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Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT COMMUNITY DEVELOPMENT Permit#: ELR2013-00189 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/05/2013 Parcel: 2S 104AC 14400 Jurisdiction: Tigard Site address: 12990 SW HILLSIDE TER Project: Hong Subdivision: HILLSIDE ESTATES Lot: 9 Project Description: Audio video prewire. Contractor: ROOM SERVICE AUDIO&VIDEO SYSTEMS Owner: HONG, LIEN Al 10120 SW NIMBUS AVE C#1 CHANCHALEUNE, SENGPRASITH PORTLAND, OR 97223 12990 SW HILLSIDE TER TIGARD,OR 97223 PHONE: 503-598-7380 PHONE: FAX: 503-598-7381 FEES Description Date Amount Specifics: Restricted Energy Permit 08/05/2013 $75.00 12%State Surcharge-Electrical 08/05/2013 $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 9 001-009 You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.3322344, 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 503.639.4175 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 RECEIVED FOR OFFICE USE ONLY City of Tigard AUG 2013 Date/Bea d© q'�,_Permit No.i Z, v 3-O/. 13125 SW Hall Blvd.,Tigard,OR 97223 �n� Plan Review ' Phone: 503.718.2439 Fax: 503.598.1961�''> OFTIGARD Date/B Other Perm _ /3 _ea/3_ II 1 T I G A R D Inspection Line: 503.639.4175 BUILDING DIVISI01 Date Ready/By: 0 See Page 2 for Internet: www.tigard-or.gov Notified Method: Supplemental Information TYPE OF WORK PLAN REVIEW New construction ❑Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked below): 0 Service or feeder 400 amps or more 0 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. less to ground,or exceeds 14,000 ❑Commercial-use agricultural iand 2-family dwelling El Commercial/industrial ❑ Accessory building amps for all other installations. buildings. Multi-family ❑Master builder ❑ Other: ❑Fire pump. ❑Installation of 150 KVA or ❑Emergency system. larger separately derived system. JOB SITE INFORMATION AND LOCATION ❑Addition of new motor load of ❑"A","E",'l-2",`9-3", Job no.: Job site address: (�Q/� y p p f I OOHP or more. occupancy. 1 a 1_t0 6 l t t 11 S l 1.e ❑Six or more residential units ❑Recreational vehicle parks. City/State/ZIP: 1 1 trs- OTz. q 7(2 2,3 ❑Health-care facilities. ❑Supply voltage for more than � ` / ❑Hazardous locations. 600 volts nominal. Suite/bldg./apt.no.: Project name:C4 LAr\ch.\e ty ri t° ❑Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: Description [ Qty. I Fee. I Total I * New residential single-or multi-family dwelling unit. 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 1 Tax map/parcel no.: Limited energy,residential DESCRIPTION OF WORK (with above sq.ft.) I 75.00 2 Limited energy,multi-family 75.00 2 \-) l l t:i \\l8--ed 7 f-e_ L..;lr► ` residential(with above sq.ft.) Renewable Energy I ❑ See Page 2 Services or feeders installation,alteration,and/or relocation af-PROPERTY OWNER ❑ TENANT 200 amps or less 100.70 2 I 201 amps to 400 amps 133.56 2 Name: ' ` `V\ (% C IA 0%E\L�y l„,A f) 401 amps to 600 amps 200.34 2 Address: II.C\cta 6L13 ‘..\;t`1 S; n -c^ 601 amps to 1,000 amps 301.04 2 1 Over 1,000 amps or volts 552.26 2 City/State/ZIP:—\--;-„, ,,,,r6... 012., ci-1 22.-5 Temporary services or feeders installation,alteration,and/or Phone:(503) 413p- 7-7 1,5--- Fax:( ) relocation 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 Owner signature: Date: Branch circuits-new,alteration,or extension,per panel ❑ APPLICANT ❑ CONTACT PERSON A.Fee for branch circuits with above service or feeder fee, 7.42 Business name: each branch circuit B.Fee for branch circuits without Contact name: service or feeder fee,first 56.18 2 branch circuit Address: Each add'I branch circuit 7.42 2 City/State/ZIP: Miscellaneous(service or feeder not included) Each manufactured or modular 67.84 2 dwelling,service and/or feeder Phone:( ) Fax: :( ) Reconnect only 67.84 2 E-mail: Pump or irrigation circle 67.84 2 CONTRACTOR Sign or outline lighting 67.84 2 Business name: �/� / Signal circuit(s)or limited-energy See �� /l "(0 / v �� panel,alteration,or extension. Page 2 2 Address: l� 12,6 Slo (VVl Aj< ,(-i , ç-1- - G Each additional inspection over allowable in any of the above l Additional inspection(1 hr min) 66.25/hr City/State/ZIP: 'D4) 1 Lt.v p en- 17 Z23 Investigation(1 hr min) 66.25/hr Phone: (93 ) 7_i 00 Fax:('/A)Sii 2 -7 30 Industrial plant(I hr min) 78.18/hr Inspections for which no fee is 90.00/hr CCB Lic.q6 2/ 7 Electrical Lic.:7j(f-(073 G • Suprv.Lic.: 0 121El4 specifically listed(1/2 hr min) ELECTRICAL PERMIT FEES Suprv. Electrician signature,required: ��,,, s,% Subtotal: 75, Print name: % '��d Date: 151 13 Plan review(25%of permit fee): V State surcharge(12%of permit fee): ! t Authorized signature: `- C TOTAL PERMIT FEE: 191, ( � p This permit application expires if a permit is not obtained within 180 Print name: J �(, Date: 0 113 days after it has been accepted as complete. ` Number of inspections allowed per permit. I.\Beilding\Permiis\ELC_Permit-.._ELR_ERE.doe Rev 05/21/2013 440-46t5T(it/05/COM/WEB Electrical Permit Application—City of Tigard Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: RESIDENTIAL WORK ONLY: FEE SCHEDULE Fee for all residential systems combined $75.00 Description I Qty. I Fee I Total I Renewable electrical energy systems: Check Type of Work Involved: 5 kva or less 100.70 2 5.01 to 15 kva 133.56 2 KI Audio and Stereo Systems* 15.01 10 25 kva 200.34 ❑ Burglar Alarm Wind generation systems in excess of 25 kva: 25.01 to 50 kva 301.04 2 ❑ Garage Door Opener* 50.01 to 100 kva 552.26 2 >100 kva(fee in accordance with OAR 918-309-0040) 552.26 2 ❑ Heating, Ventilation and Air Conditioning System* Solar generation systems in excess of 25 kva: Each additional kva over 25 7.42 3 ❑ Vacuum Systems* >100 kva—no additional charge 0.0 3 Each additional inspection over allowable in any of the above: 111 Other: Each additional inspection is charged at an hourly(1 hr min) 66.25/hr I Inspections for which no fee is 90.00/hr specifically listed('h hr min) COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES Fee for each commercial system $75.00 Subtotal: (SEE OAR 918-309-0000) Plan review,if required(25%of permit fee): State surcharge(12%of permit fee): Check Type of Work Involved: TOTAL PERMIT FEE: This permit application expires if a permit is not obtained within 180 ❑ Audio and Stereo Systems days after it has been accepted as complete. * Number of inspections allowed per permit. ❑ Boiler Controls ❑ C• lock Systems ❑ Data Telecommunication Installation El Fire Alarm Installation ❑ HVAC ❑ Instrumentation El Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ O• utdoor Landscape Lighting* El Protective Signaling F7 O• ther Total number of commercial systems: *No licenses are required. Licenses are required for all other installations t:\Building\Permits\ELC_PermitApp_ELR_ERE doc Rev 05/21/2013