Permit CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
lik DEVELOPMENT SERVICES PERMIT #: ELR2006 - 00184
DATE ISSUED: 8/3/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S 113AD - 01700
SITE ADDRESS: 16940 SW 72ND AVE ZONING: C -
SUBDIVISION: ROSEWOOD ACRE TRACTS LOT: 030 JURISDICTION: TIG
Project Description: Mens Wearhouse. Satellite Dish for music.
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: SATELLITE X
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
BRIDGEPORT LAND LLC MUZAK LLC
3939 NW ST HELENS RD 12449 NE MARX ST BLDG 10
PORTLAND, OR 97210 PORTLAND, OR 97230
Phone: 503- 241 -2875 Contact #: PRI 503- 889 -3848
FAX 503- 889 -3883
FEES Reg #: ELE 26- 1055CLE
LIC 142760
Description Date Amount
[ELPRMT] ELR Permit 8/3/2006 $75.00
[TAX] 8% State Surcha 8/3/2006 $6.00 REQUIRED ITEMS AND REPORTS
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 through OAR 952 - 001 -0100. You may obtain copies of these
rules or direct questions to OUNC at 503 - 246 -6699.
Issued By: � Permittee Signature: L
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 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
r. P Y Y a l(1 1 - ,41, a� " ' a .6 FOR O F CExUSE ONLY` #� " ^ �0 t g ;'�t, �- r
Electrical Permit � _ r �� a �� °
_ t w a k'+Sa 3,f, t t a o i , �1 't`,'"e s a ,. ,it.. , .� , < U4� til,
t i Received y _
Clty Of Tlgal d Date /By: i • 'IV IL Permit No.:6 (...,1,-,0
.., 1, ,n ,U( ed � ,
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503•598.196QU 0 2fOU .I p. ..11i' Date /B : Other Permit:
Inspection Line: 503.639.4175 HU 1,11,1 Date Ready /By: EN E1 See Page 2 for
Internet: www.ci.tigard.or.us / t L Notified /Method: Supplemental Information
x a 1 [ TTO .... •,al , , , , N c. `; k w :: PLAN REW f EVI
® New construction I . �1 n a aeration /replacement Please check all that apply:
['Service over 225 amps, comm'l ['Hazardous location
El Demolition ❑Other
['Service over 320 amps – rating El over 10,000 sq. ft.,
y CATEGOR O F CONST1 CT[ON , k r of 1- and 2- family dwellings 4 or more new residential
❑ 1 - and 2- family dwelling ® Commercial /industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
['Building over three stories ❑Feeders, 400 amps or more
❑ Multi- family El Master builder 12 Other:
p „ AND ['Occupant load over 99 persons ❑ Manufactured structures or
wry 1OB1SITE INFORMATION' LOCATION y ❑ Egress /lighting plan RV park
Job no.: Job site address: 16920 SW 72 Ave ❑Health -care facility ['Other:
Submit 2 sets of plans with any of the above.
City /State /ZIP: Tigard, Oregon 97224 The above are not applicable to temporary construction service.
FEE* '$'.0:00:0411 . , , ;,.
Suite /bldg. /apt. no.: Project name: Mens Warehouse ;
Description Qty. Fee. Total
Cross street /directions to job site: New residential single -or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no.: Limited energy, non-residential 75.00 2
n ` ( y s DESCRIPTION OF WORK d gY.
�- < .; , „�a « �.� � ,-:.� ,� Aid Each manufactured or modular
Satellite Music source dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
""''''''14-3"'" ROPERTY O, RE 11' z .' °� ;D TEN
� r 201 amps to 400 amps 106.85 2
` 401 amps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps 240.60 2
Address: .Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City /State /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits – new, alteration, or extension, per panel
"' y �' A. Fee for branch circuits with
''' ' '' ' 3 , '' '' �.. ' CU AC ' PER '' , ' service or feeder fee, each
Business name: branch circuit 6.65 2
B. Fee for branch circuits
Contact name: without service or feeder fee,
first branch circuit 46.85 2
Address:
Each add'1 branch circuit 6.65 2
City/State /ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) Fax: : ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
T R 'r energy panel, alteration, or
�1�. -, CONI)RACTOR '
.�.: . ,, , �w . . ,:.
extension. Describe: Music Page 2 2
Business name: Muzak Source
Address: 12449 NE Marx Street Bldg 10 Each additional inspection over allowable in any of the above
City /State /ZIP: Portland, Or 97230 Per inspection 62.50
Phone: (503) 889 -3848 Fax: (503) 889 -3883 Investigation per hour (1 hr min) 62.50
Industrial plant per hour 73.75
CCB Lic.: 142760 Electrical Lic.: 26- 1055CLE Suprv. Lic.: 2016 LEB 410 W'ELECTRICAL PERMI.T FEES* , .., „ , 3 ,.
Suprv. Electrician signature, required: Subtotal
Lu JL�`of) Plan review (25% of pennit fee)
Print name: j3 ,,k 1 t � ( t a 512-- Date: 8/3/06 g (" P fee)
r State surcharge 8 /o of ennit fee
Authorized signature: �� TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete
* Fee methodology set by Tri- County Building Industry Service Board
i:\ Building \hermits \ELC- PermitApp.doc 12/03 440 -461 ST(10 /02 /COM/WEB
** hwnber of inspections per permit allowed. Electrical Permit Application - City
of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT
FEES:
IZESIDErTE ?QMb:N....LI' ; , iii
Fee for all residential systems combined ...
Check Type of Work Involved:
•
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
Fee for each commercial system
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
n Fire Alarm Installation
❑ HVAC
❑ Instrumentation
n Intercom and Paging Systems
n Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
® Other Satellite Dish for music
Total number of commercial systems: 1
is \ Building \Permits \ELC- PermitApp.doc 04/03
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2006-00184
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/3/2006
Phone: (503) 639-4171 A
%Ol
Inspection Requests (24 Hrs.): (503) 639-4175 . -- Iii.
INSPECTION WORKSHEET FOR DATE: 8/4/2006 TIME: 7 PAGE: 44
SITE ADDRESS: 16940 SW 72ND AVE CLASS OF WORK:
SUBDIVISION: ROSFVVOOD ACRE TRACTS LOT #: 03o TYPE OF USE:
PROJECT NAME: MENE WFARHOUSE
DESCRIPTION: Mens Wearhouse. Satellite Dish for music.
OWNER: BRIDGEPORT LAND LLC, PHONE #: 503-241-287 6
CONTRACTOR: MUZAK LLC PHONE #: 503,869-3848
Inspection Request Scheduled For: Date: 8/4/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
Electrical final 034395-01 503-889-3848 N
C ori 6 -- • e. • _ • _ _ _ • t - -.
Q
r■ PASS fl PARTIAL APPROVAL 1 CANCEL n NO ACCESS
1 I FAIL i 1 CALL FOR INSPECTION 1 1 ADDITIONAL FEES ASSESSED
Inspector: N 08 L I Date: 4 Z 1 1 dO Phone #: (503) 718- lligir)