Permit CITY Tlak -" D ELECTRICAL RESTRICTED ENERGY PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: ELR2008 - 00107
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 5/2/2008
PARCEL: 25111 CB -00800
SITE ADDRESS: 14900 SW 103RD AVE ZONING: R -3.5
SUBDIVISION: DEL MONTE SUBDIVISION LOT: 007 JURISDICTION: TIG
PROJECT: SMELTER
Project Description: Installation of low voltage for audio /stereo wiring
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: X AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: : HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS:
Owner: Contractor:
CRAIG & JULIE SMELTER PACIFIC AUDIO VIDEO DESIGN LLC
14900 SW 103RD AVE 2407 NE MOCHA WAY
TIGARD, OR 97224 HILLSBORO, OR 97124
Phone: Contact #: PRI 503 -522 -2970
FAX 503- 844 -9007
FEES Reg #: ELE CLE41
LIC 167600
Description Date Amount SUP 3712LEB
[ELPRMT] ELR Permit 5/2/2008 $75.00
[TAX] 12% State Surch 5/2/2008 $9.00 REQUIRED ITEMS AND REPORTS
Total $84.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notifi er. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules o erect questions • t I NC at 503.246.6699 or 1.800.332.2344.
Issu d 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'N: DATE:
LICENSE NO:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
, EIectrica1 Permit Application Land Use Approval
Washington Couny, 155 N. l AV, Suite 350, MS 12, Hillsboro, OR 97124, Project #
Phone: 503- 846 -3470, Fax: 503- 846 -3993, Permit # �� i I i // /
nspection Requests: 503 - 846 -3699, www.co.washinQton.or.us
TYPE OF WORK PLAN REVIEW
❑ New construction ❑ Addition/alteration/replacement ❑ Other: Please check all that apply:
❑ Service or feeder 400 amps ❑ Hazardous locations
or more where the available ❑ Service or feeder 600 amps or more
CATEGORY OF CONSTRUCTION fault current exceeds ❑ Building over three stories
gl 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building 10,000 amps at 150 volts or 0 Marinas and boatyards
❑ Multi- family ❑Master builder ❑Other: less to ground, or exceeds g g
14,000 amps for all other ❑ Floating buildings
JOB SITE INFORMATION AND LOCATION
installations. ❑ Commercial -use agricultural
❑ Fire pump buildings
Job no.: Job address: 19 G Q 103 � ❑ Emer s ❑ Installation of ve KVA or larger
l separately derived system
City/State/ZIP: ❑ Addition of new motor
ty e ❑ ' "`I 3" occupancy
1 C. A..(1 L' e C� ' (, ZZ'& load of l00I1P or mor -
Suite/bldg. /apt. no.: Project name: ❑ Six or more residential units ❑ Recreational vehicle parks
kLl• l ❑ Supply voltage for more than
street/directions to job site: Q ❑Health-care facilities 600 volts nominal
Cross street/directions
� .tlt4t_ � ) ` s. FEE SCHEDULE
Description I Qty. I Fee I Total 1
Subdivision: Lot no.: Residential single- or multi- family dwelling unit.
Includes attached garage.
Tax map /parcel no.: 1,000 sq. ft. or less 150.00 4
DESCRIPTION OF WORK Ea. add'l 500 sq. ft. or portion 42.00
//�� Limited energy, residential 60.00 2
r7 -r1)1 b -t C AG L F -rt.J 4 P %-o ✓J re l bAk 7" (with above sq. ft.)
Limited energy, multi- family 66.00 2
.. residential (with above sq. ft.)
PROPERTY OWNER I ❑ TENANT Services or feeders installation, alteration, and/or relocation
200 amps or less 90.00 2
Name:
201 amps to 400 amps 120.00 2
Address: 401 amps to 600 amps 180.00 2
601 amps to 1,000 amps 270.00 2
City /State /ZIP: Over 1,000 amps or volts 504.00 2
Phone: ( ) Fax: ( ) Temporary services or feeders installation, alteration, and/or
relocation
Owner installation: This installation is being made on residential or farm property owned by me or a member of 200 amps or less 78.00 2
my immediate family. This property is not intended for sale, exchange or rent. (ORS 479.540(1) and 479.560(1). 201 amps to 400 amps 108.00 2
Owner signature: Date: 401 amps to 599 amps 150.00 2
❑ APPLICANT I ❑ CONTACT PERSON Branch circuits — new, alteration, or extension, per panel
A. Fee for branch circuits with
Business name: above service or feeder fee, 8.50
each branch circuit 2
Contact name: B. Fee for branch circuits
Address: without service or feeder 60.00
fee, first branch circuit 2
City/State /ZIP:
Each add'I branch circuit 8.50
Phone: Miscellaneous (service or feeder not included)
( ) Fax: ( ) Each manufactured or modular
E - mail:
dwelling, service, and/or feeder 102.00 2
Reconnect only 78.00 1
CONTRACTOR Pump or irrigation circle 60.00 2
Business name: ? I Ft Sign or outline lighting 60.00 2
L A, r),„ U.p tc.,t� C,(.t,
Signal circuit(s) or limited - 75:[i
Address: Z 4 ,01 E � (yk ., energy panel, alteration, or 1 -
'I extension. Describe: /
City/State /ZIP: Li, it /3c (2 o, 0 R «l 2
Phone: ( ) 5 z z e 9 7 O Fax: ( S05 81. t ge �] Each additional inspection over allowable in any of the above
��f � C , � „ /� Per inspection 90.00
Oo q 0:4 1��RSI ?aA. m a CCB liC. no.: 167 O jr�'! Investigation fee (See compliance)
i
° GtE 4 — 37)t (E9 ty `IS$ other:
�
Electrical lic 1 r metro lic.:
'N. ' Supervising electrician . ELECTRICAL PERMIT FEES
!• t3�
signature, required: / Subtotal 7'S . Uo
� Plan review ( 25% of permit fee) --er
Print name: A N 0 it �� C Tit A e c e f - Date: pii44 Z Q$ State surcharge (12% of permit fee) y, a0
Authorized
signature: �� TOTAL PERMIT FEE
This permit application expires if a permit is not obtained
Print name: 4 mo n V...) _ C ' tkA c c , Date: M�� 2 0 D within 180 days after it has been accepted as complete
*Number of inspections allowed per permit. Revision 10/07
CITY OF TIG ' RD
BUILDING DIVISION PERMIT #: ELR200800107
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/2 /2008
Phone: (503) 639- 4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 5/28/2008 TIME: 7:00AM PAGE: 54
SITE ADDRESS: 14900 SW 103RD AVE CLASS OF WORK:
SUBDIVISION: DEL MONTE SUBDIVISION LOT #: 007 TYPE OF USE:
PROJECT NAME: SMELTER
DESCRIPTION: Installation of low voltage for audio /stereo wiring
OWNER: SMELTER, CRAIG & JULIE PHONE #:
CONTRACTOR: PACIFIC AUDIO VIDEO DESIGN LLC PHONE #: 503.522-2970
Inspection Request Scheduled For: / Date: 5/28/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low voltage 070395-01 503. 784.9370 N
Corrections /Comments /Instructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: �w �`� Date: 6 v U 0 Phone #: (503) 718- )4111>