Permit CITY OF TIGARD
III
ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2007 - 00423
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 11/15/2007
- — PARCEL: 1 S136CD -00102
SITE ADDRESS: 11685 SW PACIFIC HWY ZONING: C -G
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: BAJA FRESH MEXICAN GRILL r
Project Description: Low voltage: Sound system.
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:
WILLIAM & SALLY FLOWBERG MUZAK LLC
834 SW ST CLAIR 12449 NE MARX ST BLDG 10
PORTLAND, OR 97205 PORTLAND, OR 97230
Phone: 503- 225 -0700 Contact #: pRI 503- 889 -3848
FAX 503- 889 -3883
FEES Reg #: ELE 26- 1055CLE
• LIC 142760
Description . Date Amount
[ELPRMT] ELR Permit . 11/15/2007 $75.00
[TAX] 8% State Surcha 11/15/2007 $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 or 1.800.332.2344.
Issued By: iGt„ .c.w. , _ Permittee Signature: .. ./.642045 .444 ,:c?
la
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.
•
• . Flkctrical Permit Application FOR OFFICE USE ONLY
ill
• R E( VED
Received
City of Tigard b �1 DateB >C� , , Perm IV, 1 // _ OD
13125 SW Hall Blvd., Tigard , R Plan Review
Phone: 503.639.4171 Fax: 503. 6 I . ; Date/By: Other Permit:
��� ° 1 5
TI G A R D Inspection Line: 503.639.4175 / Date Ready/By: 3uris: See Page 2 for
Internet: www.tigard- or.gov GOOF YOF ri AdD Notified/Method: Supplemental Information
TYPE BUMNBDNiS1OR PLAN REVIEW
ill construction
construction ❑ Other:
❑ Oth Please check all that apply (submit 2 sets of plans w /items checked below):
b ❑ Service or feeder 400 amps or more ❑ Building over three stories.
Demolition 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
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: 10' S S Ve F(IL ki 100 or more. occupancy.
❑
❑ or Six or more residential units. Recreational vehicle parks.
City/State /ZIP: "'n ( 6. a_ ^ y
G h'L3 ❑ Health -care facilities. ❑ Supply voltage for more than
I ^ � � S / ❑ Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: Project name: L .6 J � ' T (� 0 Service or feeder 600 amps or more.
FEE SCHEDULE
J
Cross street/directions to job site: Description I Qtp. I Fee. I Total I •
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'I 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
S a LtAA- C LI 5
Limited energy, (with above s multi-family 75.00 2
residential (with above sq. ft.)
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
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
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 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'I 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
CONTRACTOR Sign or outline lighting 53.40 2
w ', Signal circuit(s) or limited -
Business name:
( �(Z i L Le_ energy panel, alteration, or
Address: 1 1,4 q y N M iQ .' )p extension. Describe: 1 Page 2 ) 2
City/State /ZIP: .j2 D g J C) f L 9 1-2:3 V Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (5o3 ) — ? Lis I Fax: (SO — 3 Si-3 Investigation per hour (I hr min) 62.50 _
CCB Lic.: I(..1 60 Electrical Lic. :AIDS5 tituprv. Lic.: 20 i ()Lai Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
• Suprv. Electrician signature, required: y Subtotal:
Print name: t \ (� l[ , tti./i �� (, I D ate: Plan review (25% of permit fee):
t / o1 State surcharge (8% of permit fee):
Authorized signature: TOTAL PERMIT FEE: 7/. OD
Print name: Date:
This permit application expires if a permit is not obtain d within 180
days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:\ Building \Permits\ELC- PermitApp.doc 05/23/06 440- 4615T(11/05/COM/WEB . '] 1 /' A
Electrical Permit Application - City of Tigard e -
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
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*
❑ H eating, Ventilation and Air Conditioning System*
❑ V acuum Systems*
❑ Other.
COMMERCIAL WORK ONLY:
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
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1:\. Building \Permits\ELC- PermitApp,doc 03/23/06
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2007- 00423
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/15/'0007
Phone: (503) 639 -4171 / r +�
Inspection Requests (24 Hrs.): (503) 639 -4175 IL.
INSPECTION WORKSHEET FOR DATE: 12/3/2007 TIME: 7:00AIv1 PAGE: 48
SITE ADDRESS: 11685 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: EBAJA FRESH MEXICAN GRILL
DESCRIPTION: Low voltage: Sound system.
OWNER: FLOWBERG, WILLIAM & SALLY PHONE #: 503-225.0700
CONTRACTOR: MUZAK LL.0 PHONE #: 503.889 -3848
Inspection Request Scheduled For: Date: 12/3/2007 Pour Time:
Code # Inspection Description /Confirm,# Contact # sage
\
199 Electrical final 060618 -01 N, 971 - 6703094 Y
Corrections /Comments /Instructions: A •
N
X
\ t \ \ N. ,
i \ \ \
■
v v A X
-.. \ ( \ -1 \
J
■
X PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: er—, `be Date: 121310 Phone #: (503) 718 - 111%