Permit a
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
IN q
ii. COMMUNITY DEVELOPMENT Permit #: ELR2009 -00106
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/13/2009
Parcel: 2S115BA02600
Jurisdiction: Tigard
Site address: 16230 SW PACIFIC HWY 100
Subdivision: Lot: 0
Project: Panda Express
Project Description: Installation of (2) T- stats.
Owner: FEES
SN PROPERTIES PARTNERSHIP Description Date Amount
1121 SW SALMON ST Restricted Energy Permit 04 /13/2009 $150.00
PORTLAND, OR 97205 12% State Surcharge - Restricted Energy 04/13/2009 $18.00
PHONE:
Contractor:
WILLAMETTE HVAC
3075 SW 234TH AVE. #206
HILLSBORO, OR 97123
PHONE: 503 - 628 -6841
FAX: 503- 848 -2597
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 2
Audio & Stereo: Boiler Controls:
CCTV: Clock Systems:
Data & Telecommunications: Fire Alarm:
HVAC: Y Instrumentation: Total $168.00
Intercom /Paging: Landscape /Irrigation:
Landscape Lighting: Medical: Required Items and Reports (Conditions)
Nurse Calls: Protective Signal:
Security Alarm: Other:
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 d• • = ccordance 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 ;O days. ATTE ON: • =.o law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
95.- 001 -0010 through OA' . 2 -001 i )0. You may obt- in a copy of the rules or direct questions to OUNC by calling 503.246.6699 o{ 800.332.2344.
' A
Is. ued By: \ / _ .1 Perm ittee Signature: - I ii j" A
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.
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard APR - 2 2009 Received
INI `J g Date/By: �' 2 - Permit No.: — `�Z —60 b()2 . " 13125 SW Hall Blvd., Tigard, OR 97223 t Plan Review t
Phone: 503.639.4171 Fax: 503.598.1960 (`I'['Y QF TIG ' 1 Date/By: Other Permit:
TI G A R D Inspection Line: 503.639 BUILDING DIVIS I ate Ready/By: Ju ' : ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: 'I '1 Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ® Addition/alteration/replacement Please check all that apply (submit 2 sets of plans wfitems 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 ", "1 -2 ", "1 -3 ",
Job no.: Job site address: 16230 SW Pacific Hwy 100HP or more. cupancy.
El 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 Project name: Panda Express ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: 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'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
two T-stats 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 ❑ 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: ( ) 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
I Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: _ A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSC J above service or feeder fee, 6.65 2
each branch circuit
Business name: same i B. Fee for branch circuits
Contact name: without service or feeder fee, 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
dwelling, service and/or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Signal panel, or limited -
Business name: Willamette HVAC
energy panel, alteration, or
234th extension. Describe: 2 Page 2 2
Address: 3075 SW 234 Ave Ste206
City /State /ZIP: Hillsboro OR 97123 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (503) 628.6841 Fax: (503) 848.2597 Investigation per hour(1 hr min) 62.50
CCB Lic.: 56951 Electrical Lie.: 34346CRE Sup . Lic.: 4025LEB Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: / Subtotal: ` a)
Print name: Mike Sicard Date: 4/2/09
Plan review (25% of permit fee) ! � ,D --
State surcharge (12% of permit fee): / g � v o '
Authorized signature: TOTAL PERMIT FEE /loc,G�
Print name: Mike Sicard Date: 4/2/09 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.
I:\ Build 'ng\PermitslELC- PermitApp.doc 05/23/06 440- 4615T(11/05 /COM/WEB