Permit CITY OF TIGARD ELECTRICAL PERMIT
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'` COMMUNITY DEVELOPMENT114
Permit#: ELC2019 00787
Date Issued: 11/04/2019
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S115BA02600
Jurisdiction: Tigard
Site address: 16230 SW PACIFIC HWY 100
Project: Panda Express Subdivision: 2004-015 PARTITION PLAT Lot: 2
Project Description: (3)branch circuits for energy management system controllers and associated wiring to panel.
Contractor: LUMENAL LIGHTING LLC Owner: SN PROPERTIES PARTNERSHIP
21706 66TH AVE WEST 1121 SW SALMON ST
MOUNTLAKE TERRACE,WA 98043 PORTLAND, OR 97205
PHONE: 425-481-5001 PHONE:
FAX:
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo/Purchase 11/04/2019 $71.02
Specifics: Service or Feeder
1 ea 12%State Surcharge- 11/04/2019 $8.52
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $79.54
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 nter. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a co rules or direct questions to OUNC by calling 503 32.1'987 or 1.800.332.2344.
Issued By: .f - 4 — errnitee Signature: (lt.�a 1
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 the next available inspection date.
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 [SE OS E.\
City of Tigard x 1,E.0 Received
Date/By: ///Vi q 67--- Permit#: 5Z7t,6' - 06-7q 7
ill
: 2 Phone: 503.718'4 13125 SW Hall Blvd.,Tigard,OR 972.24 C,CO Related Permit 4:
Ni Plan Review
2439 Fax: 503.598r0,... Date/By:
Inspection Line: 503.639.4175 4 rON9 Ready DaterBy. Juris. liZI See Page 2 for
TIGARD \AO Supplemental Information
Internet: www.tigard-orgov Notified/Method: L-46:.
I\— 00 TYPE OF WORK,,A-0 O coS\ PLAN REVIEW
El New construction Ypg Additionialteraticp*anWiln Please check all that apply(submit 2 sets of plans w/items checked):
, -.31 - 0 Service or feeder 400 amps or more 0 Building over three stories.
El Demolition El Other where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
El 1-and 2-family dwelling n Commercial/industrial El Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
El Multi-family El Master builder El Other: 0 Fire pump_ El Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
0 Addition of new motor load of system.
Job#: Job site address: 16230 SW Pacific Hwy 100HP or more.
City/State/ZIP: Tigard, Or 97224 0 Six or more residential units. occupancy.
0 Health-care facilities. CI Recreational vehicle parks.
Suite/bldg./apt#: • I Project name: Panda ,,--,'. -,...,--. 0 Hazardous locations. 0 Supply voltage for more than
D Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. I Each I Total I =
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential 75.00 2
(with above sq.ft.)
Installing energy management system controllers and associated wiring to Limited energy,multi-family
75.00 2
panel. residential(with above sq.ft.)
Renewable Energy 0 See Page 2
0 PROPERTY OWNER D TENANT Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 100 70 . 2
Address: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
I APPLICANT CI CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
N
A.Fee for branch circuits with
Business name: above service or feeder fee,
7.42 2
each branch circuit
Contact name: Cathy Busser B.Fee for branch circuits without
service or feeder fee,first 1
Address: branch circuit 56.18 2
City/State/ZIP: Each add'I branch circuit 7.42 2 2
I Miscellaneous(service or feeder not included)
Phone:( 5019321174 I Fax: :( ) Each manufactured or modular
67.84 2
dwelling,service and/or feeder
Email: .
Cbusserglumenal.com Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: Lumenal Lighting LLC Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address: 21706 66th Ave west panel,alteration,or extension. 0 See Page 2 2
Each additional inspection over allowable in any of the above
City/State/ZIP: Mountlake terr Wa 98043 Additional inspection(I hr min) 66.25/hr
Phone:( 425)481 5001 Fax:( ) Investigation(I hr min) 90.00/hr
Industrial plant(1 hr min) 78.18/hr
Email: -,/ /X f,,.///il)1-
Inspettions for which no fee is
specifically listed CA hr min) 90.00/hr
CCB Lie.: Electrical Lie.:C600 Suprv.Lie.: 5627s
189817ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: I, Z5i/4144 Subtotal: 71.02
Date: 11-4-19 0 Plan Review Required(25%of permit fee):
Print name: Cathy Busser
State surcharge(12%of permit fee): 8.52
Authorized signature:
TOTAL PERMIT FEE: 79.54
This permit application expires if a permit is not obtained within 180
Print name: , ... 451,f,a14.4,_ Date: 11-4-19 days after it has been accepted as complete.
/ * Number of inspections allowed per permit.
1\Building\Permits 1 ELC_Permit pp_ELR_ERE doc Rev 06/17/2015 440-4615T(1 1/05/COMIWER