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Permit (11) • pl:SGWRE City of Tigard December 3, 2013 Parkin Electric Attn: Amanda Donaldson 14001 Fir Street Oregon City, OR 97045 Re: Permit No. ELC2013 -00552 Dear Applicant: The City of Tigard has processed a refund for fees on the above referenced permit(s) as follows: Site Address: 11530 SW Pacific Hwy Project Name: Black Rock Coffee Job No.: N/A Refund: ❑ Check # in the amount of $ ® Credit card "return" receipt in the amount of $6.65. Note: Please allow 2 -5 days for this refund, transaction to be credited to your account by the company that issued your card. ❑ Trust account "deposit" receipt in the amount of $ Comments: Per applicant's request of (1) branch circuit for sign. Refund 80% of permit fees. If you have any questions please contact me at 503.718.2430. Sincerely, v Dianna Howse Building Division Services Supervisor Enc. 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.639.4171 TTY Relay: 503.684.2772 • www.tigard or.gov City of Tigard TIGARD Accela Refund Request This form is used for refund requests of land use, development engineering and building permit application fees. Receipts, documentation and the RequestforPermitAction form (if applicable) must be attached to this request form. Refund requests are due to Accela System Administrator by each Wednesday at 5:00 PM. Please allow up to 3 weeks for processing of refunds. Accounts Payable will route refund checks to Accela System Administrator for distribution to applicant. PAYABLE TO: Parkin Electric Inc. DATE: 12/3/2013 Attn: Amanda Donaldson 14001 Fir Street REQUESTED BY: Dianna Howse Oregon City, OR 97045 TRANSACTION INFORMATION: Receipt #: 193947 Case #: ELC2013 -00552 Date: 11/14/2013 Address /Parcel: 11530 SW Pacific Hwy Pay Method: CreditCard Project Name: Black Rock Coffee EXPLANATION: Per applicant's request for refund of (1) branch circuit for sign. Refund 80% of permit fee. REFUND INFORMATION: Fee Description From Receipt Revenue Account No. Refund Example: Building Permit Fee Example: 2300000 -43104 $ Amount Electrical Permit 220- 0000 -43103 $5.94 12% State Surcharge 100- 0000 -24001 .71 TOTAL REFUND: $6.65 APPROVALS: SIGNATURES /DATE: If under $5,000 Professional Staff If under $12,500 Division Manager 01Z If under $25,500 Department Manager If under $50,000 City Manager If over $50,000 Local Contract Review Board FOR TIDEMARK SYSTEM ADMINISTRATION USE ONLY Case Refund Processed: I Date: I /_�.4 //j.3 I By: ,e§( 1: \Buildin \Refunds \RefundRe doc x 09/01/2010 Front: 11/20/2013 11 :18 #090 P.001 /003 - y of Tigard and • COMMUNITY DEVELOPMENT DEPARTMEN EC EIVE � g o Request Permit Action NOV 2 0 2013 IG.A T RD 13125 SW Hall Blvd. • Tigard. Oregon 97223 • 503.718.2439 • \\ NAW.ti_>ar - r ARD TO: CITY OF TIGARD BUILDING DIVtS G S Building Division Services Supervisor " U 13125 SW Hall Blvd., Tigard, OR 97223 0 (� Phone: 503.7182430 Fax: 503.598.1960 www ugard or.gov FROM: ❑ Owner ® Applicant n Contractor n City Staff (check one) REFUND OR Name: Parkin Electric, Inc INVOICE TO: (Bu mess of Individual) Mailing Address: 14001 Fir Street City /State /Zip: Oregon City, OR 97045 Phone No.: 503 - 657 -4958 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): ❑ CANCEL /VOID PERMIT APPLICA"1'ION. ® REFUND PERMIT FEES (attach copy of original receipt and provide explanation below). ❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below). n REMOVE /REPLACE CONTRACTOR ON PERMIT (do not cancel permit). Permit #: ELC2013 -00552 Site Address or Parcel #: 11530 S.W. Pacific Hwy Project Name: Black Rock Coffee Subdivision Name: Lot #: EXPLANATION: Partial Refund of ckt for just sign 0 Signature: ;; �� Date: //- o '.- /3 Print Name: / !ly r .. ✓Or d p r' 7, V.z , P Refund I'obec ' ' •f .5 /`-E ,tas 1 the Director in Building Official may authorize the refund of A 9'J" e — _ /,6 6 T9i../6 a) any fee which was erroneously paid or collected I>) not miiiC than 80 of the land use application fee when an application is u ithdra\en or canceled be fine an) II view et fort has been upended c) not more than 8(1" o of the land use application tee for issued permits. el) not moo than St)" o of the building plan re\ieo fee when an application a canceled before any plan rei tree elfin t has been upended e) not more than 80' o of the building permit fce liir i permits pnoi to anv incpeeuon I worst.: 2 Refunds a ill be returned to the ongtnal Pa) er in the same method in ee itch payment was recut ed Please allow 2 -4 weeks lot processing refunds FOR OFFICE USE ONLY Rte to Sys Admin- lienrffigin WM Rte to Bld• Admin: Date / T Refund Processed: EIBMANSI LP. I Invoice Processed: Date BV Permit Canceled: Date A c By rr Parcel Tag Added: Date By Receipt # Date Method Amount $ ' I. \ Building \Form: \ Roll'ornit. \ oion.doc Rev t)5 /25/2012 CITY OF TIGARD ' ELECTRICAL PERMIT 8 COMMUNITY DEVELOPMENT rho /3 Permit#: ELC2013-00552 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/18/2013 Parcel: 1 S136DA00800 Jurisdiction: Tigard Site address: 11538 SW PACIFIC HWY Project: Black Rock Coffee Bar Subdivision: PFAFFLE PLAZA CONDO Lot: 2 Project Description: (2)feeders for coffee bar. 11/14/13:Reprinted permit to include(1)branch circuit for sign light. 11/19/13,removed branch circuit for sign lighting from permit per request of contractor,Deb 11/20/13,reprinted to correct address from 11540 to 11538 SW Pacific Hwy. Contractor: PARKIN ELECTRIC INC Owner: HIGH HAT RESTAURANTS, INC 14001 FIR STREET 11530 SW PACIFIC HWY OREGON CITY, OR 97045 TIGARD,OR 97223 PHONE: 503-657-4958 PHONE: FAX: 503-557-1059 FEES Quantity Description Date Amount 2 ea Services or Feeders-200 09/18/2013 $201.40 Specifics: amps or less 1 crt Branch Circuits w/Purchase 11/14/2013 $7.42 Type of Use: COM Service or Feeder Class of Work: ALT 1 ea 12%State Surcharge- 11/14/2013 $25.06 Electrical Type of Const: Occupancy Grp: Total $233.88 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: • -•• law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 th/• gh OAR 9 =001-•'90 You may obtain a copy of the rules or direct questions to OUNC by calling 50 . 987 or 1.800,332.2344. Issued By: d eei -a �—!� Permittee Signature: if 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. Thls 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. CITY OF TIGARD ,. ELECTRICAL PERMIT•a 7 ; COMMUNITY DEVELOPMENT Permit#: ELC2013-00552 T jGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 ��9 / • ` •"� Date Issued: 09/18/2013 Parcel: 1S136DA00800 Jurisdiction: Tigard Site address: 11540 SW PACIFIC HWY Project: Black Rock Coffee Bar Subdivision: PFAFFLE PLAZA CONDO Lot: 2 Project Description: (2)feeders for coffee bar. 11/14/13:Reprinted permit to include(1)branch circuit for sign light. 11/19/13,removed branch circuit for sign lighting from permit per request of contractor,Deb Contractor: PARKIN ELECTRIC INC Owner: HIGH HAT RESTAURANTS, INC 14001 FIR STREET 11530 SW PACIFIC HWY OREGON CITY,OR 97045 TIGARD,OR 97223 PHONE: 503-657-4958 PHONE: FAX: 503-557-1059 FEES Quantity- Description- — - Date-- - - -Amount - 2 ea Services or Feeders-200 09/18/2013 $201.40 Specifics: amps or less 1 crt Branch Circuits w/Purchase 11/14/2013 $7.42 Type of Use: COM Service or Feeder Class of Work: ALT 1 ea 12%State Surcharge- 11/14/2013 $25.06 Electrical Type of Const: Occupancy Grp: Total $233.88 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 a ante 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. ATT TION: Oregonw es you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001- 10 through OAR 952- 1-00 . u may obtain a copy of the rules or direct questions to OUNC b . Ii_ 3.232.1987 or 1.00.332.2344. Issu d By: Permittee Signature: • w. O 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. CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit#: ELC2013-00552 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 li Date Issued: 09/18/2013 ILI Parcel: 1 S 136DA00800 Jurisdiction: Tigard Site address: 11540 SW PACIFIC HWY Project: Black Rock Coffee Bar Subdivision: PFAFFLE PLAZA CONDO Lot: 2 Project Description: (2)feeders for coffee bar. 11/14/13: Reprinted permit to include(1 branch circuit for sign light. Contractor: PARKIN ELECTRIC INC Owner: HIGH HAT RESTAURANTS, INC 14001 FIR STREET 11530 SW PACIFIC HWY OREGON CITY, OR 97045 TIGARD, OR 97223 PHONE: 503-657-4958 PHONE: FAX: 503-557-1059 FEES Quantity Description Date Amount 2 ea Services or Feeders-200 09/18/2013 $201.40 Specifics: amps or less 1 crt Branch Circuits w/Purchase 11/14/2013 $7.42 Type of Use: COM Service or Feeder Class of Work: ALT 1 ea 12%State Surcharge- 11/14/2013 $25.06 Electrical Type of Const: Occupancy Grp: Total $233.88 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 through OAR 952-001-0090. You may obtain a co. . •- - or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: gnature: Yee- '% 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. • From: 11/13/2013 09:37 #083 P.002/002 Electrical Permit Application EC E VE r • FOR OFFICE USE ONLY -1 l• City Tigard Received Permit No.: • 13125tSW Ball Blvd.,Tigard,OR 97223 NOV 1 3 2013 Plan Rev EGG�13`oo55. i; = Pan Review Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit: TIGARD Inspection Line: 503.639.4175 CITY OF TIGP►RD Date Ready/By: turfs: See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental Information �- IV ., .. ., .. :.. -`t•T1rPE,OF;Wo .�i ' .PLAN;REV* V eve construction ❑Addition/alteration/replacement Please check all that apply(submit a sets of plans w/items checked below): ❑Scrvtce or feeder 400 amps or more ❑Building over three stories. ❑Demolition ❑Other: whcrc the available fault current ❑Marinas and boatyards. :',., `" -- volts or ❑Floating buildings. -`LATE R'Y`QF�i GONSTRUCIRON�?:Ti::-:s:'%��:'--r� '..��s��'�:,"<=r exceeds 10,000 amps at 150 -. ..- ..:....-. ..... , ° ... - �•• less to ground,or exceeds 14,000 ❑Commercial-use agricultural ❑ I-and 2-family dwelling Commercial/industrial ❑Accessory building amps for all other installations. buildings. ❑Multi-family ❑Master builder ❑Other: ❑Fife pump. ❑Installation of 75 KVA or JOB-:SIT :.INrORMA Titi ._ ,:.�.�:.:._ Emergency system. larger separately. rived system ->•: . ..:,2- . ,'l.,Ol' 'I'I N� „_..:..., o ncwmotorloadof ❑..A,. .f„ .,1.2., .,l.v.. Job no.: Job site address: //11 { 100HP or more. occupancy. 11CF �` J�, �•.�_�- ❑Six or more residential units. ❑Recreational vehicle parks City/State/ZIP: ❑Health-care facilities. ❑Supply voltage for more than �Q (� ,, '-' 7�� ❑Hazardous locations. 600 volts nominal Suite/bldg./apt. no.: Project name: 1 ❑Service or teeder 600 amps or more. _ FEE:SCREDULE',:_- ' Cross street/directions to job site: ; �/ 1� Description I Qty. I Fee, I Tavel I■jJ New residential single-or multi-family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1.000 sq.ft.or less 168.54 4 Ea.add'I500sq.ft.of portion 33.92 I Tax map/parcel no.: Limited energy,residential 7500 ':DES.CRIP 'ION.OFsWORK' .. . . ' , (with above sq.ft.) !1 >! C/ . Limited energy,multi-family 75 5 ,00 2 residential(with h above s ft.) Services or o eders installation,alteration, relocation 2 ] / /7A-f- ot 100.70 2 .PROPERTY:OWNER. ::: . ,.,1 " - TEAT . ... %01 amps to 400 amps 133.56 2 NN , 401 amps to 600 amps 2 Name. O' c, - �� 601 amps to 1,000 amps 301.04 Address: Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation,alteration,and/or City/State/ZIP: relocation _ Phone: ( ) Fax:( ) 200 amps or less 59.36 I — 201 amps to 400 amps 125.08 2 Owner installation:This installation is being made on property that I own which is not intended for sale,lease,rent,or exchange,according to ORS 447,449.670,and 701. 401 amps to 599 amps 168,54 2 Branch circuits–new,alteration,or extension,per panel Owner signature: Date: A.Fee for branch circuits with []"APPLICANT:;.,;,°`:..,, z:. .``.,,.,'.; <..:;•:: ;,,,, above service or feeder fee. ' ,.." ..,..,_.....,, .... 1 .Q CONTACT."PERSQN,:•°.: :'.;:": each branch circuit 7.42 7 2. 2 Business name: I3.Fee for branch circuits without service or feeder fee,first 56 18 2 Contact name: branch circuit Each add''branch circuit 7.42 _ 2 Address: Miscellaneous(service or feeder not included) City/State/ZIP: ' Each manufactured or modular 67.84 2 y dwelling,service and/or feeder Phone:( ) Fax: :( ) Reconnect only 67.84 2 Pump or irrigation circle 67.84 2 E-mail: Sign or outline lighting -,2 . CONTRACTOR..: Signal circuit(s)or limited-energy Business name: Parkin Electric panel,alteration,or extension. Page 2 2 Each additional inspection over allowable in any of the above Address: 14001 Fir Street Additional inspection(1 hr min) 66.25/hr City/State/ZIP:Oregon City,OR 97045 investigation(I hr min) 66.25/hr . Industrial plant(1 hr min) 78.18/hr Phone:(503)657-4958 Fax:(503)557-1059 Inspections for which no fee is 90.00/ht specifically listed(h hr min) CCB Lic.: 3515 Electrical �`ZC/` --Suprv. Lic.: 4241-5 EIiEi'1RICAL;PER14i1total: S" . . Suprv. Electrician signature,required: Subtotal: 7, /9 . Plan review(25%of permit fee): ,B 9 Print name: David B Parkin Date: State surcharge(12%,of permit fee): // TOTAL PERMIT FIE: 8,3� Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: Date: • Number of inspections allowed per permit. I.Utuddtng1Pei mii.vt LC-PermitApp.dnr(17/(11/I(1 4.t(14615T(I INS/C(1M/WEB CITY OF TIGARD ELECTRICAL PERMIT 8 COMMUNITY DEVELOPMENT Permit#: ELC2013-00552 Date Issued: 09/18/2013 T[CARD 13125 SW Hall Blvd,Tigard OR 97223 503.718 2439 Parcel: 1S136DA00800 Jurisdiction: Tigard Site address: 11540 SW PACIFIC HWY Project: Black Rock Coffee Bar Subdivision: PFAFFLE PLAZA CONDO Lot: 2 Project Description: (2)feeders for coffee bar. Contractor: PARKIN ELECTRIC INC Owner: HIGH HAT RESTAURANTS, INC 14001 FIR STREET 11530 SW PACIFIC HWY OREGON CITY,OR 97045 TIGARD,OR 97223 PHONE: 503-657-4958 PHONE. FAX: 503-557-1059 FEES Quantity Description Date Amount 2 ea Services or Feeders-200 09/18/2013 $201.40 Specifics: amps or less 1 ea 12%State Surcharge- 09/18/2013 $24.17 Type of Use: COM Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $225 57 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 through OAR 952-001-0090 You may obtain a copy o direct questions to OUNC by calling 503.232.1987 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 603.639.4176 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. From: 09/16/2013 15:44 #010 P.002/002 Electrical Permit Application 0 FOR OFFICE USE ONLY City of Tigard s 0\3 Received �7 I 13125 SW Hall Blvd.,Tigard,OR 9 +• - 1 6 `�� — ---! ��. Phone: 503.718.2439 Fax: 503.598.1960 -S 1 Ap 114111111111111111111 Other Permit: .A / 4( ` T I G A R D Inspection Line: 503.639.4175 5 �1G S1� a ate Ready/By: ® ee Page 2 for • Internet: www.tigard-or.gov O'S ^4 \ Norified/Method (��yy A, Supplemental Information t '�� r ;tii5, <r;:�~ ;,w TYPE',OF,WOIiF,��.,:�_:. 't z" �, , , .. .. -+,, > xt_-;^,tiyTi[.- S��3;:--Zz.:��-. :j;S',xi'Js--' -, ,i�..'.��:S:a:l:,Ja i� v1^;.4'-'%+e'?,�.'je,.{;t,_ 6,::'i1 lAllrti New construction' j ❑Addition/alteratioi cement Please check all that apply(submit sass of plans w/uems checked below). 0 Service ar feeder 400 amps or more ❑Building over three stories. Demolition �❑Other: 1 where the available fault current ❑Marinas and boatyards. 'n,�-,.r 'M,Pi z, gv. ,,�,o. `'gy p Bryn ° ' a o-+`' { .i.Al xceeds 10,000 amps 1 v ?i�:z:;r�'�" 5�,:>t-� i`?;nwx'te1•�'�.�f�!. - :..�,�1;©� �oY�r4�i„S^3��.e>�:�::-��t3�r:�e "�.r��+,.�_iw�ii P 50 nits or ❑Floating buildings. less to ground,or exceeds 14,000 ❑Commercial-use agricultural ❑ 1-and 2-family dwelling ZCommercial/industrial ❑Accessory building amps for all other installations. buildings. ❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 75 KVA or az ; :,;t,: '' ": i'fi .'idly '.r'�.Ve .:0 y" �5rri., <w,-s t.,44:, ❑Emergency ofne em. larger separat ly derived system. .r. .« >i;:-,', a derive ��:' -Q�. � �-sw.��?��`�':;�ti=•'��'.�'��.4�;'.'s• ❑Addition of new motor load of ❑..A....E...1-2., .1.3.. Job no.: 1 Job site address:/1 C y0 �6CJ 100HP or more. occupancy.❑Six or more residential units ❑Recreational vehicle parks City/State/ZIP: 7 art / �f 9 7,223 ❑Health-care facilities. ❑Supply voltage for more than ❑Hazardous locations. 600 volts nominal Suite/bldg./apt.no.:U Project name: ❑Service or feeder 600 amps or more. Cross street/directions to job site: Deseripnon I Qty. I Fee. 1 Total 1 • New residential single-or multi-family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq.ft.or less j 168.54 4 Tax map/parcel no.. ' Ea.add'l 500 sq.ft.or portion 33.92 1 ��_ _ _ Limited energy,residential '' - .^';i*,,S.C121P:.Xkli'0.Tt..,WORK r=. r9•}.„r�4;4. z tl- :• (with above sq ft.) 75.00 2 _ 4., € ;:?”%";:c„�;_.a >` c, '” .'' with a v /2_ p,, �� may} Limited energy.multi-family 7S 00 2 0) goo 47,, r 412e.„5 -to l44,0 residential(with above sq.ftJ c�p� Services or feeders installation,alteration,and/or relocation -ra CCi.7 200 amps or less (9, 100 70 Jet 90 2 ' I';PROP = :,S<I= am to 400 am s ERT:Y?,UWIVlili;.�`y:t;r,�:2`i.�!�i�.:=��.;.,i'i�as��:�'.'.!`�,'_s'Z+H, F%.� 20l p, 2 F , •rYf :; Ps 133.56 (✓I� r'O c l( / r�� 401 amps to 600 amps 200.34 2 Name: /� / t-O d-T"C _ 601 amps to 1,000 amps 301.04 2 ' Address: `1/52/0 S 4 NW), Over 1,000 amps or volts 552.26 2 Temporary- o l CX 6 4 7,9073 relocation services or feeders installation,alteration,and/or City/State/ZIP: j Phone:( ) Fax:( ) 200 amps or less 59.36 1 Owner installation:This installation is being made on property that I own which is not 201 amps to 400 amps 12508 2 intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 599 amps 168.54 2 Owner signature: Date: Branch circuits-new,alteration,or extension,per panel A.Fee for branch circuits wish'=1`t` service or feeder fee, i_<; ..ski; i+`'®t A1'I+I�tfW,�; <+.;'c: f?f` t�r cxt;.ti:j0(CQNTC�I RSt11NF; ,r 1; above 7 4 - ta':- . e, each branch circuit 2 2 Business name: B.Fee for branch circuits without service or feeder fee,first 56.18 2 Contact name• branch circuit Each add'l branch circuit 7.42 2 Address: Miscellaneous(service or feeder not included) Each manufactured or modular City/State/ZIP: dwelling,service and/or feeder 67.84 2 Phone:( ) Fax: :( ) Reconnect only 67.84 2 Pump or irrigation circle 67.84 2 E-mail: = i'`-' .;;4x± t Jr: >�`t`'ivL'ONi'12AC'iiOR'1' '': �.s cr " c>c,. Sign or outline lighting 67.84 2 •_*;i,-Zrf:> ..k - xX.. . s:s•: .•,_-y-'tr.tr-$ n"4:t Signal circuit(s)or limited-energy Business name.Parkin Electric panel,alteration•or extension. Page 2 2 . Each additional inspection over allowable In any of the above Address: 14001 Fir Street Additional inspection(I hr min) 66.25/hr City/State/ZIP:Oregon City,OR 97045 Investigation(1 hr min) 66.25/hr Industnal plant(1 hr min) 78.18/hr Phone:(503)657-4958 Fax:(503)557-1059 Inspections for which no fee is /.t'/�,_ specifically listed(S hr min) hr CCB Lic.: 3515 r� Electrical Liicc..: 34-4C 4/ ' Jttprv.Lic.: 4241-S ✓ ` "�'•'""1'H"" E �}y IVC:kl` (@p(� -, //��!� c Ki t.y."^}2l tit«il-.'la:`a.q••'7�,'F}4V;r !`. ��tal:W.''.k...Y.`•'ti'i'. !�.`•n• Subtotal: Suprv.Electrician signature,required: Plan review(25%of permit fee): G/•y� Print name: David B Parkin Date: State surcharge(12%of permit fee): a//. 17 TOTAL PERMIT FEE: 3, 5',5-7 Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: Date: • Number of inspections allowed per permit. I:t nuildmy\Permits'ELC•PermiApp.doe 07/01/10 440.4615T(i 1I05/COMAVEB Location: Record Type: Inspection Type: Comments: Inspection Date: Record ID: Result: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 11538 SW PACIFIC HWY, TIGARD, OR, 97223 Commercial - Electrical 199 Electrical ﬁnal 2013-11-21 00:00:00 ELC2013-00552 PASS - No C of O Violation Summary: Inspector Contractor