Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Permit
,� ELECTRICAL RESTRICTED ENERGY PERMIT t CITY OF TIG RD - 7 COM MUNITY DE Permit #: ELR2010 00116 D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/30/2010 T p ` Parcel: 2S101AC00400 Jurisdiction: Tigard Site address: 7095 SW GONZAGA ST Subdivision: Lot: 0 Project: WILLAMETTE DENTAL Project Description: Low voltage for stereo system. FEES Owner: NATIONAL SAFETY COMPANY Description Date Amount 17010 SW WEIR RD Restricted Energy Permit 06/30/2010 $67.84 ,BEAVERTON, OR 97007 12% State Surcharge - Electrical 06/30/2010 $8.14 PHONE: • Contractor: MUZAK LLC 12449 NE MARX ST BLDG 10 PORTLAND, OR 97230 PHONE: 503 - 554 -2594 FAX: 503 - 889 -3883 Type of Use: COM Class of Work: ALT Total"Number of Systems: Audio & Stereo: Y Boiler Controls: N CCTV: N Clock Systems: N Data & Telecommunications: N Fire Alarm: N HVAC: N Instrumentation: N Total $75.9 Intercom /Paging: N Landscape /Irrigation: N Required Items and Reports (Conditions) ' Landscape Lighting: N Medical: N . Nurse Calls: N Protective. Signal: N Security Alarm: N 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 he—"roles---a• • •ted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 001 -0010 through OAR 952 - 001 -0100. You m- • • - .+ he rules or • ect questions to OUNC by calling 503.246,6699 or 1.800.332.2344. Issued By : ., _ = ' Permittee Signature: ' - :__� —A Ai /IIN 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. CaII 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. • Electrical Permit .Application FoR ©FFICEusE � Received Cl Of Z 1 and Permit No. •—• I ° 1'3`1 Hall Blvd , Ti a rd, OR 97223 ! 1 Date /By: , 4� as, • ( +�1 1 g @^ Plan Review x O Permit: P— �4 s , Phone: 503.639.4171 Fax: 503.598:I960��j Date7B : ( ' n 70 I - ... T I GA Dl Inspection Line: 503.639.4175, r ., ci \fl Date Ready /13yr, Ed See Page 2 for vii • Internet www tigard 1V ' -or gov A , cs. 0 L Notified/Method: PL pp ment m T•yyPE, Qill !'V . RK y 1� o, AN RE ' 1 on 0 < , ' ' • Please "check all that a _.. UIE I f ah !1!;;& ® New construction Addition /alteration /re ' e t r ��v� (submit 2 sets of plans w /items checked below): � 11 lS ❑ Service or feeder 400 amps or.more El Building over three stories. ❑ ,._De .. , -,❑ Oth w L1/ where the available fault current ❑ Marinas and boatyards. iTECQRY OF�CUIYSTR Ilj ! exceeds 10,000 amps at 150 volts or ❑ Floating buildings. ` ` : ' ` ' " less to ground; or exceeds 14,000 ❑ Commercial-use agricultural ❑ 1- and.2- family dwelling El Commer /industrial ❑ Accessory building amps for all other. installations. buildings. ❑ M f , ❑ Master-builder ❑ Other: • ❑ Fire puinp. ❑ Installation of 75 KVA or nr J`OB �n .- bra Emergency system. larger separately derived system. S I EE t1VF �i OCATION .. .. ��..., , , ,� 0 Addition ofnew motor load of ❑«A„ « ..1.2„ "1-3", Job no.: Job site address: 7095 SW GONZAGA 100HP or more. occupancy. ❑ Six or more residential units. ❑ Recreational vehicle parks. City /State /ZIP: TIGARD, OR 97223 ❑ Health -care facilities. ' ❑ Supply voltage for more than ❑ Hazardous locations. • 600 volts nominal. Suite/b ldg. /apt. no.: Project name: WILLAMETTE DENTAL ❑ Service or feeder 600 amps or more :3 FE1I jEDuL Cross Street/directions to job site: Description - i Qty. J m Fee. 1 Total 1 New residential single - or multi - family dwelling unit. Includes• attached garage. Subdivision: Lot no.: 1,000 sq, ft. or les 168:54 4 Ea. add'l 500 sq. ft. or portion 33.92 1 Tax map /parcel no Limited energy, residential $,� 67.84 2 DESCRII'THHON O WORK , , / t (with above sq. fl:) . Limited energy; multi - family 67.84 2 LOW VOLTAGE SOUND SYSTEM residential (with above sq. ft.) Services or - feeders installation, alteration, and/or relocation 200 amps;orless 100.70 2 ❑ PROERTI' ow1�i R ❑(N r1ANT s 20 amps to 400 amps 133.56 2 1 .... P s ew, � _ r- P P 401 amps to 600 amps 200.34 2 Name: ' 601 amps to.1,000 amps 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: ( ) Fax: ( ) 200 amps or less 59.36 I 201 ampssto.400 amps 125.08 2 Owner installation: This installation is being made on property that I own which is not - '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, per panel Owner signature: Date: A. Fee.for branch circuits with r,e s a serv or f f ee, . t1PgICANT t ❑ yCVQ,,, I . I' >RSQN 7.42 2 i �r�.. ,,,, , k : .. ; _. , a: , .. ,, 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'l branch circuit 7.42 2 Address: Miscellaneous (service or feeder not included) • Cit /State /ZIP: Each manufactured or modular 67.84 2 y dwelling,,service and/or feeder Phone: ( ) Fax: : ( ) Reconnect only . 67.84 2 Pump, or,:irrigation 67.84 2 • Email: Sign outline f 67.84 2 CONTRA TORE t nor ou ine ligh ing g , , r,. �i 1 v.,,..!, u. ,,„ t . Signal circuit(s),or limited - energy Business name: MUZAK LLC panel,- alteration,.or extension: 1 Paget 67 2 Each additional inspection over allowable, in any of the above Address: 12449 MARX STREET Additional inspection (1 hr min) 66.25/ hr • City/State /ZIP: PORTLAND, OR 97230 Investigation (1 hr min) 66.25 / hr Industrial.plant(1 hr min) 78.18/ hr • Phone: (803) 554 -2594 Fax: (503)252 -1109 Inspections for which no fee is 90:00/ hr specifically - listed CA" hr min) CCB Lic.: 142760 Electrical Lic:: 2 -1055C S.uprv,. Lic.: 3837LEA ,.r L'EORI TCAL,,,PERMZT" F E�? ; ' . Suprv. Electrician signature, require '7/ ( J/i „, Subtotal: 67.84 c:/_........„. Plan review (25% of permit fee): 0 Print name: PAT LYNCH Date: 6/28/2010 State. surcharge (12% of permit fee): 8.14 TOTAL PERMIT FEE: 75.98 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 umber of inspections allowed per permit. r1 ft., aV s �k24. 1 t £LC 1: \Building \Yerinits \ PermltA c 10 /01 /0 440- 4615"T(1 l /05 /COM/WEB . Electrical` Permit Application,, - City of'Tigard, Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: PRESIDENT AL WOIK Fee for all residential systems combined $67.84 Check Type of Work Involved: ❑ Audio and Stereo Systems* • Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning; System* ❑ Vacuum Systems* ▪ Other: CQM titeM7WQRK ONLY „ Fee for each commercial $67.84 system (SEE OAR 918-309-0000) Check Type of Work Involved: Ei Audio and Stereo Systems • ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation Fire Alarm Installation ❑; IIVAC - t ❑ Instrumentation ❑ :Intercom and Paging Systerns • • Landscape Irrigation. Control *'' ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ .Protective Signaling ❑ Other Total number of commercial systems: 1 *No licenses are required. Licenses are required for all other installations li \Building \ Permits \ELC- PermitApp.doc 10/01/09