Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2009 -00273
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/05/2009
- Parcel: 2S115BA02600
Jurisdiction: Tigard
Site address: 16230 SW PACIFIC HWY 100
Subdivision: Lot: 0
Project: Panda Express
Project Description: 3 sign lighting
Owner: FEES
SN PROPERTIES PARTNERSHIP Quantity Description Date Amount
1121 SW SALMON ST
PORTLAND, OR 97205 • 3 ea Signor Outline Lighting 06/05/2009 $180.20
PHONE: 1 ea 12% State Surcharge - 06/05/2009 $19.22
Electrical
Contractor:
CARLSON SIGN CO
1605 NE FORBES RD
BEND, OR 97701
PHONE: 541 - 382 -2182
FAX: 541- 382 -2196
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Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
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Total $179.42
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. 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 the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through OA 9 01-0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. r
Issued By: d Permittee Signature:
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' 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.
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. " Electrical Permit Applicat EC El VED FOR OFFICE USE ONLY
JUN 0 2 2009 Received
City of Tigard Date/By: Z O / Permit No.: �� 7,005' - Q Z ��
M ill
13125 S1V I fall Blvd.. igard, OR A ' OF TIGARD t' Review
Phone: 503.6 ?9.4171 Pax: 503.5' , DanJDv: Other Pcnuit:
TIGARD Inspection Line: 503.G39.417PLANN1NGfENGINEERI c tic Ready/By: laic. 0 See Page 2 for
Internet www.Iigard_or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
Please check all that apply (submit 2 sets of plans w /iletns checked below):
® New construction ❑ Addition/alteration/replacement
❑ Service or feeder 401) amp.; or more ❑ Building over three stories.
❑ Demol111011 ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10.001) snips at 150 volts or ❑ Floating buildings.
less to ground. or exceeds 14.000 ❑ Commercial - use agricultural
❑ I - and 2-family dwelling IS Commercial /industrial ❑ Accessory building amps for all orbcrinstallaliwts. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of item motor load of ❑ "A "'I :'• "I �'• ' 1 -3'
I001-UP or moat. occupancy.
Job no.: Job site address: 16230 S\\' Pacific Highway
❑ Six ur more residential units. ❑ Recreational vehicle paths.
City /State /ZIP: Tigard, Oregon 97223 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: Panda Express ❑ Service or feeder 600 amps ur more.
FEE SCHEDULE
Cross street /directions to job site: S \V Durham Road DesoIptlo„ I Qt ,.. I r ,,c. I Total I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. fl. or less 145.15 4
Ea. add'I 500 sq. IL or portion 33.40 1
"fax map /parcel no.: Limited energy. residential
(with above sq. 11.) 75.00 2
DESCRIPTION OF %YORK (
a'i I
Limited energy, multi-family 75.00 2
(3) sets of LED lit channel letters residential (with above sq. u.)
Services or feeders installation. alteration. and /or relocation
200 amps or less 80.30 2
® PROPERTY OWNER ❑ TENANT 201 snips 10 400 amps 106.85 2
Name: Ha'sch Investment Properties LLC 401 ampsIo600amps IG0.G0 2
601 amps to 1,000 amps 240.60 2
Address: 1 121 S \V Salmon Street, Ste. 500 Over 1.000 amps or volts 454.65 2
City /Slate /ZIP: Portland, OR 97205 Temporary services or feeders installation, alteration. aid /o•
relocation
Phone: (503)242 -2900 x 248 Fax: (503)274 -2093 200 amps or less 66.55 I
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 599 amps , 133.75 2
Branch circuits - new, alteration. or extension, per panel
Owner signature: Date: A. Fee for branch circuits n ird
APPLICANT ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: Carlson Sign Company 13. Fee for branch circuits
Contact name: Chris Cox wirhotu service or feeder fee. 46.85 2
Itst branch circuit
Address: 1605 NE Forbes Rd Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City /Slate /ZIP: Bend Oregon 97701 Each manufactured or modular 90.90 2
dwelling, service and /or feeder
Phone: (541) 382 -2182 Fax: : (541) 382 -2196 Reconnect only 66.85 2
E -mail: randeev@superiorsigns.com superiorsigns.com Punmp or irrigation circle 53.4(1 2
CONTRACTOR Sign or outline lighting 3 53.40 160.20 2
Business name: Carlson Sign Company Signal circuit(s) or limited -
energy panel, alteration, or
Address: 1605 N E Forbes Road extension. Describe: Page 2 2
City /State /ZIP: Bend, Oregon 97701 \ Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (541) 382 -2182 Fax: (541) 382 -2196 Investigation per hour (1 hr min) 62.50
CCB Lie.: 64549 Electrical Lic.: 9- 255cls Suprv. Lic.:, j`7 ji C,. Industrial plant per hour 73.75
/ ' 1 ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: 7 , / e 1n\
I Subtotal: 160.20
f ,. [ / t �..txa�
/ Plan review (25% of permit fee): ae}9$s
Print rint name :�(,11 LA NT (r., ✓ Date: Y � /� D C,)
State surcharge (12% of permit fee): 19._2
2,
Authorized signature: TOTAL PERMIT FEE: ...... .W.‘13---
permit application expires if a permit is not obtained within 180 ,fq
Print name: Dale. days after it has been accepted as complete. 74
• s Number or inspections allowed per permit. I Y1
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