Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
II: COMMUNITY DEVELOPMENT Permit #: ELR2009 -00188
q [ G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/16/2009
Parcel: 2S115BA02600
Jurisdiction: Tigard
Site address: 16230 SW PACIFIC HWY 100
Subdivision: Lot: 0
Project: Panda Express
Project Description: Low voltage for audio /stereo wiring.
Owner: FEES
SN PROPERTIES PARTNERSHIP Description Date Amount
1121 SW SALMON ST Restricted Energy Permit 07/16/2009 $75.00
PORTLAND, OR 97205 12% State Surcharge - Electrical 07/16/2009 $9.00
PHONE:
Contractor:
MUZAK LLC
12449 NE MARX ST BLDG 10
PORTLAND, OR 97230
PHONE: 503- 554 -2594
FAX: 503 - 889 -3883
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: y Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: N Fire Alarm: N
HVAC: N 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 t he regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in a r with roved fans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATT TION. Oregon law quit you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth \ in OAR
952 -001 -0 10 throu h OAR 952 -0 -0100. o ay obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued y: `—C Xa--fi6.4 0-14 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.
' Electrical Permit Application FOR OFFICE ust O\ l.1
' City of Tigard RECEIVE .� Received 7 l4 Q Permit No.:
Y ma
II y,
13125 SW Hall Blvd., Tigard, OR 97223 Date /B : _/ f�
Plan Review Other Permit:
JUL 16 200
I Phone: 503.639.4171 Fax: 503 Date/B :
T I G A R D Inspection Line: 503.639 Date Ready /By: ® See Page 2 for
Internet: www.tigard- or.gov CV& OF TIGAR I Notified/Method: Supplemental Information
TYPE OF WO1l IL,DING UIVISI1P PLAN REVIEW
® New construction Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Addition/alteration /replacement
❑ 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 ", "1 -3 ",
Job no.: I Job site address: 16230 sw pacific hwy 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: Tigard , Or 97224 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: 100 1 Project name: Panda Express ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I ely. 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
Tax map /parcel no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
a Sound System Limited energy, multi- family
Low Voltage y residential (with above sq. ft.) 75.00 2
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
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City/State /ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I 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 599 amps 133.75 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT I I] CONTACT PERSON above service or feeder fee,
each branch circuit 6.65 2
Business name: B. Fee for branch circuits
without service or feeder fee,
Contact name: 46.85 2
first branch circuit
Address: Each add'l branch circuit 6.65 _ 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Signal circuit(s) or limited -
Business name: MUZAK energy panel, alteration, or
Address: 12449 NE MARX STREET extension. Describe: Page 2 2
City/State /ZIP: PORTLAND,OR 97230 Each additional inspection over allowable in any of the above
Phone: (803) 554 -2594 I Fax: (503) 252 -1109 Per Invest inn 62.50
igation per hour (1 hr min) 62.50
CCB Lic.: 142760 I Electrical Lic.: lbssGI Suprv. Lic.: Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: ' �'� -Ill Subtotal: 75.0 0
Plan review (25% of permit fee):
State surcharge (12% of permit fee):
TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
* Number of inspections allowed per permit.
1:\Building\Permits\ELC- ermitApp.doc 05/23/06 440- 4615T(11/05/COM /WEB
won
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*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ 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*
n Medical
❑ Nurse Calls
❑ 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