Permit •
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
a COMMUNITY DEVELOPMENT Permit #: ELR200900185
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/13/2009
''�' Parcel: 2S115BA02600
Jurisdiction: Tigard
Site address: 16230 SW PACIFIC HWY 100
Subdivision: Lot: 0
Project: Panda Express
Project Description: Install restricted energy for HVAC.
FEES
Owner:
SN PROPERTIES PARTNERSHIP Description Date Amount
1121 SW SALMON ST Restricted Energy Permit 07/13/2009 $75.00
PORTLAND, OR 97205 12% State Surcharge - Electrical 07/13/2009 $9.00
PHONE:
Contractor:
DC HEATING & AIR CONDITIONING INC
7110 NE 157TH AVE
VANCOUVER, WA 98682
PHONE: 360- 695 -9757
FAX:
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: N Fire Alarm: N
HVAC: Y Instrumentation: N Total $84.00
Intercom /Paging: N Landscape /Irrigation: N Required Items and Reports (Conditions)
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N
Other Desc:
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 0 R 952 - 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: �� -�C) 1 QuO `Q 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.
"ElectI ical Permit Application FOR OFFICE USE ONLY
City of Tigard Date/By: Permit No.: 142009 , 06186 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Other Permi - - /
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Page 2 for
® Inspection Line: 503.639.4175 Date Ready/By: / Notified/Method: Anis: la Se lemental Information
Internet: www.tigard- or.gov I.[( PP
TYPE OF WORK PLAN REVIEW
❑ New construction g Addition/alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. 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 new motor load of ❑ "A ", "E ", "l -2 ", "l -3 ",
Job no.: Job site address: ! Ca 2.. ' 0 S W Pit eZF !4'1 �i 14 W rky Six or or more r es. occupancy.
Six or more residential units. 0 Recreational vehicle parks.
l voltage City/State /ZIP: 1 1G � > t Q QC Ci 0 i`1 ❑ ❑ Supply voila Health - care facilities. for more than
�t �-n , � 4 , ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: 140 Project name: P km >t+V Ex p 'SS ZeSrr Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site:c eN r t'Fl- ti-ru}st sk SyJ J QFlisit l 1D. Description I Qty. I Fee. I Total I
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family
75.00 2
residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER I A TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: F D,kr -C� ` 1 w . ( .
601 amps to 1,000 amps 240.60 2
Address: t (0Q ? (),? Art W V 1 C� R.fx1 E hatoJ V E Over 1,000 amps or volts 454.65 2
City/State /ZIP: F.,0 °1 i � 9 �'}'� Temporary n services or feeders installation, alteration, and/or
`
Phone: (6 2) '99_C1 I Fax: ((P 24a r3 4 ; 2 ---' 'ec 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 599 amps 133.75 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
A. Fee for branch circuits with
® APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 6.65 2
C l k COA.I> 1 ` i'bM u Fee branch branch circuit
Business name: circuits
i) ;{E}I�'� n?� C k �Cc i Nom- � B. Fee for branch circ (( without service or feeder fee,
Contact name: 46.85 2
Cc iJL� 6kCt.(.) first branch circuit
Address: 71,10 10 C t s tort Each add'l branch circuit 6.65 _ 2
n n Miscellaneous (service or feeder not included)
City/State/ZIP: V J tJ CO V V lee 4-- - d Co �C2. Each manufactured or modular 90.90 2
eco Rnnee ct o only
Phone: ( .lp) kg 5 q Fax: : ( c qi4- It -030-4- in ice
and/or feeder
Reco 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: S K- E.- ,�f E Signal p t(s) or limited-
�T f\-c?, O energy panel, alteration, or
Address: extension. Descrbe: Page 2 2
City/State /ZIP: Each additional inspection over allowable in any of the above
Per inspection 62.50 i
Phone: ( ) Fax: ( ) Investigation per hour (1 hr min) 62.50
CCB Lie.: Iwo 3 rs Electrical Lic.: C ( 2 Suprv. Lie.: Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: f. _ Subtotal: _
Print name: CO 1J el- ' i Q, kG VT' Date: /3, Plan review (25% of permit fee):
Sta te surcharge (12% of permit fee):
Authorized signature: a CAP TOTAL PERMIT FEE: R 14 , 00
This permit application expires if a permit is not obtained within 180
Print name: 0.0 (),..) Z 11. R v Date: j // /2,cG, days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:\ Building \Permits\ELC-PamitApp.doc 05/23/06 440- 4615T(I1/05 /COM/W1B
Electrical Permit Application - City of Tigard -
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*
n Burglar Alarm
n Garage Door Opener*
d Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
n Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I: \ Building \Permits\ELC- PermitApp.doc 03/23/06