Permit ., A
71 �� �� CITY OF TIGAR ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2009 -00295
?1GARD
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/25/2009
�. , � , , Parcel: 2S101BCO2800
Jurisdiction: Tigard
Site address: 8250 SW HUNZIKER RD
Subdivision: Lot: 0
Project: Horizon Distribution
Project Description: Install! restricted energy for satellite music system.
Owner: FEES
SEVERSON, JAMES A & ROBIN 0 Description Date Amount
29404 SW HEATER RD Restricted Energy Permit 09/25/2009 $75.00
SHERWOOD, OR 97140 12% State Surcharge - Electrical 09/25/2009 $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: N 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 OAR 952 - 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: ��M c k 41 \ fl-- & Permittee Signature: �,,1 Q �l c'� a 44.
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 ApplicatiQ FOR
_�, IV OFFICE USE ONLY City of Tigard Date/By: • i) Perm No. ( 2�4 _ cc i
, 13125 SW Hall Blvd., Tigard, ard, OR 97223 y s�
g S E P 2 2009 Pl an Review
Other Permit:
Phone: 503.639.4171 Fax: 503.598.1960 Date /By:
'
...
TIGARD Inspection Line: 503.639 Date Ready /By: J is: H See Page 2 for
Internet: www.tigard- or.gov CITY OF TiG DISK) Notified /Method: t Supplemental Information
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® 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;-O 9NSTRPFP,P " ' -. '` _ exceeds 10,000 amps at 150 volts or ❑Floating buildings.
'' < " , ,11 '' "' Y e to ground, or exceeds Commercial-use agricultural
u
`''`" "" ° " ` "' "=`'' " ` � less d, d 14,000 ❑ C I a is It ura
❑ I- 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
s,v. ;ice Vii • ,, ,,•, -, ❑ Emergency system. larger separately derived system.
L tn SA ), . 1,OB S�TE LN,FORNTA; ''1Q A1Vll L OCJION ' ; ' ', ' y Addition of new mo or load of
Job no.: Job site address: 8250 SW HUNZIKER RD 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/bldg. /apt. no.: Project name: HORIZON DISTRIBUTORS #635 ❑ Service or feeder 600 amps or more.
"r',; r : _V FE' CHEllt0.: s,y;::u" ' :; " a•9
Cross street/directions to b i
job site: Description n �' `� E Sm4.,, Total ,,,� .,
J I Qty. � � Fee. � ����� � • ° � TOtal
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Tax map /parcel no.: Ea. add'l 500 sq. ft. or portion 33.40 I
Limited energy, residential 75.00 2
. e-Wi P I(I)11° f Oft ; ,: , ,�' :' < (with above sq. ft.)
Limited energy, multi - family
Satellite music for on holds stem 75.00 2
Y residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
PR3 t} : N j t 4 106.85 2
❑, ItTX,,, EI2': �'(,]�TNANT. 20] amps o 00 amps
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City /State /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1
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 599 amps 133.75 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
r . 1 rYN A t.0* N. above service or feeder fee,
3. all: _ .. A .�- ��... >T � „',i',:;'i INC, rt? `�- d��,,...:•r.� ,. ... 6.65 2
each branch circuit .
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
first branch circuit
Address: Each add'! branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City /State/ZIP: Each manufactured or modular
' dwelling, service and/or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
_ E -mail: Pump or irrigation circle 53.40 2
" .. s`.:: 2 4 > -! ; c Sign or outline lighting 53.40 2
Business name: Muzak LLC Signal circuit(s) or limited -
energy panel, alteration, or
Address: 12449 NE Marx St extension. Describe: Page 2 2
City /State /ZIP: Portland, Or 97230 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (803) 554 -2594 Fax: (503) 252 -1109 Investigation per hour (1 hr min) 62.50
� In dustrial plant per hour 73.75
CCB Lic.: 142760 Electrical Lic.:') (,-- (D�js�,�✓,Suprv. Lic.: �� � � "
Suprv. Electrician signature, required: Subtotal:
F�
Print name: T L' j N at Date: G` C I iy Plan review (25% of permit fee):
(—� I State surcharge (12% of permit fee):
Authorized signature: TOTAL PERMIT FEE:
Print name: Date: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
* Number of inspections allowed per permit.
1:\ Building \Hermits \ELC- 1'ermitApp.doc 05/23/06 440- 4615T(11/05/COM/WEB
-,_Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
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:
1 UMMERCI€AI WORK
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved: •
❑ 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 MOH
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
l:\ Building \Permits\HLC - PermitApp.doc 03/23/06