Permit CITY OF TIGARD ELECTRICAL PERMIT .,
1 'I ' COMMUNITY DEVELOPMENT Permit #: ELC2012 -00174
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/27/2012
Parcel: 1 S135AB04500
Jurisdiction: Tigard
Site address: 10250 SW GREENBURG RD 101
Project: LC Cafe Espresso Subdivision: 1991 -055 PARTITION PLAT Lot: 1
Project Description: (1) branch circuit
Contractor: CAPITOL ELECTRIC CO INC Owner: LINCOLN CENTER LLC
11401 NE MARX STREET BY SHORENSTEIN PROPERTIES LLC
PORTLAND, OR 97220 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE: 503 - 255 -9488 PHONE:
FAX: 503 - 257 -7121
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 03/27/2012 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 03/27/2012 $6.74
Type of Use: COM Electrical
Class of Work: ALT •
Type of Const: •
Occupancy Grp:
Total $62.92
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 OA 2 -00 You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: CAI r/ 1 I C
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.
03/27/2012 10:36 5032577121 CAPITOL ELECTRIC PAGE 02/02
Dail OFFICIO USE 9>iNlt.1
Electrical Permit .Applicati i Ec i t �" Rae;vcd
PP,�� natc/gy:� ; /�• ,tna �LG ' �_/ .2 - o/
IN ...ra7 city of Tigard
■ 13125 SW H.63al l)31v4., Tigard, OR 9722 P lan ROVICW
Other Permit:
Phone 5039 Fax 503 �' Dale/By:
T i c, A h. D Inspection Line: 503.639,417S Date Ready /Hy: J uric: % , • see page 2 r e
w
Internet: ow.tigprd- or•gov CITY OF TIGARD Notified/Method: l! Si emental ternonntion
Rui1numn n /isn
-
TYPE OP WORK PLAN REVrBW
Li Ncw construction LI Addition/alteration/rcploeerncnt Meese check all that apply (submit 2 seta of plans w /terns checked below):
❑ Demolition Q Other: CJ Ssrwbe or feeder 400 amps or more ❑ Building over ihres atones
CAA�++- T��EOORY OF CONSTRUCTION where the available fault current 0 Marinas and boatyards
- and 2
1•fhmily dwelling L'J Commercial /industrial L Accessory building exceedS 10,000 amps at 150 volts or L] Floating buildings
❑ Multi - family U Master Builder ❑ Other - less to ground. or exceeds 14.000 [ 1 Commercial-use agricultural
JOB SITE INFORMATION AND LOCATION amps for all other Installations. bulldine
❑ fire Pump ❑ Inetallaisbn of 75 KVA or
Job nv.: 120508 I Job site address; 10250 SW Greenburg Rd El Emergency system Iergor separately derived system.
J ❑ Addlllon of new motor load of ❑ "A°, "e".1-2 "1.3 °,
City /StatcJZ1P: Tigard OR 100HP or more. 0 occupancy
I 11 Six or more residential units ❑ Recreational vehicle parks.
Suite/bldg. /apt no.: 101 !Project name: LC Cab Espresso
L.] Health-care facilities ❑ Supply voltage for more than
Cmm Strcet/Directions to job site: 111111 L] Hazardous locations 600 volts nominal.
❑ Service ur feeder 600 amps FIT more
FEE SCHEDULE
Subdivision: [ Lot n o . pperipelee i Qty. I p,u j 7aa1
Tax map/pared no.: , New residential . single or multidkmlly dwelling unit.
_ DESCRIPTION OF WORK Includes attached :ara:c.
Install 30a - • • - 410 outlet 1000 sq. ft. or lc t. _ $ 190 _ 4
la. Add'I 500 sq. it or portion S 33.92 I
LL PROPERTY OWNER L_ LJ TENANT Limited energy residential
r (with above sq. R) S 75.00 2 -
Namc: Limited energy. multi °family
-
residentialifith above sq. ft $ 75.00 2
Address; '
Service or feeders installation. alteration, and /or relocation
-°• 200 am • s or Tess S I D0.70 2
City /State/ZIP: 201 amps to 400 amt . S 133.56 2
401 amps to 600 amps S 200.34 2
phone: Fax 601 amps to 1000 amps S 301 04 2
Owner installation: This installation is being made on property that 1 own which is not Over 1000 amps or volts S 552.26 2
intended for sale, Iwo, rent or exchange. according to ORS 447, 449, 670, and 701 Temporary services or feeders Installation, alteration, anti/Or
Owner Signature: Date: relocation
200 snips or Tess 5 59.36 1
APPLICANT CONTACT PERSON 201 am s to 400 am s S 1 25.08 2
401 ampa to 599 amps S 168.54 2
Business Name: .
Branch circuits - new, alteration, or extension, per panel
A. Fee for branch circuits with
Contact name: service or feeder fee, each
branch circuit 5 7.42 2
Address: A. Fee for branch circuits
without service or feeder fee,
City /State/Z)P: first branch circuit 1 5 56.18 56.18 2
Each additional branch circuit: S 7.42 2
Phone: Fax; Miscellaneous (service or feeder not Included
F.-mail: Each manufactured or rnodalar
CONTRACTOR dwelling service and or feeder S 67.54 2
Reconnect only - 5 67.54 2
Business Name! CAPITOL ELECTRIC CO., INC. pump or irriFption circle S 67.84 2 -
-- Sir, or outline lighting S 67.84 2
Cannel name: Gary Stolen Signal circuits) or limited -
energy pailS1. alterations, or
Address: 11401 NE MARX ST. extension. Describe: 5 75.00 2
-
Page 2
City /SratdZlP: PORTI ANp, OR 97220-1041 Bach additional Inspection over allowable In soy of die above
Per inspection S 66.25
(Inc! 503455 -9488 Pox: 603- 187'7121 Investigation per hnuril hr rnin)__ S 6625
i 1 (TB Lie.: 4 8748 electrical Lic.; Z6-496C ' uprv, Lie.: 3132 -S /
Industrial plant per hour _ 5 76.18 _
i �� Subtot 'JtICAi, PF..RM1T FEES* Suprv. Electrician signature, tCquirod: Subtotal $ 58.18
Print Name: Darrell McNG Date: 03/27/1i Plan review (25% of permit fbc1
State snrcha gc ( 12% of permit feet $ - 6.74 - /
Authorized signature: f."./.0°4/141( TOTAL PERMIT FRP. $ 62 V
Print Name: Darrell McNceT
TM permit npp,rcmbo etprra If s p•rmle b one attained whbin IRO
aye after is hn, Wm accepted on rnmprere.
• Number a F inspCCllana per permit allowed.
19p.ikusturennitma1c- rennlinpp.doo in/n1/07 440.06151(n