Permit f CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
1 1 a` COMMUNITY DEVELOPMENT Permit#: ELR2014-00196
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/03/2014
Parcel: 2S 109CA01800
Jurisdiction: WASCO
Site address: 15025 SW 137TH PL
Project: Phillips Subdivision: MOUNTAIN GATE NO.2 Lot: 112
Project Description: Low voltage installation of Cat5 wiring.
Contractor: R& D AUDIO&VIDEO INC Owner: PHILLIPS, PAUL V AND NANCY M
2373 NW 185TH AVE#179 15025 SW 137TH PL
HILLSBORO, OR 97124 TIGARD,OR 97224
PHONE: 503-705-4658 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Restricted Energy Permit 09/03/2014 $75.00
12%State Surcharge-Electrical 09/03/2014 $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' •.=,.on law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 .ugh OAR 9 .-001-r r•r. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.3 2.2344.
Issued = : • .1�� / 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—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Description I Qty. I Each I Total I *
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
❑ Garage Door Opener* >100 kva(fee in accordance
with OAR 918-309-0040) 552.26 2
❑ Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over25 7.42 3
❑ Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ Other: Each additional inspection is 66.25/hr
charged at an hourly(I hr min) •
Inspections for which no fee is 90.00/hr
specifically listed('/2 hr min)
ELECTRICAL PERMIT FEES
COMMERCIAL WORK ONLY:
Subtotal(Enter on Page 1):
Fee for each commercial system: $75.00 * Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
1:\Building\Permits\ELC_PermitApp_ELR_ERE.docx Rev 04/21/2014