Permit q CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
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' `: o . COMMUNITY DEVELOPMENT Permit #: ELR2010 00147
• 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/06/2010
T ['A ft T� g Parcel: 1S133AD16200
Jurisdiction: Tigard
Site address: 12700 SW NORTH DAKOTA ST 100
Subdivision: Lot: 0
Project: Pasta Pronto
Project Description: Stereo system.
Owner: FEES
PACIFIC CREST PARTNERS SCHOLLS L Description Date Amount
1430 EASTSIDE RD Restricted Energy Permit 08/06/2010 $75.00
HOOD RIVER, OR 97031 12% State Surcharge - Electrical 08/06/2010 $9.00
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: 1
Audio & Stereo: y Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: N Fire Alarm: N
HVAC: N Instrumentation: N Total $84.00
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 the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through 0: -' 2- 001 -0100. You ir�•e of the rul= • or •iu=c_is nr ,;.ns to OUNC by calling 503.246.6699 or 1.800.332.2344.
___ 11:1.,64,45=;rz__ .
• Issued c. 4•10f:: Permittee Signature: •
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 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 . 1 OR h
HICE ONI Y .;
CI
}xr of Tigard g �±�1 E ew ili , �Q , /' f// / Pemt No.: A - �. 131SW Hall BlvdTigard, OR 972 C
Phone: 503.639.4171 Fax: 503.598.19 Q Date /By: Other Permit:
T 1 G A R D Inspection Line: 503.639.4175 ` O � � Date Ready /By: Juris: Ea See Page 2 for
Internet: www.tigard-or.gov \ Notified/Method: !� `- Supplemental Information
TYPE OF WORK ';' o ' : 4 % 0 ii PLAN REVIEW*
F New construction ❑ Addition/alteration//rrr Please check all that apply (submit 2 sets of plans w /items checked below):
l � ❑ Service or feeder 400 amps or more ❑ Building over three stories.
El Demolition 11 Other: where the available fault current ❑ Marinas and boatyards.
0.,.;:' fidoi& OF CONSTRUCTIONy s ,, exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ound or exceeds 14,000 gr , ,
❑Commercial -use agricultural
❑ 1- and 2- family dwelling ' . Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
t � JOB SiTE `INFORMATiON'AND LOCATIONS ❑Emergency system larger separately derived system.
�,a. <. . ,: a� .,, , ❑ Addition of new motor load of ❑ "A" "E" "I - 2" "l - 3"
Job no.: Job site address: t. 00 s� l '� IOOHP or more occupancy.
❑Six •
or m ore residential units. ❑ Recreational vehicle parks.
City/State /ZIP: IA G. A.41. b D ' Q_ 4:111.',3 ❑ Health -care facilities. ❑ Supply voltage for more than
v ❑ Hazardous locations 600 volts nominal.
Suite/bldg. /apt. no.: toy\ VV . I Project name:QA Pr f --o ❑ Service or feeder 600 amps or more
<, EEE SC, HEDULE '; , %: ; , ;. s
Cross street/directions to job site: Description 1 Qty I Fee. 1 Total 1
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: . Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'l 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
,,, ,,: ., f J i iitiOt RI C rION OF, WORK 'l (with above sq. ft.) 75.00 2
/// Limited energy, multi - family
Cr e � ' .7 LOW U01.i - S t S
.e residential (with above sq. ft.) 75.00 2
�� �`�^� Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
® PROPERTY OWNER ❑' TENANT Y 201 amps to 400 amps 133.56 2
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 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
< ,:;,,igEl 810.0-00111:' I above service or feeder fee
n _ CONTACT PERSO 7.42 2
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'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67.84 2
tY dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E-mail: Si or outline tin 67.84 2
c� � i
, � ._ . _. . _ . ., �CONTR AC"COR - , -x . _ . _ # '° Si c or limited - energy , __
Business name: ,p panel, alteration, or extension. l Page 2 7 S _ 2
u ,, tA'�— je. Each additional inspection over allowable in any of the abov
Address: `)., 4 4,c, N L. f _ * A fc Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: y �L f O2 g--1-12 O Investigation (1 hr min) 66.25/ hr
Industrial plant (i hr min) 78.18/ hr
Phone: (C603)SS �LJ ci 4 Fax: (503) 2-SZ -1 Lo `) Inspections for which no fee is 90.00/ hr
specifically listed (Y: hr min)
CCB Lic.: ‘ 4,171 b 0 Electrical Lic.: 1 obSCItEprv. ic.: 3 R3 - I LEA. ,.. _ I ELECTRICAL:,EERMr174FEES .
Subtotal: 1S, 06
Suprv. Electrician signature, required: — o
Plan review (25% of permit fee): 14p-
Print name: 'R km c Date: fel b 1-La+, b State surcharge (12% of permit fee): 1.400 �l TOTAL PERMIT FEE: ,
Authorized signature: This permit application expires if a permit is not obtain within 180
days after it has been accepted as complete.
Print name: Date: * Number of inspections allowed per permit.
1:\ Building \Pemtits\ELC- Permi1App.doc 07/01 /10 440 - 4615x(11/05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
W0.5iENTIAL WQRBWONLY T . '
Fee for all 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:
COMMERCIAL WORK,ONLY 'ffigga 31779
v
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
d 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
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I:\ Building \Permits\ELC- PermitApp.doc 07/01/10