Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
"II 3 - COMMUNITY DEVELOPMENT Permit #: ELR2009 -00191
Date Issued: 07/21/2009
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S115BA02600
Jurisdiction: Tigard
Site address: 16230 SW PACIFIC HWY 100
Subdivision: Lot: 0
Project: PANDA EXPRESS
Project Description: Low voltage cabling - Data
FEES
Owner:
SN PROPERTIES PARTNERSHIP Description Date Amount
1121 SW SALMON ST Restricted Energy Permit 07/21/2009 $75.00
PORTLAND, OR 97205 12% State Surcharge - Electrical 07/21/2009 $9.00
PHONE: 503 - 450 -0778
Contractor:
CHRISTENSON ELECTRIC INC
111 SW COLUMBIA ST, STE 480
PORTLAND, OR 97201
PHONE: 503- 419 -3300
FAX: 503 - 419 -3695
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: y Fire Alarm: N
HVAC: N Instrumentation: N Total $84.00
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N Required Items and Reports (Conditions)
1 Pln Gen FINAL INSPECTION BY PLANNING
Nurse Calls: N Protective Signal: N 2 Pln Gen INSTALL 6 ADDITIONAL PKNG. SPACES
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 OA 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.
Issued By: 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.
' 7UL-16-2009 THU 02:41 PM CHRISTNtN6tIVE T. FAX NO 95034193695 P. 01
- Electrical Permit Application 14)14 0141(1: lisE oNIN
City of Tigard R.ceive4
2 009
14 -- " 13125 SW Hall Blvd„ Tigard, OR 977,23 JUL 1 6 2 ... Date/a . ___ (--5
Plan Review Pc_rtnit_No.: ;-. 4 2, ice- co( ii
; . Phone: 503,639.4171 Fax: 503.598,1960 Other Permit:
Inspection Line: 503.639.4175 Reis; Ed See Page 2 for
TItiAlti) .
ntr
Ienet: WwW.tigard-nr.gov
C11 OF TIGAR I Datialai ; e lB . th r
Supplemental Information
i
!I! s i , —, -
4•NAPI'ir I IIIb046j3gbd.,,.,...44,1;yr:09NITN;I.I.,.,01II,III a•IIIi'IV:OIrIII • pi, , stv iei
.i t:, ,; .2r. sari ..:, . .: . .9m : w - st ,, Irs , s,7 ,,,. - . , ... - ss,1 ,,,,:+ ,sius . .s.., s - -, ,s ss !.„ ., 0, , , i 1 .', ,,■ ,,,,, , 10H . " , ,,,,,,, , p
few construction le Addition/alteration/replacement PienSe check all that apply (submit Z sets of plans w)liernS checked below);
0 Service or feeder 400 amps or more 0 Building over three atones.
U Demolition 0 • tiler: whore the available fault current I:I Marinas and boatyards.
;'41'1IIIIYII■tIiP.I! exceeds 10,000 amps at 150 volts or 0 Floating buildings.
, I 1 , JP' f ':..‘, , • .■ ,,' ,” 'LL .1 ' [ 1 1 ' '..
. ' . .. . . ' ' . ' ' *. ' . ''' ' , '4 v4.1,.ttilA,,o,e,41 . ' '.." . ' A . T" • less to ground, or exceeds 14,000 0 Commercial-use agricultural
0 1- and 2-family dwelling Commercial/i ndustrial 0 Accessory building amps for all other installations, buildings.
0 Multi-family Master builder L] Other: OFirepuirrp. 0 installation of 75 KVA or
liner Separalely derived sysiern.
*W 0 Addinon of new motor load of 0 "A", "E", "1-2", "1-3",
Job no.: tk P. 1 Job site address: a50 5 A tt ,, 0 N , , y
. . . . .. . k
Si x or more residential units. occupancy.
ra Recreational vehicle l u r k s .
City/State/ZIP; \, CKAA 0 C._ C A C I D-(9'.
s ,.. i H He it a fh
Health-core eilines.
ardona locations. 0 Supply voltage for more than
J
600 volts nominal.
Suite/bldg./apt. no.; c D Project name: liithEipaf..
0 Service or feeder 600 amps or more.
M
f',lio-9'1"::);PR'.'1;'
Cross street/directions to job site: 4,icripriall 1 Qty. I fec. I Total I •
b(N1 .
New residential single- or multi-tamily dwelling unit.
1 7 Z)1 )t : ' - Includes attached garage. . , .
Subdivision: Lot no.: 1,000 sq. R. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40
_ . i .
Tax map/parcel no.: Limited energy, residential
75,00 2
l :l'l'-•J . ';!''' : '.',;:.; ; ': : l 1 ,i'll40,t4C*10 , 1t*(0*tiiWf,!''(§! ., ;;;i•'l :2 0::, .!:Rf; ( wit!")°vs4.92)-----_
, I OUk, V0)C.&bit)le1 ; 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 J ■. . An .. .
14 fl..#,*.,, q.1 ' I '1 2 01 amps 10 400 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
/State/ZIP; Temporary services or feeders Installation, alteration, and/or
. /-• '
relocation
r .“4111,11 ( ) I Fax: ( ) 200 amps or less 66.85 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 509 amps 133.75 2
Branch circuits- new, alteration, or extension, per panel
Owner signature; Date: A. Fee for branch circuits with
■:::' 'Itri40,0:6W vi4:s 71'.'?;' ' ,''; ' iosi*iiii46, above service or feeder fee,
!: '1.! IL ,.,; ,,! • . ,. '1•:./ 4.': I 6,65 2
each branch circuit
Business name: B. Fee for branch circuits
„ .
without service or feeder fee,
Contact name: first branch circuit 46-85 2
- -
, Each add'i branch circuit 6.65 2
Address: - . .
.. Miscellaneous (service or feeder not included) . ..
City/State/ZIP: . Each manufactured or modular 90
.
., 2
dwelling service and/or feeder 90.
Phone; ( ) [Fax: ; ( ) 2 Reconnect only
66,85
... .. . - . .
E-mail: Pump or irrigation circle 53,40 2
• 53.40
'.,;,•'.':4'..:l",:1,.:, .,',_'!., .:. •-1'.'l 4.l:' , ,. - '., :• '.' •,.',!, ..'-';, : . '.'..: ,:!.' Sign or outline lighting 2
Signal circuit(s) or limited-
Business name: Christenson Electric, Inc.
energy panel, alteration, or
Address: 111 SW Columbia, Suite 480 extension. Describe: Page 2 2
City/State/ZIP: Portland, OR 97201 C. — Each additional inspection over allowable in any of the above
—
Per inspection . 62.50
Phone: (503) 419 . ' 4_ ' LIC,k Fax: (so3)..gooq5 investigation per hour (i lie min) 62.50
CCB Lie.: 458 s i Electrical Lie.: 26-34C Suprv. Lie.: 1194S Industrial plant per hour 73.75
A
ll ,i"FeES;
Suprv. Electrician signature, required: 11111111MWrif Subtotal: ' O
Print name: Robert Axt Date: ( t7 . Plan review (25% of permit fee):
State surcharge (12% of permit fee): 14W
-
_.iorized signature: TOTAL PERMIT FEE:
...
i This permit application expire/ if a permit is not obtainc it to ISO
Print name: Date7 days alter it ban been accepted as complete.
• Number of inspectim allowed per permit.
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