Permit . t
`!�' ) ELECTRICAL PERMIT
liAll CITY OF TIGARD F,
° a COMMUNITY DEVELOPMENT ISSUED: 2/11 /2009 PERMIT #: ELC2009 -00057
DATE IS
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1S136CC-02100
SITE ADDRESS: 11746 SW PACIFIC HWY ZONING: C -G
SUBDIVISION: DUTCH BROS. COFFEE LOT : JURISDICTION: TIG
PROJECT: DUTCH BROS. COFFEE
Project Description: Install (1) 200 amp panel, and (25) branch circuits.
RESIDENTIAL UNIT TEMP SRVC/FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
• EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HM/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10):
SERVICE/FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: 1 W /SERVICE OR FEEDER: 25 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: >=4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
GRUNBAUM FAMILY TRUST AC & E ELECTRIC CO
21390 SW EDY RD 3535 DEL WEBB #100
SHERWOOD, OR 97140 SALEM, OR 97303
•
Phone: Contact #: PRI 503- 363 -2301
FAX 503 - 363 -2302
FEES
Description Date Amount Reg #: ELE 24 -IC
[ELPRMT] ELC Permit 2/11/2009 $246.55 LIP 591
[TAX] 12% State Surchar 2/11/2009 $29.59 SUP 4702S
Total $276.14 REQUIRED ITEMS AND REPORTS
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in
OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By: (Min !If M Permittee Signature: .QQ . .2419( I `t r 4 c ) n
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.
d .,,,,_ r .
Electrical Permit Application RECEIV r I:OR OFFICE USE ONLY
City of Tigard FEB 112009 Received Permit No
° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review - 1 \ • 09 E��O� . 7
. Phone: 503.639.4171 Fax: 503.598.1961tnTY OF TIGARD Date/By: Other Permit. 2OcR , OOc 7
T I G A R D Inspection Line: 503.639:4175 Date Ready/By: Juris: ei See Page 2 for
Internet: www.tigard - or.gov BUILDING DIVISIO Notified/Method: T 1 Q`) Supplemental Information
TYPE OF WORK PLAN REVIEW
Please check all that apply (submit 2 sets of plans w /items checked below):
® New construction ❑ Addition/alteration /replacement
❑ 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
❑ I- 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 LNFORMATION AND LOCATION JOB system. larger separately derived system.
. ❑ Addition of new motor load of ❑ "A ", "E ", "l -2 ",' l -3 ",
Job no.: Job site address: 11744 SW Pacific Hwy IOOHP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: Tigard OR 97223 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: Dutch Brothers Coffee ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qn• 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 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Coffee Store Limited energy, multi - family 75.00 2
residential (with above sq. ft.) - _
Services or feeders installation, alteration, and /or relocation
200 amps or less 1 80.30 80.30 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps - 106.85 2
Name: _ _ . . - 401 amps to 600 amps 160.60 2
I , .. _ - 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 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 599 amps 133.75 2
Owner signature: Date: Branch circuits- new, alteration, or extension, per panel
A. Fee for branch circuits with
. ❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee, 25 6.65 166.25 2
each branch circuit
Business name: B. Fee for branch circuits
without service or feeder fee,
Contact name: first branch circuit 46.85 2
Address: Each add'I 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 circuit(s) or limited -
Business name: AC &E Electric energy panel, alteration, or
Address: 3535 Del Webb. extension. Describe: Page 2 2
City /State /ZIP: Salem OR 97301 • -- - - • - -- - - • -- Each additional inspection over allowable in any of the above '
Per inspection . . 62.50 .
Phone: (503) 363.2301 - - . _ . - Fax: (503) 363.2302- - -- -- - - - -- -- - Investigation per hour (I hr min) " . 62.50 -- - -
CCB Lic.: 591 - Electrical Lic.: 2 IC - Suprv. Lic.:- 5387S - - -- In dustrial plant hour - -" - 73.75
ELECTRICAL PERMIT FEES • Suprv. Electrician signature, required: / v�� - Subtotal: - 246.55
!La/L Plan review (25% of permit fee): -
Print name: Carl Duncan Date: 2/10/09
State surcharge (12% of permit fee): 29.59
Authorized signature: TOTAL PERMIT FEE: 276.14
Print name: This permit application expires if a permit is not obtained within 180
Date: days after it has been accepted as complete.
• Number of inspections allowed per permit.
l:\ Building \Permits\ELC- PermitApp.doc 05/23/06 440-46t5T(11/05 /COM/WEB
CITY OF TIGARD •
BUILDING DIVISION t PERMIT #: .0j'7
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 Aoy'
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 4124 169 TIME: PAGE:
SITE ADDRESS: ‘I1 L �6 s(.1,) pgaFic
CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 411:1 b a Pour Time:
Code # Inspection Description Confirm # Contact # Message
Corrections /Comments/ Instructions:
FA PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G" utl be L Date: Z/ D 9 Phone #: (503) 718- lg j'
•
CITY OF,TIGARD
BUILDING DIVISION PERMIT #:ar,ZQ 06'7
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2 -1` ,o
Phone: (503) 639 -4171 Aroototal#
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: . � .09 TIME: PAGE:
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SITE ADDRESS:%I "1 b 5 W j 6* , �A �-1�t . CLASS OF WORK:
SUBDIVISION: LOT #: J TYPE OF USE:
PROJECT NAME: tcrc.AN Uts .
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: Ail 2310(1 Pour Time:
Code # Inspection Description Confirm # Contact # Message
Corrections /Comments /Instructions:
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n PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: N b Q t Date: 23 0 Phone #: (503) 718- _
CITY OF TIGARD
•
BUILDING DIVISION PERMIT #: — nSe2256 ^ 09fl
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639-4171
Requests (24 Hrs.): (503) 639 -4175 F:_..
INSPECTION WORKSHEET FOR DATE: 1.� `, \ L),, TIME: PAGE:
SITE ADDRESS: \ 11 1 - 4 j `c, S vV CLASS OF WORK:
SUBDIVISION: LOT : TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: Ile -ALA, • Pour Time:
Code # Inspection Description Confirm # Contact # Message
Corrections /Comments / Instructions:
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•
1174pAss ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: Yv t® ( -#C" Date: 4 \ 1 4I 0 Phone #: (503) 718- eid4
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CITY OF TIGARD kit
BUILDING DIVISION PERMIT #:E1S02809 • 1
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 Ata
Inspection Requests (24 Hrs.): (503) 639 -4175 A P.
INSPECTION WORKSHEET FOR DATE: LA I1 1( 001 TIME: PAGE:
SITE ADDRESS:\ 1 S w PA 4 g t,V CLASS OF WORK:
SUBDIVISION: V LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #: •
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date:41 1 3J GI Pour Time:
Code # Inspection Description Confirm # Contact # Message
115 S V1
Corrections /Comments/ Instructions:
(1) its(i� . 312 . b • • Vicarmi 1(:). A" w► - w
I,N 6 i ore" 6 Vi< e p...)s-L •
❑ PASS ❑ PARTIAL APPROVAL n CANCEL ❑ NO ACCESS
A FAIL A CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: V : mb Date: 1 Phone #: (503) 718 - 1,
CITY OF TIGARD
BUILDING DIVISION PERMIT #:ELC2b61-•6006'1
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2 (� 0)1
Phone: (503) 639- 4171
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: L 1 9101 TIME: PAGE:
SITE ADDRESS: 1 l 1 "1 ® 661/4) Pn c* � r1 CLASS OF WORK:
SUBDIVISION: _ LOT #: TYPE OF USE:
PROJECT NAME: Vl Oik CSC V)6 0A1(,`'.
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 419161 Pour Time:
Code # Inspection Description Confirm # Contact # Message
Corrections /Comments /Instructions:
c-vR.e 101' 2'i o a P60 1 - Pte, + ‘1 3 () •
38 '2 - b
n PASS ^ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
X FAIL / CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: Cr • J bel t--E Date: 41 911 Phone #: (503) 718- lggt•
•
CITY OF TIGARD .
BUILDING DIVISION PERMIT #11, t2,001•6
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2 89
Phone: (503) 639 -4171 4‘,41011& Inspection Requests (24 Hrs.): (503) 639 -4175 `1
INSPECTION WORKSHEET FOR DATE: 141 S Jo I TIME: PAGE:
SITE ADDRESS: % r A l0 5 w PA CtVI(. N wy CLASS OF WORK:
SUBDIVISION: / LOT #: TYPE OF USE:
PROJECT NAME: 1)v'l %tuts, . coRKE
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 1A(t(bq Pour Time: or O't_
Code # Inspection Description Confirm # i Contact # Message
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Corrections /Comments /Instructi6ns:
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LA RA 1 O..— .. kO 3 GO .
1 O S_ v 1►1 000 449 t PA s $
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.,J Attu Nt. Wd pA-L`D -1,
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n PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G 1 v Kle L- Date: I A I e•1 01 Phone #: (503) 718-
CITY OF TIGARD
• BUILDING DIVISION PERMIT #: Ej 2 x.0006
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171
Agjij A4Ir
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 3 .63 0'01 TIME: PAGE:
SITE ADDRESS: y 6 S Tow-WI L. CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: a-`l.'b.t Pour Time:
Code # Inspection Description Confirm # Contact # Message
1 215 GOVE
Corrections /Comments/ Instructions:
7.4. PAS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G.-b. N 66 L Date: 3. Phone #: (503) 718-IRAN
CITY OF TIGARD
BUILDING DIVISION PERMIT #:ELC %OOlq•a006
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 1.
Inspection Requests (24 Hrs.): (503) 639 -4175 ''.I..
INSPECTION WORKSHEET FOR DATE: . (Y31 TIME: PAGE:
SITE ADDRESS:V11 oS W Pp, c.%r C. f w CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date:34S.0 CI Pour Time:
Code # Inspection Description Confirm # Contact # Message
Corrections /Comments/ Instructions:
❑ PASS PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: �� � Date: 34 6 1 . Phone #: (503) 718- 26.6
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❑ Case At Number Street Name Suffix Unit At Description Active Task Opened Balance A ; __
❑ ELC2OrC 11746 PACIFIC Hi^IY Install (1) 200 amp pa... Inspections_ 02; 11/2009 0 D
CAP ID: ELC2009 -00057 • Menu _�_1 New ei Cancel Reschedule T ! Help I ; 1
7-4 il
— + Go To 21 Contacts (0) Documents (0) Fee (2) GIS (2) Hearings Inspections (2) Organization Owner (1) Parcel (2) P. J 11
Inspection Type Scheduled Scheduled Inspector inspection Result Result Comment R ..-.N III
❑ Date Time Date • i t
❑ _ _ _, ca rough -in 03/19/ 12:00 Gary Noble Scheduled 0 ,=:-:1--_--..11 t - f
111 :: _ = secs. =:ca: *cuui - -:r' 03/11.2009 12:00 Gary Noble 03/11 /2009 PART ROOF CONDUIT (M... 0 ' I
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