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Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT COMMUNITY DEVELOPMENT Permit #: ELR2012 -00122 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/13/2012 Parcel: 1 S135AB01006 Jurisdiction: Tigard Site address: 7800 SW DURHAM RD 500 Project: Kor Subdivision: ASHBROOK FARM Lot: 6 Project Description: Audio and Stereo Systems Contractor: ROOM SERVICE AUDIO & VIDEO SYSTEMS Owner: METZGER VENTURES, LLC 10120 SW NIMBUS AVE C#1 PO BOX 400 PORTLAND, OR 97223 SHERWOOD, OR 97140 PHONE: 503 - 598 -7380 PHONE: FAX: 503 - 598 -7381 FEES Description Date Amount Specifics: , Restricted Energy Permit 06/13/2012 $75.00 12% State Surcharge - Electrical 06/13/2012 $9.00 Type of Use: COM Class of Work: ALT Total Number of Systems: 1 Audio & Stereo: Y Boiler Controls: N CCTV: N Clock Systems: N Data & Telecommunications: N Fire Alarm: N HVAC: N Instrumentation: N Intercom/Paging: N Landscape /Irrigation: N Landscape Lighting: N Medical: N Nurse Calls: N Protective Signal: N Security Alarm: N Other: N Total $84.00 Other Desc: 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 OA 952- 001 -00 0. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. N l 1 Issued By: Permittee Signature: D 14 pp� c A77t L . 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. 06/11/2012 11:35 5035987381 ROOM SERVICE PAGE 01/03 ./ Electrical Permit A, 1 :01r, OFFICE USE ONLY NED Received Parmlt No (� 01 a.y City of Tigard Date/By: ce6 e- -11 �T G� L 3 - vl a lig • 13125 SW Ball Blvd., Tigard, OR ti22 1 2rB12 Plan Review Other Perini p°l0/d` ,. 6 -3 Phone: 503.718.2439 Fax: 50‘..598.1116u- DateBr . far Inspection Line; 503.639.4175 Oats Ready/By: it ' HI Supplobil Se an 2 information T I t. /1 R D -q• kaD Notlfied/Mc hod: Internet: www.tigard-or.gov ov ' OF r 1 iO 7 - PIP ,q.i — ^., FI i, 1'.i vR ^�'^�P.. �i' •7:1 )� S 1 • '::•'-':...I..::".......4-:4:::::' f, . ,:2," i t li, ij � 4;41 d i11 ii +' ,lh' { IIJ I I l l : I I � W ' I ,l i? (u l C�rr {� k4IIjii i il9 :I'r! p nett ?M 0I i .l •et: f)_`, FV_ •r . :,ri � iMw'a;r ■4i .i r.��� kllr..rl G -I':l il 1?1 I ...I. I.LI. I II � V Tl�l�r � �:������..._,.. � k.', ....:. : .., . ,,::: • ... .::: - c,i�ldlil ., JI:.... -,i• h .` . FII rf r.._ .. .... '■:' New construction ❑ Addition/alteration /replacement Please chock all that apply (submit 2 sets of plans wlitems ohedced below): ❑ Service or ftcda 400 amps or more ❑ Building ova three stories. ❑ Demolition 0 Other: where the available fault current ❑ Marinas and boatyards. '''''171.901"! . i fs �+ w1;;. 'f!r exceeds 10,000 amps at 150 volts or ❑ Pleating buildings. i n ' LfiG•1- + � lean to around. cu exeooda 14.000 ❑ Commercial -use agricultural ❑ 1 - and 2- family dwelling Commercial/industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi - family b Master builder ❑ Other: ❑ Fire pump. ❑ Installation of75KVAor s:ap Ir; std ..C....0....: _ d „ - ❑ emorgcncy system. larger separately derived system. 1 x ;` ` ,12 ,1 _,. l,:ilnl.lc'r: + �r :, i °• ,.. • • ❑ Addition of new motor load of 0 "A "."E ". "1- 2 ", "1.3 ". 10014P or mere. occupancy. rob no.: Job site address: }Q�� -76; ' LIANA Ytr1 ID Six or mere residential units. ❑ Reereadonal vchick parks. _ City/State/ZIP: IT et Ote. el i 225 ❑ Health -care facilities ❑Supply voltage for more than ❑ Hazardous locations. 600 volts nominal. Suitabldg./apt no,: Project name: I ❑ Service or feeder 600 amps or mere, gg !;i :',, , y 'r.l;11:Yirii,: n��. 5x,111 i'i .)d';:',',111"i f' (IlZi,lllr 1 I ''ll' i'1'I.'r� ill? I, n' 11(,'II cross street/directions to job site: Dawn ..0 hu. Fee. TOW New residential single- or multi- family dwelling unit. Indudea attached garage. Subdivision: Lot no.: 1 ,000 sq, ft, OT ICSS 168.54 4 Ea. add', S00 sq, ft, or portion 33.92 1 Tax map /parcel no.: p't� Limited ras tial 2 7500 I . ry . , y . ',, . + /1 ^t' l i' �siq t 'otr{' ` - .'k': , .; ....�,:;: coral e esq.ft.) red suer r ,.�" ,�'.`�s�;^ l`:1Ft �� ;� ��.• (with abov Li ited energy, multi-family 75.00 2 I., •I1 /- • ti tetidcntial (with above sq. R) Services or feeders installationalteration, and/or relocation 200 amps or less 100.70 2 • ; ,^i'ylbb '.; ?) i.g w . e 201 amps to 4 00 amps 133.56 2 • 401 amps to 600 amps 200.34 2 601 amps to 1,000 amps 301.04 2 Address: Over 1,000 amps nr vole 552.26 2 Temporary services or feeders Installation, alteration, and /or relocation 200 amps or less 59.36 1 201 amps to 400 amps 125.08 2 that I own which is not . intended Owner installation: This installation is , ORS r 701. 401 amps to 599 amps 168.54 2 Branch circuits — new, alteration, or extension, per panel • s A. Fee (br branch circuits with 4 1rr,i( d'k�'';aai tl c above service or feeder fee, 7.42 2 • a,x.. 1xkp� . � „'u'= - r.,.s'ni ® c each branch circuit Business name: B. Fcc for branch circuits without service or feeder fee. first 56.18 2 Contact name: branch circuit Each add branch circuit 7.42 _ 2 Address: Miscellaneous (service or feeder not included) Each manufactured OT City /State/Z1P: dwelling service and/or modular feeder 67.84 2 Phone: ( ) l Fax: : ( ) Reconnect only 67.84 2 E-mail; Pump nr irrigation circle 67,84 2 ,., a il; / ., - ,1,.s.. Sign or outline lighting 67.84 2 s :,N;,MI« l :+11 •u .r , ; , rte S IC.;+ CQNTYtA . 5W( Signal circuit(s) or limited - energy Business name: V . l panel, alteration, or extension. ( ' Page 2 5' 2 " run. —� & . • • + 41 F to a Each additional inspection over allowable in any of the abov Address: (es/ 2 Std A) „ 5 ■ 4- G C Additional inspection (I hr min) 6625/ hr City /State/ZIP: R er d a ei -, investigation (1 hr min) 66.25/ hr / Industrial plant (1 hr min) 78.1R/ hr Phone: (50S ) S s 7 1 3cgd Fax: (5o3 ) Set g' i s$ 1 16 1 1 1 (4 Inspcctions for which no fcc is 90.00 / hr A specificallylisted(%hrmin) B � Lie.: 9p ( ectrical L Sypt'v. Lic.: .,... ..-•:.: .:;,,ELF' Gi"lf°r1q�''i;liA:10$1 I Suprv. Electrician signature, required? ' Subtotal: 5 . ITU Of Plan review (25% of permit fee): Print name: _ _ T Date: rD 1 1 State surcharge (1 of permit fee): 1 .Op Authorized signature: / TOTAL PERMIT FEE: 159.60 / .1 ......... .. This permit application expires if a permit is net obtained within 1RO `r Date: G 11 a days after It has been accepted as complete. Print name: ,A4 , . _ __+ 1 Number of inspections allowed per permit 1:1auilding1Pamibl©.GPormitA p.doc 07/01 /10 440- 1615T(IIIOS/COM/WPD 06/11/2012 11:35 5035987381 ROOM SERVICE PAGE 02/03 Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: Lr ^: 5) 1 :4;:'01 1 4Irn . Fcc for 11 residential systems combined $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* ❑ Heating, 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: jo Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ I-WVAC ❑ 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 arc required for all other installations I:\ Building \Pmmiu \ELC•Pei nitApp.doe 07/01 110