Permit CITY OF TIGARD ELECTRICAL PERMIT
I COMMUNITY DEVELOPMENT Permit #: ELC2009 -00166
Date Issued: 04/15/2009
T I G ARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S 115BA02600
Jurisdiction: Tigard
Site address: 16230 SW PACIFIC HWY 100
Subdivision: Lot: 0
Project: Panda Express
Project Description: TI - (2) feeders and (4) branch circuits for HVAC units and GFI receptacle.
•
Owner: FEES
SN PROPERTIES PARTNERSHIP Quantity Description Date Amount
1121 SW SALMON ST 2 ea Services or Feeders - 200 04/15/2009 $160.60
PORTLAND, OR 97205
amps or less
PHONE: 4 crt Branch Circuits w /Purchase 04/15/2009 $26.60
Service or Feeder
Contractor: 1 ea 12% State Surcharge - 04/15/2009 $22.46
R C COSTELLO ELECTRICAL CONTRACTING INC Electrical
PO BOX 336
AURORA, OR 97002
PHONE: 503 -982 -7400
FAX: 503- 982 -7400
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $209.66
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 Center. Those rules are set forth in OAR
952 - 001 -0010 ugh 0 52- 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 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'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 Received PermitNo.: 4LC�'l j cio o
i
DateB : 'Y / S 0 ' 7
1 1113/44 [
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
= Phone: 503.639.4171 Fax: 503.598.1960 DateBy: Other Permit:
Inspection Line: 503.639.4175 Date Ready /By: 3uris: 0 See Page 2 for
T I G A RD
Internet www.ttgard- or.gov Notified/Method: �� Supplemental Information
• TYPE OF WORK PLAN REVIEW 1 ? f v
Please check all that apply (submit 2 sets of plans w /items checked below):
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❑ New construction ❑ tion /alteration /replacement P ❑ Building over three stories.
ur/ ❑ Service or feeder 400 amp or more
❑ Demolition Other: T where the available fault current ❑ Marinas and boatyards.
CATEG,RY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings. • less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
l�J
❑ 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
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of
I OOHP or more. occupancy.
Job no.: Job site address: 162030 SW i �� ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: ❑ Health - care facilities. ❑ Supply voltage for more than
� L ❑ Hazardous locations. 600 volts nominal.
al
�iii� • ldg. /apt. no.: 160 Project name: PGI n d♦a. Exerts s S he 1 I ❑ Service or feeder 600 amps or more.
r• FEE SCHEDULE
Cross street/directions to job site: Dv r he, M R0 4 rand q I q (4 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
DESCRIPTION OF WORK ' , . (with above sq. ft.) 75.00 2
roe R A Limited energy, multi - family 75.00 2
2 f e d e r 5 y branch tC it u i +s 1 Nil C. residential (with above sq. ft.)
J /� �• Services or feeders installation, alteration, and/or relocation
U /1 I T S ail d G f T ReCep + it Ie 200 amps or less 2„ 80.30 /40,6c 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name:
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 I 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 ❑ CONTACT PERSON above service or feeder fee, q 6.65 2 c 60 2
each branch circuit
Business name: B. Fee for branch circuits
without service or feeder fee, 46.85 2
Contact name: 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
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 circuit(s) or limited -
Business name: R. C. C // E/ a4icq / Cvrr7/��'elti energy panel, alteration, or
Address: p 30x 33, extension. Describe: Page 2 2
City/State /ZIP: fjord 0 9 FJoo2_ Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (503)9$ 2.9Lioo Fax: (503 7 _ Investigationperhour(1hr min) 62.50
CCB Lic.: 57y02, Electrical Lic.: 3 - 3 Li tic Suprv. Lic.: ,3 ',3 5 Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal. / 8 9. 20
tt Plan review (25 %of permit fee):
Print name: R� ��. C. Co de. !O Date: / / S /O9 State surcharge (12% of permit fee): ' 22 . -i Z
Authorized signature: TOTAL PERMIT FEE: 20 q. b b
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
• Number of inspections allowed per permit.
I\ Building \Permits \ELC- PennitAppdoe 05/23/06 440.46I5T(II /05/COM/WEB