Permit 1 14 CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
0 COMMUNITY DEVELOPMENT Permit #: ELR2010 00206
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/05/2010
Parcel: 1S1260000300
•
Jurisdiction: TIGARD
Site address: 9416 SW WASHINGTON SQUARE RD KO8
Subdivision: WASHINGTON SQUARE MALL Lot: 0
Project: GNC .
Project Description: Low voltage for sound system.
FEES
Owner:
PPR WASHINGTON SQUARE LLC Description Date Amount
2235 FARADAY AVE STE #O Restricted Energy Permit 10/05/2010 $75.00
CARLSBAD, CA 92008 12% State Surcharge - Electrical 10/05/2010 $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
Landscape Lighting: N Medical: N Required Items and Reports (Conditions)
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N
Other Desc:
This pe issued su• - ' to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be a in accordance with ap• •ve• • -ns. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
s. ATTENTION: Oregon law quires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
52- 001 -0010 thr•ugh OAR 952 • • o may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
1
I ssued By: — _t. /' ..i Permittee Signature: (_ . . I _l ......_ , r• 1 V
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 FOR OFFICE USE ONLY
City of Tigard Received
Date/B : /O PermitNo.: i4 ,AQ��a,
° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
AffillWilli
' C . Phone: 503.639.4171 Fax: 503.598.1960 Date /B : Other Permit:
T I G A R D Inspection Line: 503.639.4175 Date Ready /By: Juris: H See Page 2 for
Internet: www.tigard- or.gov Notified/Method: Supplemental lnformation
TYPE OF WORK PLAN REVIEW
54-New construction ❑ Addition /alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION 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 commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
❑ Emergency system larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E ", "1 - ", "1 - 3 ",
Q IOOHP or more. occupancy.
Job no.: Job site address: 1 1.� `y C; Sti � 1n S% ❑ Six or more residential units. 0 Recreational vehicle parks.
City/State/ZIP: •, ( n
6 t 13 b „ l -1'L'L1, ❑ Health-care facilities. ❑ Supply voltage for more than
Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: I Project name: &N ". ❑ Service or feeder 600 amps or more.
job site: Description FEE SCHEDULE
Cross street/directions to
J 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'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
(with above 75.00 2
DESCRIPTION OF WORK ( sq. ft. ) ,
1).3 V 4 Limited energy, multi-family 75.00 2
VV `� r.0 residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation _
200 amps or less 100.70 2
❑ PROPERTY OWNER I ❑ TENANT 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
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
tY 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
❑ APPLICANT , ❑ CONTACT PERSON above service or feeder fee, 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: / State/ZlP: 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:
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy 75'
�/►,� • ' , panel, alteration, or extension. l Page 2 2
Business name:
r e Y t x.2 ArK LLC Each additional inspection over allowable in any of the above
Address: 1'1,4 Ct N C A A A11 sn Additional inspection (1 hr min) 66.25/ hr
-� 1 •"` � -7 Investigation (1 hr min) 66.25/ hr
City / State/ZIP:
( (z. `� ( L. 9113 13 o Industrial plant (1 hr min) 78.18/ hr
Phone: (63) C, 5 q -LS5 ..f / Fax: ( 5 3 2 -2. 1 Inspections for which no fee is 90.00 / hr
1 1 specifically listed ('/ hr min)
CCB Lic.: I4 �•, , b Electrical Lic.:Z(, -toss prv. Lic.: 3 g , ELECTRICAL PERMIT FEES _
Subtotal: `>' cld
Suprv. Electrician signature, required:
e Plan review (25% of permit fee):
Print name: ept 4 �� .. Date: L O Is.Vic7 State surcharge (12% of permit fee): 7 .49°
TOTAL PERMIT FEE: `Q' DC/
Authorized signature: This permit application expires if a permit is not obtained thin 180
days after it has been accepted as complete.
Print name: Date: * Number of inspections allowed per permit.
1:U 3uilding \Permas\ELC- PermitApp.doc 07/01 /10 440- 4615T(11/05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
r RESIDENTIAL WORK ONLY:
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:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
Q 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
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