Permit CITY OF TI GARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
1:141 DEVE ICES 639 -4171 DATEERMIIED: ELR2004-00363
13125 %29/2004
SITE ADDRESS: 12288 SW SCHOLLS FERRY RD PARCEL: 1S134BC -00300
SUBDIVISION: GREENWAY TOWN CENTER ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
Project Description: Low voltage.
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:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
BPP RETAIL LLC MUZAK LLC
BY BURNHAM PACIFIC PROPERTIES 3318 LAKEMONT BLVD
ATTN: JOHN WATERS FORT MILL, SC 29708
SAN DIEGO, CA 92101
Phone: Phone: 503 254 - 7400
Reg #: LIC 142760
ELE 26- 1055CLE
MET 00006434
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 11/29/2004 $75.00 Elect'I Final
[ELPLCK] ELR Pln Rev 11/29/2004 $6.00
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 95 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699.
Issued by Permittee Signature <t&) &Q P
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
E_et l Permit Application FOR l)FFICF: I'si: ONLY
City of Tigard RECEIVED D Received B;� Permit No.: _ 9f 3
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 '''- - r . I . ' Date/B Other Permit:
Inspection Line: 503.639.4175 N O V 2 9 2004 � ......a AL �., Date R eadyBy. ® See Page 2 for
Internet: www.ci.tigard.or.us - Notified/Method i 1 G Supplemental Information
CITY OF TIGARD
B LBIPF, / I H'f lb PLAN REVIEW
❑ New construction A /replacement Please check all that apply:
❑ Demolition ❑Other: ❑Service over 225 amps, comm'I ['Hazardous location
❑Service over 320 amps — rating ❑ Buildng over 10,000 sq. R,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling 0-6ommercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi - family El Master builder ❑Other: ❑Building over three stories ['Feeders, 400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lightingplan RV park
5 N SC . �ur� n A ❑Health care facility DOther:
t (
Job no.: Job site address: 11 �cJJ Submit 2 sets of plans with any of the above.
City/State/ZIP: — vv ./ .442_,D a 912:0, The above are not applicable to temporary construction service.
FEE* SCHEDULE
Suite/bldg. /apt no.: �" Project name: C 1,0 S C1/'etarrp al
Description I Qty. I Pea I Total I ••
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'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
S n dwelling, service and/or feeder 90.90 2
vw ``� C 6'1( � Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER I ❑ TENANT 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
Phone: ( ) I Fax: ( ) relocation
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
❑ APPLICANT I ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee,
each branch circuit 46.85 2
Address: Each add'I branch circuit 6.65 2
City/State/ZIP: Miscellaneous (service or feeder not Included)
Pump or irrigation circle 53.40 2
Phone: ( ) Fax: : ( ) Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
extension. Describe: ( Page 2 2
Business name: M u:2444.... (AC._ 3 o,,, 44 S
Address: 1 Z��L� N� �( p QT 1p Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State/ZIP: { ft �L P. T12 3 0 Investigation per hour(1 hr min) 62.50
F
Phone: (563) 816— 354 (S03)1' 37 83 Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES*
CCB Lic.: I97 1 by I Electrical Lic.`2Fo- loSsc Lf Suprv. Lic.: 2,p( J3 Subtotal 1 s. tto
Suprv. Electrician signature, required: Qh? (, Plan review (25 %ofperrlrit fee)
Print name`,l,p'viA —6 - mss .(t Date: (tlZ`� S tate surcharge (8 % of permit fee) i
• TOTAL PERMIT FEE g
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: • Fee methodology set by Tri- County Building Industry Service Board
•' Number of inspections per permit allowed.
i:\ Building \Pennits\ELC- PermitApp.doc 17/03 440.4615T(I0/O2/COM/WEB
Electrical Permit Application - City of Tigard n . _
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined........ $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
•
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial system. $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
Audio and Stereo Systems
❑ Boiler Controls •
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation V
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical ,
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems: V
*No licenses are required. Licenses are required
for all other installations
i:\BuildingTermits\ELC-PennitApp.doc 04/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Businbgs Line: (503) 639 -4171 MST
BUP
Received Date Requested /l' 3 AM PM BUP
Location - - :: �.. _. i L./L. -uite MEC
Contact Person Ph ( / _) PLM
Contractor Ph ) SWR
BUILDING Tenant/Owner j ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR ,140 y' a) 3
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain l�
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PAS RT FAIL
LECTRICA !
Service
Rough -In
UG/Slab
Low Voltage
ire Alarm
PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
:ati SIT Please call fo reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date c 2 Inspector Ext
Other:
Final ' O NOT REMOVE this Inspection. record f rom the ob site.
PASS PART FAIL
•