Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
'.. COMMUNITY DEVELOPMENT Permit #: ELR2012 -00094
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/14/2012
Parcel: 2S109DA18800
Jurisdiction: Tigard
Site address: 12706 SW WILLOW POINT LN
Project: Arlington Heights No. 3, Lot 117 Subdivision: ARLINGTON HEIGHTS NO.3 Lot: 117
Project Description: Limited energy wiring for audio /video and security
Contractor: ROOM SERVICE AUDIO & VIDEO SYSTEMS Owner: STONE BRIDGE HOMES NW LLC
10120 SW NIMBUS AVE C#1 16869 SW 65TH AVE #505
PORTLAND, OR 97223 LAKE OSWEGO, OR 97035
PHONE: 503 - 598 -7380 PHONE:
FAX: 503 - 598 -7381
FEES
Description Date Amount
Specifics: Restricted Energy Permit 05/14/2012 $75.00
12% State Surcharge - Electrical 05/14/2012 $9.00
Type of Use: SF
Class of Work: ALT
Total Number of Systems:
Audio & Stereo: N •
Security Alarm: Y
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 2- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
ern 2.2344.
Issued By: Permittee Signature: bk 4PPL1 � old
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.
05/09/2012 1:5@ 5035987381 ROOM SERVICE PAGE 01/03
Electrical Permit Applicatio,FiEcE iv E D rim OFFICE'. 11,SE ONI..1
City of Tigard Recivcd Dste/B ; 45. I #3111111 v "
" 00(fi1 '
N I 13125 SW Hall Blvd., Tigard, OR 97223 MAY — 9 2012 PIOJI c Review Permi
t! a -
• . Phone: 503.718.2439 Fax: 503.598.1960 Date/B; other go( ,?- voosq
Inspection Linc: 503.639.4175 CITY OF T1GAqD Date Ready/By; ivr;s: ' El See Page 2 for
i
TLE..: ARD . nteract www.tigard-or.gov 1 • Notified/Method: , • Supplemental Infortnadon
• mr, rmiicintij
a6 ,)-,..-:;.;,;::..`.?:- .::: ........; .... '.'.":..•.....: . ;;.,..,'.'-.. .; .,...':'......' I .:. 3 .1ri.'' ...1t
New construction 0 Addition/alteration/replacement nIgir'!..
Please check all thnt apply (submit a seta of pl W
ans w/items checked ow)!
g (:) service or fecdcr 400 amps or more 0 Building over three storiel.
1:1 Demolition 0 Other: where the available fault entrant 0 Marinas and boatyards.
,,, :- ...--- :: , . . . : .. :., . ; . exceeds 10,000 amps at's° volts or D Floating buildings.
less to ground. or exceeds 14,000 0 Commerciase l-u agricultural
2) 1- and 2-family dwelling 0 CommerciaVindustrial I: Access : ory bui : lding amps for all other installations. buildings.
0 Multi-family 0 Master builder 0 Other: 0 Fire pump. El Installation of 75 KVA Or
• CEmeritensY sYstem. Urger separately derived system.
II .17,144' K , 1 inn §ol: 011 91016 .. . ,.. ' ',VivitoPo......,........0ittb...*::.: : :',, • - I • ••.. • .: cl Addition of nevi motor load of 0 "A". "E", "1-2", "1-3",
0H P or morn
Job no.: Job site address: 12706 Willow Point 10 in Recreational vehieie pArkS.
0 Six or more residential uni occupancy. ts.
City/State/ZIP: Tigard, OR 97224 1:Health facilities, 0 Supply voltage for mom than
0 Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: 1 Project name: ga '147344 0 Service or feeder 600 amps or more.
/ . .!'..,I■t ; ; I .Fi l' 1 , 111"0 ;_liZ...
Cross street/directions to job site: 4-or& 7 nesetipaeo giy, Fee. Totil •
New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Es. addi 500 sq. ft. or portion 33.92 1
Tax map/parcel no.: Limited energy, residential
71..441.1...DEsctillitlosvollow . - • • :
..
• (with above sq. ft.) .- • - 2
Limited energy, multi-family 75 2
Limited energy wiring for audio/video and security residential (with above 9. 11,) . .
Services or feeders installati000lteration, and/or relocation
200 amps or less 100.70 2
0 -Th rr rithi
;" „.. ' - • ..• ••' • ': • •:: • • - " • . , 201 turps to 400 amps 133.56 2
401 amps to 600 amps 200,34 2
Name:
- 601 amps to 1,000 amps 301 301.04 2
Address: Over 1,000 amps or volts 552.26 2
.
- Temporary services or feeders installation, alteration, and/or
City/State/ZIP: relocation
Phone: ( ) I Fax: ( ) 200 amps or Icas 1 59.36 I
Owner installation: This installation is being made on property that 1 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
Branch circuits- new, alteration, or extension, ELI. )and
Owner signature: Date: A. Fee for branch circuits with
'-'' - - - - • . , I.i.. )111 earx .. . . . .. I . .. . . ..e:CoNT ACT.iER—stiNi . above service or feeder fee, 742 2
, . each branch cheek .
Business name: B. Fee for branch circuits without
service or feeder fcc, first 56.18 2
Contact name: branch circuit
Each add branch circuit 7.42 1 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular
67.84 2
csg,!ecrvi and/or feeder
Phone: ( ) j Fax: : ( ) Reconnect only 67.84 2
E Pump or irrigation circle 67.84 2
-
. Sign or outline lighting 67.84 2
.."- :‘'. • ' •••• .• _, . . ... ....
: :. Signal circuit(s) Or limitzsl I
Business name: Room Service...Het e Technologies -, 5 panel, alteration, or extension. Page 2 - — - . -- 2 —;'
Each additional inspection over alto . : . , . • y of the abov
Address; 10120 - . • imbus Suite C1 \14 Additional inspection (I hr min) 66.25/ hr
-
City/State/ •.• : Portland, OR 97223 AI' '
Investigation (1 hr min) 6615/hr
industrial plant (1 hr min) 78,18/ hr
• \-
Phone: 7 1 3) 598 ( , . - F . 503) 5987381 Inspections for which no fez is _
1 specifically listed Gi hr min) 90.00/ hr
CCB ' ic.: 90213 II bi ;1 Icctrical Li . 885LEA itA uprv. Lic.: • • .: • :IELECtilleWBBRIVIEW : 5 1 A: 41, .
• l• I ,
Sup . Electrician signature, r-. ' . :24.,,,,,,-,..1°A.. Subtotal: 75
Plan review (25% of permit fee):
Print na - • r • • 7. . Dare: 5/9/12 State surcharge (12% of permit fce): 9
TOTAL PERMIT FEE: 84
Authorized signature: AirA 'ffi- -I • This permit application expires if a permit is not obtained within ISO
Print name: Mark I i ' C. I Date: 5/9/12 N days after it has been accepted as complete.
* umber of inspections allowed per permit.
lAtluildingTerrniUNELC-ParmitApp.dot 07/01/10 440.461571 I/OS/COM/WEB
05/09/2012 10:50 5035987381 ROOM SERVICE PAGE 02/03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
.pNLY:'
Fcc for all residential systems combined .. $75.00
Check Type of Work Involved:
E) Audio and Stereo Systems*
® Burglar Alarm
❑ Garage Door Opener.*
❑ Ileating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other
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
El 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
I: k13uild 'uig\ Perm idlELC•PormiNpp.doc 07/01 /10