Permit illii: CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
: DEVELOPMENT H BMENT Tigard, � 639 -4171 DATE PERMIT #: ISSUED: E2R8003 -00381
13125 SITE ADDRESS: 12282 SW SCHOLLS FERRY RD PARCEL: 1S134BC-00300
SUBDIVISION: GREENWAY TOWN CENTER ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
Project Description: (2) limited energy installs, CCTV system & Audio /stereo. Job No. 140817
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: CCTV X
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
BPP RETAIL LLC MUZAK LLC
BY BURNHAM PACIFIC PROPERTIES 12449 NE MARX
ATTN: JOHN WATERS PORTLAND, OR 97230
SAN DIEGO, CA 92101
Phone: Phone: 254 - 7400
Reg #: LIC 142760
ELE 26- 1055CLE
MET 00006434
FEES Required Inspections .
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 12/18/03 $150.00 Elect'I Final
[TAX] 8% State Surchart 12/18/03 $12.00
Total $162.00
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
starte. : ! days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires
yo o follow rules a• • pted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -001 -0010 throuc
I . ued by , • C ' � f : 16 Permittee Signature At.
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 / j & • 70 DATE: 2 . 1 3
LICENSE NO: 3g3ZL
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
flpitr
Electrical Permit Application FOR OFFICE USE ONLY
Received Electrical
Date/By: /2" / 7 0 3 co Permit No.: ea-0 V5-00 ail
City of Tigard Planning Approval Sign
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 Post - Review Land Use
_I ' ' Date/By: Internet: www.ci.tigard.or.us f Case No.:
I _� Contact t Ju .: ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name/Method: /6' • Supplemental Information.
M TYPE OF WORK PLAN REVIEW (Please check all that apply)
New construction Demolition ❑ Service over 225 amps-
0 Health care facility
❑
Addition/alteration/replacement ❑Other: commercial ❑ Hazardous location
❑ Service over 320 amps - rating of ❑ Building over 10,000 square feet,
CATEGORY OF CONSTRUCTION 1 & 2 family dwellings four or more residential units in
❑ 1 & 2- Family dwelling E Commercial/Industrial ❑ System over 600 volts nominal one structure
El Accessory Building Multi- Family ❑ Building over three stories ❑ Feeders, 400 amps or more
❑ Master Builder ❑ Other: ❑ Egress/lighting rt over
lan99 eons ❑ Manufactured structures or RV park
plan 0 Other:
JOB SITE INFORMATION and LOCATION Submit _ sets of plans with any of the above.
Job site address: NM LW tENOI,IS WRY The above are not a to temporary construction service.
FEE* SCHEDULE
Suite #: I Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: PI7aA soma Description Qty Fee(ea.) Total
Cross street/Directions to ob Site' New residential - single or multi - family per it
MO // F �QQy dwelling unit. Includes attached garage.
LLS 111 4 Service Included:
1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 I
Subdivision: Lot #: Limited energy. residential 75.00 2
Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
DESCRIPTION OF WORK service and/or feeder 90.90 2
IN 4- p WI, I � -,r� Services or feeders - installation,
ter SYS
f6 f\ D y alteration or relocation:
200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
❑ PROPERTY OWNER I ❑ 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,
Cl /State /Zl alteration, or relocation:
Ty p 200 amps or less 66.85 I
Phone: Fax: 201 amps to 400 amps 100.30 2
❑ APPLICANT ❑ CONTACT PERSON 401 to 600 amps 133.75 2
Branch circuits - new, alteration, or
Narne: 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: I 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: 140217 Signal circuit(s) or a limited energy panel,
Business Name: Mlaig LLC alteration, or extension I Page 2 75 2
Description:
Address: II449 NE MAgX ST.
City /State /Zip: POQfLAND OR. g7130 Each additional inspection over the allowable in any of the above:
Per inspection per hour (min. I hour) I 62.50
Phone: 503. M. 7400 I Fax: 154. lam Investigation fee:
CCB Lic. #: 144160 Lic. #: 16 - I pS CLf_, Other:
Electrical Permit Fees*
Supervising electrician Subtotal $ 44 R.50 •'-°
signature required: Plan Review (25% of Permit Fee) $
Print Name: Argo cyNc L i . #: 3s371a'A State Surcharge (8% of Permit Fee) $ / -O"
TOTAL PERMIT FEE $ $4 ` /4
Authorized Notice: This permit application expires if a permit is not obtained within
Signature: # �- • � Date: 12. IS . 03 180 days after it has been accepted as complete.
•Fee methodology set by Tri -County Building Industry Service Board.
ROCK (.SIN N
(Please print name)
is \Dsts\Permit 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
n 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:
0 Audio and Stereo Systems
Boiler Controls
• Clock Systems
0 Data Telecommunication Installation
• Fire Alarm Installation
▪ HVAC
• Instrumentation
0 Intercom and Paging Systems
• Landscape Irrigation Control
0 Medical
O Nurse Calls
❑ Outdoor Landscape Lighting
O Protective Signaling a`,
WI Other CC 1 gn � S 1 Sf EM
1 Number of Systems
•
* No licenses are required. Licenses are required for all
other installations
i:\Dsts\Permit Forms\ElcPermitAppPg2.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST
BUP
Received Date Requested AM PM BUP
Location 1 22 S - Z Sc._ e) lls - ��✓'r ite MEC
Contact Person % Ph ( q S'— 17 (1,-; PLM
Contractor Ph ( ) - <61•1 3 — 040317
BUILDING Tenant/Owner 43P-3— C) 0-7
Footing
Foundation ELC
Ftg Drain
Access: 4 3 _ 0 6 1
Crawl Drain
Slab Inspection Notes: SIT) �G'1
Post & Beam NO.) A Vl.��a -
Shear Anchors J/
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler J
Fire Alarm /
Susp'd Ceiling
Roof C -✓
Other:
Final
PASS PART FAIL /"+ '-
PLUMBING
2 17---------- ----7
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
S PART FAIL
4LECT AL
Service
Rough -In
UG/Slab
Low Voltage
Alarm
Final El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
• PART FAIL
SIT Please call for reinspection RE: ❑ Unable to inspect – no access
Fire Supply Line
ADA .-) "
Approach/Sidewalk Dat 9 — C 5 IT El Rein / Ext
Other: •
Final DO NOT REMOVE this Inspection record fr th e site.
PASS PART FAIL