Permit W CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
DEVELOPMENT SERVICES PERMIT #: ELR2006 - 00045
� I , . DATE ISSUED: 2/3/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S 113AD - 01700
SITE ADDRESS: 16920 SW 72ND AVE ZONING: C -
SUBDIVISION: ROSEWOOD ACRE TRACTS LOT: 030 JURISDICTION: TIG
Project Description: LV audio /stereo.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: X 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: 1
Owner: Contractor:
BRIDGEPORT LAND LLC MUZAK LLC
3939 NW ST HELENS RD 3318 LAKEMONT BLVD
PORTLAND, OR 97210 FORT MILL, SC 29708
Phone: 503- 224 -2676 Contact #: PRI 503- 889 -3848
Reg #: LIC 142760
FEES ELE 26- 1055CLE
Description Date Amount
[ELPRMT] ELR Permit 2/3/2006 $75.00
[TAX] 8% State Surcha 2/3/2006 $6.00 REQUIRED ITEMS AND REPORTS
Total $81.00
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 Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or direct questions to OUNC at 503 - 246 -6699.
Issued By: _ i • 1/a Permittee Signature: L Q () `
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.
jilli mr t1 Perm '; !Jul,[�;' Y 1 1 '' FOR OFFICE USE ONLY
jirigard Received Date /B -e Permit No.:�'� �. , •
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.59. t 03 206 Amigoo, I ' DateB : Other Permit:
Inspection Line: 503.639.4175 el I � Date Ready /By: Igini El See Page 2 for
Internet: www.ci.tigard.or.us
a ryl' F `} f 9 �� Notified/Method: Supplemental Information
c i i v l � I � r PLAN REVIEW
El New construction Bon/alteration/replacement Please check all that apply:
❑ Demolition 0 Other: ['Service over 225 amps, comm'l ['Hazardous location
['Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling ® Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi - family ❑ Master builder ❑Other: ['Building over three stories ❑Feeders, 400 amps or more
['Occupant load over 99 persons ['Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress /lighting plan RV park
Job no.: Job site address: 16920 SW 72 Ave ❑Health -care facility ['Other:
Submit 2 sets of plans with any of the above.
City/State /ZIP: Tigard Or 97224 The above are not applicable to temporary construction service.
Suite /bldg./apt. no.: Project name: DSW FEE* SCHEDULE
Description I Qty. I Fee. I Total •.
Cross street/directions to job site: New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or Tess 145.15 4
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 I
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
Install Sound System dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( )
200 amps or less 66.85 I
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
❑ APPLICANT ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee,
first branch circuit 46.85 2
Address: Each add'l branch circuit 6.65 2
City/State /ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) Fax:: ( )
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
extension. Describe: Page 2 2
Business name: Muzak LLC
Address: 12449 NE Marx Bldg 10 Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State /ZIP: Portland, Oregon 97230 Investigation per hour (1 hr min) 62.50
Phone: (503) 889 -3848 Fax: (503) 889 -3883 Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: 142760 Electrical Lic.: 26- 1055CLE I Suprv. Lic.: 2016LEB Subtotal
Suprv. Electrician signature, required: W Plan review (25% of permit fee)
State surcharge (8% of permit fee)
Print name: dt t � s Date: /3/06
TOTAL PERMIT FEE
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: * Fee methodology set by Tri- County Building Industry Service Board
'• Number of inspections per permit allowed.
i:\ Buildin g\Permits\ELC- PermitApp.doc 12/03 440- 4615T(10 /02/COM/WEB
• CITY OF TIGARD ' �"Lg
BUILDING DIVISION PERMIT #: 6-00(4 s
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED:
Phone: (503) 639 -4171 t
Inspection Requests (24 Hrs.): (503) 639 -4175 -�± ∎. t''I I�
INSPECTION WORKSHEET OR DATE: TIME: PAGE:
SITE ADDRESS: /6 9 a, o 7), .-teii CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: •
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: -3 -o Pour Time:
Code # Inspection on De6cription Co C• nfirm # Contact # Message
/ q Corrections /Comments / Instructions:
•
J PASS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
n FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: (k.X.6 0 L Date: ail( a Phone #: (503) 718 - %j •
G
CITY OF TIGARD
BUILDING DIVISION PERMIT #: FIR :AM-00046
0046
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/3 /)006
Phone: (503) 639 -4171 .' �I
Inspection Requests (24 Hrs.): (503) 639 -4175 L�_': °:.
INSPECTION WORKSHEET FOR DATE: 2f9 /2006 TIME: 7: 014.4 PAGE: 65
SITE ADDRESS: 1W20 SW 72ND AVE CLASS OF WORK:
SUBDIVISION: ROSEWOOD ACRE TRACTS LOT #: 030 TYPE OF USE:
PROJECT NAME: DSW SHOES
DESCRIPTION: LVaudio/stereo.
OWNER: BRIDGEPORT LAND LLC, PHONE #: 603-224-7,67
CONTRACTOR: MUZAK I--l..0 PHONE #: tiO3- 81:39 - 31
Inspection Request Scheduled For: Date: 2/9000 6 Pour Time:
Code # s section Description Confirm # Contact # Message
136 Loot voltag • 026630.01 003:24 2. 78B1 N
Corrections /Comments/ Instructions:
,,,_, ,,„_.„.
,--„,,,,,...____,.____
■I■ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
�[ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
r: v u " v� Date: v Phone #: (503) 718 -4