
Business name: Digital Theater Solutions LLC pone!, alteration, or extension. Page 2 2
Each additional Inspection over allowable io any of the above
Address: 2373 NW 185 Ave #239 Additional inspection (1 hr min) 66.25/ hr
City/State/ZIP: Hillsboro, OR 97124 Investigation (1 hr min) 6625/ hr
Industrial plant (1 hr min) 78.18 / hr
Phone: (593) 757 -2513 1 Fax: (503) 941 -9659 Inspections for which no fee Is
specifically listed ('/: hr min) 90,00 / hr
CCB Lic.: 183699 112° Electri c,; F -241 Suprv, Lie.: 4333LEB RLP tC t. l'BRM1T:.'FF,EA •„ , .' ,.,. ...
1iG� l atf t� Subtotal:
Suprv. Electrician signature, required: Plan review (25% of permit tee): 75.00
Print name: Ryan Welsh Date: 9/21/12 State surcharge (12% of permit fcc); 9.00
Authorized signature:
TOTAL PERMIT FEE: 84.00
,. , •Rah rmit application expires if a
tM pp p permit is not obtained within 180
days after It has been accepted as complete,
Print name: Dustin Rich. • s Date: 9/21/12 • Number of inspections allowed per permit.
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