Permit rt. CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2009 -00049
COMMUNITY DEVELOPMENT DATE ISSUED: 2/3/2009
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 BROTHERS COFFEE LOT : JURISDICTION: TIG
PROJECT: DUTCH BROS. COFFEE
Project Description: Installation of temporary service for construction of new drive -thru coffee stand.
RESIDENTIAL UNIT TEMP SRVC/FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: 1 PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HMI SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10):
SERVICE/FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: 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 -
[ELPRMT] ELC Permit 2/3/2009 $66.85 LIC 591
[TAX] 12% State Surchar 2/3/2009 $8.02 SUP 4702S
Total $74.87 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 tha days. NTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in
OAR 9 - 001 -0010 through • R 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC t 503.246.6699 or 1.800.332.2344.
Issue By: 1 # jjj / .Li 2 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: . ��;E►rl� d��� 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 DDace� /109 , Permit No.: 6.6 9-.69
° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review - �•�
' C Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
T 1 G A K D Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: e/ !,. Supplemental Information
TYPE OF WORK PLAN REVIEW
® New construction ❑ Addition/alteration /replacement Please check all that apply (submit 2 sets of plans w/iteins checked below):
❑ 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
❑ 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
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑'`A ", "E ", "I -2 ", "I -3 ",
Job no.: Job site address: 11744 SW Pacific Hwy l00HP or more. occupancy.
y ❑ 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 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'l 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.)
Temp Service Limited energy, multi - family 75.00 2
P residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 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
City/State /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 1 66.85 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
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
.. A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 6.65 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'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
Business Signal circuit(s) or limited -
usiness 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 1115` Electrical Lic.: 24- C Suprv. Lic.: 5387S Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: ��� Subtotal: 66.85
Print name: Carl Duncan 1 Date: 2/3/09 Plan review (25% of permit fee):
. State surcharge (12% of permit fee): 8.02
Authorized signature: TOTAL PERMIT FEE: 74.87
Print name: Date: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
• Number of inspections allowed per permit.
1 :\ Building \Permits\ELC- PermitApp.doc 05/23/06 440-4615T(II /05 /COM/WEB