Permit CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
-11, PERMIT SERVICES PERMIT #: ELR2003 -00278
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/12/03
SITE ADDRESS: 13500 SW PACIFIC HY 17 OLD CNTRY BUF PARCEL: 2S102CC -00500
W
SUBDIVISION: ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
Project Description: Reconnect speakers (audio and stereo 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:
OCB RESTAURANT CO. MUZAK LLC
1460 BUFFET WAY 12402 NE MARX
EAGAN, MN 55121 PORTLAND, OR 97230
Phone: 651- 365 -2142 Phone: 254 -7400
Reg #: LIC 142760
ELE 26- 1055CLE
MET 00006434
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 9/12/03 $75.00 Elect'l Final
[TAX] 8% State Tax 9/12/03 $6.00
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 throuc
I
Issued by , G, _ , ._ / . 4 ./f , 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'N DATE:
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
n i
Electrical Permit Application FOR OFFICE USE ONLY
Received Q Electrical �7
Date/By: /y ex? Permit No.: � 2 S '60 0
Cit of Ti and Planning Appro • •al Sign
Y g Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503-598-1960 4,,,,,,,1141,,,,, Post - Review Land Use
:r6 '� Date/By: Case No.:
ru
Internet: www.ci.tigard.or.us , ,� �I Contact ns.:
24 -hour Inspection Request: 503- 639 -4175 ` " " "- ® pee Page 2 for
P q Name/Metho Supplemental Information.
All ' ` , TYPE',�F WOIUC -. _ . :� _
�. +:" � " ; . - = � - • � "� _ _ ", • . :R)t.Ah[ VIEW. (Please checlt that �aP.P .� � '�
� � ' ° i
❑ New construction El Demolition v - � ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑
lddition/alteration/re , � lacement El Other: Other: Hazardous o on
Service over 320 amps- rating of ❑ Building over er 10 10,000 square feet,
_ , ' CATEGORY OF CONSTRUCTfON _I. :.. 1 & 2 family dwellings four or more residential units in
❑ 1 & 2- Family dwelling 43-Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stones ❑ Feeders, 400 amps or more
El Accessory Building ❑ Multi- Family
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
"• . , . - • . = - .OB SITE IN FOBMATION.aud.LOCATION _ Submit _ sets of plans with any of the above.
The above are not applicable to temporary construction service.
Job site address: l . o c) s'^' ? c c. 0-7/ - ' , 'b: FBE * SCHEI)I7LE. ,.,. • .. �_,- . .. •
. : . � : , •
Suite #: Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: 01 J Co,,, 3,.r .,/ 1. -, .r . 4 Description Qty Fee (ea.) Total i
New residential - single or multi - family per
Cross street/Directions to job site: dwelling unit. Includes attached garage.
Service Included:
1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 1
Subdivision: I Lot #: Limited energy, residential 75.00 2
Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
' _ , = DESCB1PTTOgOF,WORK •, service and/or feeder 90.90 2
Services or feeders - installation,
V ..e Cr0 ^ f c-k S v,' k- 4' ' 5 alteration or relocation:
1 200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
:❑ 'ROPERTy OWNER "- ! :1• ❑ TENANT, _ _ . 601 amps to 1000 amps • 240.60 2
Over 1000 amps or volts 454.65 2
Name: Reconnect only 66.85 2
Address: Temporary services or feeders - installation,
City/State/Zip: alteration, or relocation:
ty P 200 amps or less 66.85 1
Phone: Fax: 201 amps to 400 amps 100.30 2
401 to 600 amps 133.75 2 • APP IcAlsjr :_`,: - , _ ❑. CONTACT PERSON • ' "• ' Branch circuits - new, alteration, or
Name: extension per panel:
Address: A . Fee for branch circuits with purchase of
service or feeder fee, each branch circuit 6.65 2
City /State /Zip: B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46.85 2
Phone: Fax: Each additional branch circuit 6.65 2
E -mail: Misc.(Service or feeder not included):
. CONTRACTOR Each pump or irrigation circle 53.40 2
Each sign or outline lighting 53.40 2
Job No: Signal circuit(s) or a limited energy panel,
alteration, or extension Page 2 2
Business Name: /111,-s Description:
Address: \i /5.7 o ,r ( S 4-.
ClCity/ State/Zip: Each additional inspection over the allowable in any of the above:
`.7 P Ru+ l- \ +^ c� 1 i2- d Per inspection per hour (min. 1 hour) 62.50
Phone: (co ,)25 - vt- 711 b6 Fax: ._ Investigation fee:
CCB Lic. #: ( 4 ( 276 0 Lic. #: Z. - 1 try cc. Other;
- ••. Electrical- PermitFees *' ' .: ' .
Supervising electrician Subtotal $
signature required: Plan Review (25% of Permit Fee) $
Print Name: (t,, ‘ �y t ) ,,,, .,,..,1 Lic. #: 37 ez L,t State Surcharge (8% of Permit Fee) $
TOTAL PERMIT FEE $
• Authorized Notice: This permit application expires if a permit is not obtained within
Signature: Date: 180 days after it has been accepted as complete.
*Fee methodology set.by Tri -County Building Industry Service Board.
(Please print name)
iADsts Temiit Forms\ElcPermitApp.doc 01/03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved:
Audio and Stereo Systems
El Burglar Alarm -�
Garage Door Opener
❑ Heating, Ventilation and Air Conditioning System
Vacuum Systems
Other
COMMERCIAL WORK ONLY:
Fee for each system. $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
Audio and Stereo Systems
Boiler Controls
▪ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
HVAC
O Instrumentation
0 Intercom and Paging Systems
Landscape Irrigation Control
0 Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting
0 Protective Signaling
•
Other
1 Number of Systems
* No licenses are required. Licenses are required for all
other installations
•
i:\Dsts\Permit Forms \ElcPermitAppPg2.doc 01/03