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Permit rt CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT ` COMMUNITY DEVELOPMENT Permit #: ELR2012 -00062 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/06/2012 Parcel: 2S 109DA15500 Jurisdiction: Tigard Site address: 15298 SW GREENRIDGE PL Project: Arlington Heights No. 3, lot 74 Subdivision: ARLINGTON HEIGHTS NO.3 Lot: 74 Project Description: Limited energy for audio /video and data /telecommunications. Contractor: ROOM SERVICE AUDIO & VIDEO SYSTEMS Owner: STONE BRIDGE HOMES 10120 SW NIMBUS AVE C1 4230 GALEWOOD ST, STE 100 PORTLAND, OR 97223 LAKE OSWEGO, OR 97035 PHONE: 503 - 598 -7380 PHONE: 503 - 387 -7577 FAX: . FEES Description Date Amount Specifics: Restricted Energy Permit • 04/06/2012 $75.00 12% State Surcharge - Electrical 04/06/2012 $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: Y 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 withih 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 -0 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. — Issued By: /1:{ PerrnitteeSignature. O 4 1. # 3 L/e_4 1-- 7 70 ^/ 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 603.639.4176 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. 04/05/2012 14:07 5035987381 ROOM SERVICE PAGE 01/03 Electrical Permit Application 4 %0 FOR OFFICE: USE ONLY City of Tigard CV) RRe�tdB ./> ,it xe.:�� 0 2042 _A9614 .?, y� ��. e Phone: SW 11811 Blvd„ Tigard, Olt 503,718,2439 Fax: 503,598.1 G �,%\� Plan Review // Other 1 mlt s�,ZO /� �Q 7/ hone% 0 Date/13y; 7 r 1 c n R D Inspection Line: 503,639 ,,` Date Ready/By: Juris: ® See Page far Internet: www.tigard- or.gov �G ` � `� �,` Notified/Method; '� l7 Supplemental Information ? ^.o,. ; ! w... ,:.�I y e; x y! ! sro �,; r...." 1 ,,. .yl : u ., .l' r ,, N:. :��:; a. ,,i .rr>• i.r •,i �; � •lr I I iO CI4 ∎ ;l'i"'� t(� I i 11:1 _ILL /I/'' e .i r e., . ': I� n 5, !.II !N 3! i,kl 1 � f.� 414 l kj� {�jll��``�Ih p1 I33 g r� 'YIII �I I ' Por'C••a A'C �- 'n .�,.,.:�� :. G' i: l:. �i�� u ,:u I, I �.. ,C.L ,..I t.. srl... ��. �, 4hl�a,�i1..9 �s�2. t�il�`.hi�ifl i4 •ucieu ilil, III , I. ? New construction 0 Addition/alt •. . , acement Please check all that apply (submit j sets of plans wfrtcme checked below): Demolition Other: ❑ Service or fader 400 amps or more ❑ Building over throe stories. ❑ where the available fault eurrenl ❑ Marinas and boatyards. 14 1Y...L4 i �p!'t "-':i9e�19'3ii:,"Tn,' .. , . exceeds amps at 150 volts or ' ,d te. M �:. eds 10 .,.�,..; . _ uo-�I I o s ,d.:e ,,.... -. ... ,.� ... � 000 Ds O Floating buildings. less to ground, or exceeds 14.000 ©Commercial -use agricultural ❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building mllps far all other installations, buildings. ❑ Multi - family ❑ Master builder ❑ Other: Ftre pump. ❑ Installation of 75 KVA or • "•F. 7 kT�:T • �� 411:47;4;1‘i'''''/711'"n - CI mergency system. larger separately den d system - • F'1L1",:i ...... . • . . terleadof ❑° 1 . ,., ��N � . ❑ A ition of new A" "E ", "1.2" , ,. , , �" Job no.; Job site address: (r 2 3 stn.) E5p id Ply Six o roo e r si Recreational vehicle par f] Six or more residential units. ❑ Reaaatlon City/State/ZIP: "V; a , r d 0 ' 1 ' 2.t) ❑ Health-care facilities. ❑ Supply voltage for more than ©Hazardous location . 600 volts nominal, Suite/bldg. /apt no.: Project name: ❑ Service or feeder 600 amps or more, I v y Y. w ^x,•iwM,n••..•.� i u, ( 'rO55 5heet/dlreetl0nSt0�ObSI[e7 Description �J 4.'�,. 1�, = I '. .I�-ID:i��l�������iFl: Ji1 !I� lil•irli� 7a� 1 l u�l taII.I'' tl . k Description Qty. pm Toter • New residential single- or multi- family dwelling unit. Includes attached garage. Subdivision: A I ■ h)•„` ` L ot no.: 1 L 1.000 sq. it or less 168.54 4 Tax map /parcel no.: �— Ea add Soo sq. ft. or portion 33,92 1 `kisb>sR i�15iv Limited energy, residential A;I �w � 1 , F,sfitIf: ''O) (1 ! (with above sq. f .) 75.00 �r f � 2 Limited energy, multi - family 75.00 2 �Jiri S o/ I e ' Z t ✓ t R4.a 1 awl-7, SiS�e.�,�,, residential (with abovesq.R.) Services or feeders installation and/or relocation 200 amps or less 100,70 2 •1 b " _ „.,' " i - -. 4 ' ,I lr '` • : ..13'.' - . ' Q' T�PA)lT 201 amps to 400 amps 133.56 2 • .. • Name: • 401 amps to G00 amps 200,34 2 601 amps to 1,000 amps 301.04 2 Address: Over 1,000 amps or volts 552.26 2 City /Stale/Z1P: Temporary services or feeders installation, alteration, and/or relocation Phone: ( ) Fax; ( ) 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, !case, 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, r panel Owner signature; Date: A. Fee for brunch circuits with .. ,e ' ( I . ' ;, - �`' above service or feeder fix, jbaS" ', ;�r - .r.. , . ,. Ali. i ' ;; .' �A , " . each branch circuit 7.42 2 Business name: B. Fee for branch circuits without — service or feeder foe, first 56,18 2 Contact name: branch circuit Each add'l branch circuit - 7.42 2 Address: Miscellaneous (service or feeder not included) City/State/7,.TP: - Each manufbctttrcd or modul 67.84 2 dwelling, service and /or feeder • Phone: ( ) Fax: : ( ) Reconnect only 67.84 2 E r' �Q e Pump or irrigation circle 67.84 2 ;.� ` T ns. � : . d V i Sign si or outline lighting 67.84 2 al drouit(s) or timlled- energy y Business name: p „ �; •, • ancl, alteration or extension. Pa - e 2 2 `�011� � O a e Each additional inspection over allowable in an of the above Address: /0 /2-0 , sI/J AI; rA.6./s 5 u<.. G 1 Additional inspection (1 hr min) 66.25/ hr City/State/ZIP: ?pi- q 4 C) _ C 1 , 2 _ 2 _ Investigation (l hr min) 66,25/ hr I Industrial plant (1 hr min) 73.18 / hr Phone: (5o3 ) 8 7 b I Fax: (g e3) S^z r � 1 '�$ 1 ✓ Inspections for which no fee is C$ Lic� ( T >lecttiCal Lic. �p i 1 / //� f�Il listed %hr min 90.00 /hr a z 3 y � . C ' / Sup z o : y ,, Er: >ana �> t 9,. h r � ,� ;,•i? : L,' Suprv. Electrician signature, required: r fir/ �Q Subtotal: r . J , tan review (25% of permit fee): Print name; 'iA•5 '1-42.6.c-.r Date: Let / G j ) _ - State surcharge (12 %ofpermit fee): , ORD • ( TOTAL PERMIT FEE: signature: , 00 . -n6. 4 ._, Thu permit application expires if a permit is not Obtained within 180 Print n ame: 444..04.... K(,�1 � Date: L1 days atter it has been accepted as complete. 444..04.... N � L.\ I / / � �1 • Number of inspections allowed per permit T:, BuildinglPamitta \I/i,C- rermaApp.doc 0)M, /In Aa 04/05/2012 14 :07 5035987381 ROOM SERVICE PAGE 02/03 Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: 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* ErOthcr: Sfrve-41mCl � •-e- 4e £ ,1-. l~crt..c_ Fee for lath 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 ❑ Othcr Total number of commercial systems: *No licenses are required. Licenses are required for all other installations 1:1 BulldIng1PCa7 11ite16S.C•PcrmitApp, 07/01 /I0