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Permit f ` ELECTRICAL PERMIT - A CITY T I G A R D RESTRICTED ENERGY ;�1,, DEVELOPMENT H BMEN ) 639 -4171 DATEESSU E% /7 02 2 -00009 13125 SITE ADDRESS: 07150 SW SANDBURG ST PARCEL: 2S101 DC 03900 SUBDIVISION: SALEM FREEWAY SUBDIVISION ZONING: C -P BLOCK: LOT: 004 JURISDICTION: TIG Project Description: Installation of paging system /sound system. A. RESIDENTIAL B. COMMERCIAL AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING: X 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: PROGRESSIVE CASUALTY MUZAK LLC INSURANCE COMPANY 12402 NE MARX 6300 WILSON MILLS RD PORTLAND, OR 97230 MAYFIELD VILLAGE, OH 44143 Phone: Phone: 254 -7400 Reg #: LAC 142760 ELE 26- 1055CLE FEES Required Inspections Type By Date Amount Receipt Low Voltage Inspection PRMT CTR 1/17/02 $75.00 2720020000 Elect'l Final 5PCT CTR 1/17/02 $6.00 2720020000 Total $81.00 This Permit is issued subject to the regulations contained in the Tigard Munidpal 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 s withirt—lt,30 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law r wires you to follo riles adopted • the Oregon Utility Notification Center. Those rules are set forth in OAR 52- 001 -0010 through O • R 952 -I) -008'. You may obtain copies of these rules or direct uesli ns UNC at (503) 246 -1987. ' Issued by , ! ��' � /��/ Permittee Signature k 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 y Electrical Permit Application Date received: / 17 O2 Permit no.: szAAo0.3.-evoo? 4„ 1..t f I A. ,,, , ,. I City of Tigard Project/appl. no.. Expire date: CifyujTigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By: Receipt no. Phone: (503) 639 -4171 Fax: (503) 598 -1960 Case file no.: Payment type: Land use approval: TYPE OF PERMIT • ❑ I & 2 family dwelling or accessory ommercial/industrial ❑ Multi- family ❑ Tenant improvement 0 New construction ❑ Addition/alteration/replacement O Other: 0 Partial • JOB SITE INFORMATION Job address: 7 . 0 Ski S4A, 1 et,(//6 Bldg. no.: Suite no.: Tax map /tax lot/account no.: Lot: (Block: (Subdivision: / Project name: , / ZS S /Vii. I Description and location of work on premises: Estimated date of completion /inspection: 'Z AJ L 9L4J' /(., CONTRACTOR APPLICATION • FEE SCI IEDU.E Job no: Fee Max Business name: M V Z4X Description Qty. (ea.) Total no. insp New residential - single or multi- family per Address:' ` Z yO'� Ailt -, ,f /Z)( .5 /' dwelling unit. IIncludes attached garage. City: /� IState:e2/ ZIP: y'7 - 30 Service included: Phone: Z 5 y / -7yC1/4' I Fax: 1E-mail: 1000 sq. ft. or less 4 CCB no.: / Y7 7E O I Elec. bus. lie. no: 2 -/C Ss C Each additional 500 sq ft. or portion thereof Limited energy, residential 2 City/ etro ic. no.: Limited energy, non- residential 2 li ll�� / - I . 7 - L0 .Z Each manufactured home or modular dwelling Sig atur f supbrdising electrician (required) Date Service and/or feeder 2 Sup. elect. name(print): d . ..Iv . t_ License / 1 / z J G - Services or feeders - installation , alteration or relocation: PROPERTY OWNER 200 amps or less 2 Name (print): 201 amps to 400 amps 2 401 amps to 600 amps 2 Mailing address: 601 amps to 1000 amps 2 City: I State: I ZIP: Over 1000 amps or volts 2 Phone: 'Fax: 1E-mail: Reconnect only 1 Owner installation: The installation is being made on property I own Temporary services or feeders - which is not intended for sale, lease, rent, or exchange according to installation, alteration,orrelocation: ORS 447, 455, 479, 670, 701. 200 amps or less 2 201 amps to 400 amps 2 Owner's signature: Date: 401 to 600 amps 2 ENGINEER Branch circuits - new, alteration, or extension per panel: Name: A. Fee for branch circuits with purchase of Address: service or feeder fee, each branch circuit 2 City: I State: I ZIP: B. Fee for branch circuits without purchase of service or feeder fee, first branch circuit: 2 Phone: Fax: E-mail: Each additional branch circuit. ('LAN REVIEW (Please check all that apply) Misc. (Service or feeder not included): O Service over 225 amps- commercial 0 Health -care facility Each pump or irrigation circle 2 O Service over 320 amps- rating of I &2 0 Hazardous location Each sign or outline lighting 2 family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel, ( O System over 600 volts nominal more residential units in one structure alteration, or extension * - l 2 O Building over three stories 0 Feeders, 400 amps or more *Description: T2Eil\ MS will O Occupant load over 99 persons O Manufactured structures or RV park Each additional inspection over the a lowable in any of the above: 0 Egress/lightingplan ❑ Other. Per inspection Submit sets of plans with any of the above. Investigation fee The above are not applicable to temporary construction service. Other Permit fee $ _ 75 Not all junsdicuons accept credit cards, please call jurisdiction for mom information. Notice: This permit application ' O Visa ❑ MasterCard expires if a permit is not obtained Plan review (at _ %) $ U Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ Expires accepted as complete. TOTAL $ Name of cardholder as shown on credit card $ Cardholder signature Amount 440-4615 (6/00/COM) ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES: ' ‘` Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY /� Restricted Energy Fee $75.00 Number of Inspections per permit allowed (FOR ALL SYSTEMS) Service included: Items Cost Total 4, Check Type of Work Involved: Residential - per unit 1000 sq. ft. or less $145.15 4 ❑ Audio and Stereo Systems* Each additional 500 sq. ft. or portion thereof $33.40 1 ❑ Burglar Alarm Limited Energy $75.00 Each Manufd Home or Modular ❑ Garage Door Opener' Dwelling Service or Feeder $90.90 2 • Services or Feeders ❑ Heating, Ventilation and Air Conditioning System' Installation, alteration, or relocation 200 amps or less $80 30 2 ❑ 201 amps to 400 amps $106 85 2 Vacuum Systems 401 amps to 600 amps $160 60 2 601 amps to 1000 amps $240 60 2 ❑ Other Over 1000 amps or volts $454.65 2 Reconnect only $66.85 2 Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY Installation, alteration, or relocation Fee for each system $75.00 200 amps or less $66.85 2 (SEE OAR 918- 260 -260) 201 amps to 400 amps $100 30 2 401 amps to 600 amps $133.75 2 Check Type of Work Involved: Over 600 amps to 1000 volts, see "b" above. ❑ Audio and Stereo Systems Branch Circuits ❑ New, alteration or extension per panel Boiler Controls a) The fee for branch circuits with purchase of service or ❑ Clock Systems feeder fee. Each branch circuit $6.65 2 ❑ Data Telecommunication Installation b) The fee for branch circuits without purchase of service ❑ Fire Alarm Installation or feeder fee. First branch circuit $46.85 Each additional branch circuit $6 65 ❑ HVAC Miscellaneous ❑ Instrumentation (Service or feeder not included) Each pump or irrigation circle $53.40 �r-�y Each sign or outline lighting ' $53.40 C�� Intercom and Paging Systems • Signal circuit(s) or a limited energy panel, alteration or extension $75.00 ❑ Landscape Irrigation Control' Minor Labels (10) $125.00 Each additional inspection over ❑ Medical the allowable in any of the above Per inspection _ $62.50 ❑ Nurse Calls Per hour $62.50 In Plant $73.75 n Outdoor Landscape Lighting Fees: ❑ Protective Signaling Enter total of above fees $ ❑ Other 8% State Surcharge $ Number of Systems 25% Plan Review Fee See "Plan Review" section on $ No licenses are required. Licenses are required for all other installations front of application. . Fees: Total Balance Due $ Enter total of above fees $ ❑ Trust Account # 8% State Surcharge $ Total Balance Due $ All New Commercial Buildings require 2 sets of plans. i:\dsts\forms \etc - fees.doc 08/30/01 .