Permit CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
� DEVELOPMENT SERVICES PERMIT #: ELR2001 -00255
--- 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/12/01
SITE ADDRESS: 09485 SW WASHINGTON SQUARE RD A -6A PARCEL: 1 S126C0 -01107
SUBDIVISION: WASHINGTON SQUARE ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
Project Description: Installation of audio system. (TI)
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: X AUDIO & STEREO: 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:
PPR WASHINGTON SQUARE LLC MUZAK LLC
P.O.BOX 21545 12402 NE MARX
SEATTLE, WA 98111 PORTLAND, OR 97230
Phone: Phone: 254 -7400
Reg #: LAC 142760
ELE 26- 1055CLE
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT CTR 10/12/01 $75.00 2720010000 Elect'l Final
5PCT CTR 10/12/01 $6.00 2720010000
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes
and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow rules adopted by the Oregon Utility Notification Center. Those les are set forth in OAR
952 - 001 -0010 through OAR 952 - 001 -0080. You may obtain copies of these rules irect ques • ns to OUNC at (503)
246 -1987. _,_ -. . Issued by Permittee Signature
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale. ease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO: 5/ 7 uZ_C
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Electrical Permit Application
, Date received: a .9.- Permit no.: !_:./ • 0, A � �
1 j�, j; i i! City of Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: CON Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory 0 Commercial/industrial ❑ Multi- family Tenant improvement
❑ New construction 0 Addition/alteration /replacement 0 Other: ❑ Partial
JOB SI'Z'E INFORMATION
Job address: e3—$-g---• va,� / Bldg. no.: Suite no, 4 Tax map /tax lot/account no.:
Lot: Block: I Subdi lion:
Project name: 5 e4.i' „ Gi 115 I Description . d location of work on premises: 44_ .-e' .e... 7 1..4 if, i c r ,4.4 e, Sri
Estimated date hf completion/inspection: P 41 /
CONTRACTOR APPLICATION FEE SCIIEDU,E
Job no: Fee Max
Description Qty. (ea.) Total no. ins
Business name: (J New residential - single ormuhi- family per P
Address: ` 2'44 � Z. /1/ 1 w 371 dwelling unit. Includes attached garage.
City: II 1 c ■i k-. I State:s2 [ZIP: cj )Z ZQ . Service Included:
Phon433- 1111 -- Z q_74412, I Fax: I E -mail: 1000 sq. ft. or less 4
CCB no.: / �A7/00 I Elec. bus. lic. no:, Q /o66c,L.0
Each ed energy, 500 sq. ft. or portion thereof
Limited energy, residential 2
City/m /l g r lic. no.: 0.- Limited energy, non- residential 2
(a — /2 - O / Each manufactured home or modular dwelling
Signature ' supervising electrici (required) Date r ? Service and/or feeder 2
Sup. el - name (print): l ' a 'tv p. („.. License no: 57) Services or feeders— installation,
alteration or relocation:
PROPERTY OWN ER 200 amps or less 2
Name (print): 201 amps to 400 amps 2
Mailing address: 401 amps to 600 amps 2
601 amps to 1000 amps 2
City: I State: I ZIP: Over 1000 amps or volts 2
Phone: I Fax: I E -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 am.s 2
- ENGINEER Branch circuits - new, alteration,
Name: or extension per panel:
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
Phone: Fax: E-mail: of service or feeder fee, first branch circuit: 2
Each additional branch circuit:
PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included):
O Service over 225 amps- commercial ❑ Health -care facility Each pump or irrigation circle 2
O Service over 320 amps -rating of 1&2 ❑ Hazardous location Each sign or outline lighting 2
family dwellings ❑ 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* ' 75? 7 2
O Building over three stories ❑ Feeders, 400 amps or more *Description:
❑ Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
❑ Egress/lightingplan O 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 $ 76 Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application
. tlo
ce
❑ Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ b • tea
Expires accepted as complete. TOTAL $ ` I . 00
Name of cardholder as shown on credit card
Cardholder signature Amount 440-4615 (6/00/COM)
Ir..
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES:
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
p 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 n 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
Dwelling Service or Feeder $90.90 2 n Garage Door Opener
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 I � I
New, alteration or extension per panel l i 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 ❑
or feeder fee. Fire Alarm Installation
First branch circuit $46.85
Each additional branch circuit $6.65 ❑ HVAC
Miscellaneous Fi
Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40
Each sign or outline lighting $53.40 ❑ 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 ❑ Outdoor Landscape Lighting*
Fees: ❑ Protective Signaling
Enter total of above fees $ r 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 $
All New Commercial Buildings require 2 sets of plans.
Total Balance Due $
i:\dsts\forms\elc- fees.doc 08/30/01
CITY OF TIGARD BUILDING INSPECTION DIVISION
24Hoar Inspection Line: 639 -4175 Business Line: 639 -4171 MST
D BUP
Date Requested /0 — / AM PM BLD
Location "! J Z(4> 1 Suite MEC
Contact Person Ph p7 5 -71 ao PLM
Contractor Ph SWR
BUILDING Tenant/Owner ,7 ii ✓ �` ELC
Retaining Wall ELR A 4
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes: n
� rr / /rt SIT
Post & Beam
V
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL •
PLUMBING
Post & Beam
Under Slab
Top Out
_ Water Service %
Sanitary Sewer i
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam -
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
-.
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
-1, PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin •
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA !� �;
Other oach /Sidewalk Date C 7 a 1 ` of c / Inspector J d Ga:3 , Ext
Final �J
PASS PART FAIL DO NOT REMOVE this inspection record --from the-job.site.