Permit (148) CITY OF TIGARD
,
^ yI.'j DEVELOPMENT SERVICES RESTRICTED ENERGY
PERMIT #: ELR97 -0304
DATE ISSUED: 10/23/97
PARCEL: 2S115BA -00101
SITE ADDRESS...:16200 SW PACIFIC HWY #X
SUBDIVISION • ZONING:C —G
BLOCK • LOT • JURISDICTN: TIG
Project Description : Installation of low voltage systeo for Muzak.
A. RESIDENTIAL - - -- B. COMMERCIAL--- -
AUDIO & STEREO...: 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..: ::X
TOTAL # OF SYSTEMS: 1
Owner: FEES - -- - -- - - - -- - -- --
CAPITAL /B4IT HOLDINGS TWELVE IN type amount by date recpt
C/O FORUM PROPERTIES PRMT $ 40.00 DRA 10/23/97 97- 300346
8705 SW NIMBUS 5PCT $ 2.00 DRA 10/23/97 97- 300346
BEAVERTON OR 97005
Phone #i 606--•2277
Contractor: --
SOUND COM NORTHWEST /FAUX FX $ 42.00 TOTAL
AUSTAL INC
1827 SW THIRD DR -- REQUIRED INSPECTIONS --
GRESHAM OR 97080 Ceiling Cover Low Voltage Insp
Phone #: 674 -8435 Wall Cover Elect' 1 Final
Reg #.. : 123612
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. 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 • within 180
days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you t: follow e adopte' by the
Oregon Utility Notification Center. Those rules are set forth in OAR 952- 001 -0010 through OAR 952 -001 080. lou say obta' copies of
these rul or dir t question to OUNC at 5031246 -1987.
Issue by• • Permittee Sign> .�;: ""
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: 7/,q DATE:
-
LICENSE NO: • • 1' '� 1 CS�✓�
++++++++++++++++++++++++++++++++++++++++++++++++++ + + + ++ ++ + + + ++ + + + + + + + + + + + + + + +-H ++
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
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a
CITY OF TIGARD Electrical Permit Application Plan Ch
13125 SW .HALL BLVD. Rec'd
TIGARD OR 97223 Date Recd D ' 3
I Date to P.E.
Phone (503) 639 -4171, x30 D ate to DST
Print or Type (/
Inspection (503) 639 -4175 Incomplete or illegible will not be accepted Permit # L L �
Fax (503) 684 -7297 Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development Number of Inspections per permit allowed
Name (or name of business) M,A .SHA -U-S 41 01 I 0 Service included: Items Cost Sum
I
Address I L 2-0 0 S. R). Pf4c' - t Cr . 14.&)\J , 4a. Residential - per unit
Ci /State /Zi 1 ° Q Each ad it or less $110.00 4
ty p , Each additional 500 sq. ft. or
Commercial ® Residential ❑
portion thereof $25.00 1
Limited Energy $25.00
Each Manuf'd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
(Attach copy of all current licenses) n C / 4b. Services or Feeders
Electrical ContractorAUST� SG M i7r c A'.,S .,NDI.UAM Installation, alteration, or relocation
Address I R Z"? S . W . T+1 t a-b. ail_ . 20 amps to or less $60.00 2
201 amps to 400 amps $80.00 2
City G2eSH. State GP Zip 91 Dgc) 401 amps to 600 amps $120.00 2
Phone No. s7D3 (04 84 601 amps to 1000 amps $180.00 2
Job No. Over 1000 amps or volts $340.00 2
Elec. Cont. Lice. No. Zt q q Cu Exp.Date Reconnect only $50.00 2
OR State CCB Reg. No. /2-3(' / 2 Exp.Date co/ S(CIX 4c. Temporary Services or Feeders
COT Business Tax or - O No. Exp.D to Installation, alteration, or relocation
200 amps or less $50.00 •2
Signature of Supr. El - .. 401 amps to 600 amps $100.00 2
Over 600 amps to 1000 volts,
License No. Y T2- Exp.DatelvAr see "b" above.
Phone No. 4d. Branch Circuits
New, alteration or extension per panel
2b. For owner installations: a) The fee for branch circuits with
purchase of service or
Print Owner's Name feeder fee.
Address Each branch circuit $5.00 2
b) The fee for branch circuits
City State Zip without purchase of
Phone No. service or feeder fee.
First branch circuit $35.00 2
The installation is being made on property I own which is not Each additional branch circuit $5.00 2
intended for sale, lease or rent. 4e. Miscellaneous
(Service or feeder not included)
Owner's Signature Each pump or irrigation circle $40.00 2
Each sign or outline lighting $ 40 . 00 /� 2
3. Plan Review section (if required):* Signal circuit(s) or a limited energy ,I
panel, alteration or extension I $40.00 2
Minor Labels (10) $100.00
Please check appropriate item and enter fee in section 5B.
4 or more residential units in one structure 4f. Each additional inspection over
Service and feeder 225 amps or more the allowable in any of the above
System over 600 volts nominal Per inspection $35.00
Classified area or structure containing special occupancy Per hour $55.00
as described in N.E.C. Chapter 5 In Plant $55.00 /
* Submit 2 sets of plans with application where any of the above apply. 5. Fees: // 0
Not required for temporary construction services. 5a. Enter total of above fees $
5% Surcharge (.05 X total fees) $ e71,'
NOTICE • Subtotal $
5b. Enter 25% of line 5a for
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review if required (Sec.3) $
NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK Subtotal $ IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY 4.60
TIME AFTER WORK IS COMMENCED. ❑ Trust Account #
Total balance Due $
I: \DSTS \ELC96.APP Rev 9/96
6/30/99 Activities for Case #: ELR97 -00304
4:43:04 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELRC001 Application Received 10/23/97 DRA RECD DRA 10/23/97
ELRC003 Permit Created 10/23/97 DRA PASS DRA 10/23/97 '
ELRC700 Ceiling Cover 10/28/97 MJR PASS J'H 11/6/97 Electrical and low voltage cover
approved.
ELRC725 Low Voltage Inspection 11/12/97 MJR PASS MJR 11/12/97
ELRC799 EIecaI Final 11/12/97 MJR PASS MJR 11/12/97
ELRC500 (F) Issue permit 10/23/97 DRA PASS DST 10/23/97
ELRC800 Case finaled 11/12/97 MJR PASS MJR 11/12/97
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