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Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT . COMMUNITY DEVELOPMENT Permit #: ELR2010 -00220 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/19/2010 Parcel: 2S109DA17700 Jurisdiction: TIGARD Site address: 15305 SW SUMMERVIEW DR Subdivision: ARLINGTON HEIGHTS NO. 3 Lot: 106 Project: Arlington Heights No. 3, Lot 106 Project Description: Audio and stereo system. Owner: FEES STONE BRIDGE HOMES Description Date Amount 16869 SW 65TH AVE #505 Restricted Energy Permit 10/19/2010 $75.00 LAKE OSWEGO, OR 97035 12% State Surcharge - Electrical 10/19/2010 $9.00 PHONE: 503 - 387 -7577 Contractor: ROOM SERVICE HOME TECHNOLOGIES 10120 SW NIMBUS AVE C #1 PORTLAND, OR 97223 PHONE: 503 - 598 -7380 FAX: Type of Use: SF Class of Work: ALT Total Number of Systems: Audio & Stereo: Y Security Alarm: N Garage Door Opener: N HVAC: N Total $84.00 Vacuum System: N Required Items and Reports (Conditions) Other: N Other Desc: 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 • _- .01 -0100. You y obtain a co y of direct questions to OUNC by calling 503.24.. • 69: or 1.800.332.23 • • 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 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. Electrical Permit Application VSS) l (1lt (1 f l I c I: IJ S I : (1 \ l . Cl of Ti and Received / Permit No.: 131 Hall 9619,A% lvd., Tigard, OR 9722 PDIate/By: ew i /l et 1 D 15T� ..GL/e- ap / U -- rt- 7?„1-C) G Phone: 503.639.4171 Fax: 503.598.1 p) �� Date/By: Other Permit: 0-15 ....00 6 p ( 5-7 'II C A 1: 1) Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for Internet: www.tigard -OGgoV . Supplemental Information TYPE OF WORK ` n� lS • PLAN REVIEW kNew construction ❑ Addition/alteration/ Please check all that apply (submit a 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. 1- and 2 - famil y dwellin g ❑ Commercial/industrial ❑A ccessory building less to ground, or exceeds 14,000 ❑ Commercial -use agricultural 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 ", "I - ", "1 - ", 100HP or more. occupancy. Job no.: Job site address: j 53 Q S 5 w „., r*t,vt,(5, , ❑ Six or more residential units. 0 Recreational vehicle parks. City/State /ZIP: 1 Z2.c, ❑ Health -care facilities. ❑ Supply voltage for more than °� b1 1 1 ❑Hazardous locations. Suite/bldg. /apt. no.: V Project name: ' to (-1,4i,„ L 0 ❑ Service or feeder 600 amps or more. FEE SCHEDUL 600 volts nominal. Cross street/directions to job site: Description I Qty. 1 Fee. 1 Total 1 • New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: k. t 4 kit,--As Lot no.: / ok, 1,000 sq. ft. or less 168.54 4 Q Ea. add'I 500 sq. ft. or portion 33.92 1 Tax map /parcel no.: Limited energy, residential DESCRIPTION OF WORK (with above sq. ft.) ( 75.00 75, vsi- 2 Limited energy, multi - family 75.00 2 A ��t1)/v i k a L \) (1 1-k 0 ,,--, residential (with above sq. ft.) 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: 1, f ./ �f� b 5. - ,,,, Al 401 amps to 1, 0 amps 200.34 2 Y — � � C � - %✓ f)✓' t 601 amps to I ,000 amps 301.04 2 Address: ) 3 0 S S,,, �.\ 11�� Over 1,000 amps or volts 552.26 2 ���HHf Temporary services or feeders installation, alteration, and/or City/State /ZIP: Pi4s rv ,_,k ©a— 9 7 Z ZL( 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 1 ❑ CONTACT PERSON above service or feeder fee, 7 42 2 each branch circuit Business name: B. Fee for branch circuits without service or feeder fee, first 56.18 2 Contact name: branch circuit Each add'I branch circuit 7.42 2 Address: Miscellaneous (service or feeder not included) City/State/ZIP: Each manufactured or modular 67.84 2 tY dwelling, service and/or feeder Phone: ( ) 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: S I � panel, alteration, or extension. Page 2 2 oyvt ere,/ i c - _ - 4rylA_r_ I e:(' ,lv■JAAvt 0 O.T Each additional inspection over allowable in any of the above Address: J b j ?� 5y3 t. 1 r 1. / , CA U Additional inspection (1 hr min) 66.25/ hr ( Investigation (1 hr min) 66.25/ hr City/State /ZIP: �DY \L' c(2___ 9 2-4-3 Industrial plant (1 hr min) 78.18/ hr Phone: r5o 3 ) 5- , W v Fax: ( ) Inspections for which no fee is 90.00 / hr _ specifically listed (%: hr min) CCB Lic.: / b2i S Electrical Lic.: 311— (-J rv. Lic.: _ ELECTRICAL PERMIT FEES / / Subtotal: -7 - Suprv. Electrician� �i�i required: Gk Plan review (25% of permit fee): Print name: S � a _ ate lO / �. t . 0 State surcharge (12% of permit fee): cf JG / TOTAL PERMIT FEE: Authorized signature: This permit application expires if a permit is not obtained within 180 Print name: Date: days after it has been accepted as complete. N um b er of inspections allowed per permit. 1:\ Building \Permits\ELC- PennitApp.doc 07/01 /10 440- 4615T(1I/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 T e of Work Involved: Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: COMMERCIAL WORK ONLY: Fee for each commercial $75.00 system (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.doc 07/01/10