Permit rt CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00299
.T1GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/21/2012
Parcel: 1 S 135AB01003
Jurisdiction: Tigard
Site address: 10300 SW GREENBURG RD 370
Project: ID Experts Coffee Subdivision: METZGER, TOWN OF Lot: 9
Project Description: (1) branch circuit w/o service or feeder
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 05/21/2012 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 05/21 /2012 $6.74
Type of Use: COM Electrical
Class of Work: ALT
. Type of Const:
Occupancy Grp:
Total $62.92
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through • i 01 -00!0. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
„�%' /i tJ� �
Issued By: 1�� • Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 603.639.4176 by 7:00 a.m. for the next available Inspection date.
This permit card shall be kept In a conspicuous place on the Job site until completion of the project.
Approved plans are required on the job site at the time of each Inspection.
05/21/2012 09:20 5032577121 R ECE/: TOL ELECTRIC PAGE 02/02
Electrical Permit Application MAY 21 2012 Received / S+r Permitn
City of Tigard Date/By 6 a4 � (a e -•e1 a--0 oast"
II i • 13125 SW Hall B11/$ Tigard, Oft 97223 CITY OF TIG D Plan Review Date/By; Pe�t(,��1 a- _ 0 00 8 ge
Phone: 503,639 -4171 Fair 503.598.1960 , 2 1 Nee ra
1��� R, ]uriJ ( /a L I raw IV Inspection T,Sna 50�.fi39.4175 BUILDING Dl�1I Ready /By: (Q I, ,,t rnnmmar oft
Internet; vvwW.tigard- or.gov Ndtificd/Method:
TYPE OP WORK PLAN REVIEW
W Ncw construction [] Addition/alteration/replacement Please check all that apply (submit 2 sets of dams w/Iteme checked below):
❑ Demolition ❑ Other: ❑ Service or feeder 400 amps or more ❑ Building over three stories
CATEGORY OF CONSTRUCTION where the available fault current ❑ Marinas and boatyards
L I I- and 2 -family dwelling Li Commercial /industrial Accessary building exceeds 10,000 amps at 150 volts or ❑ Floating buildings
n Multi- family_ ❑ Master Builder ❑ Other tees to ground. or exeeods 14,000 [Ti Commercial -use agricultural
JOB SITE INFORMATION AND LOCATION amps for all other Instaltatlone. buildings
❑ Firo Pump ❑ Installation of 75 KVA or
Job no.: 120877 I .lob site address; 10300 SW Greenburg Rd
❑ Emergency ;.ytlem larger separately derived system.
7 Addition of new motor load of 0 "A', "E ",'1.2 ", -1 -3-.
( :ity/Statc/ZIP; Tigard OR '
100HP or more, ❑ occupancy
0 Six or more residential unite ❑ Recreational vehicle parks.
Suite/bldg./Opt. no.: 570 Project name: IDEltports Coffee ❑ I fealdl -care facilities CI Supply voltage for more than
Cross Strect/DircctionS to job site: ❑ Ibrardous locations 600 volts nominal.
Li Service or feeder 600 amps or more
FEE SCHEDULE
Subdivision: I lot no.; Daeeripti � O4• I Fee• { Total "
Tax map /parcel no.: New residential - single nr multi - family dwelling unit.
DESCRIPTION OP WORK Inch.das attached garage- _ -
Install dodie lted coffee outlet 1000 sq. ft. or less $ 168.54 4
— Es. Aden 500 sq. ft Or portion 5 33.92 I
PROPERTY OWNER I (,,,,,I TENANT Limited energy residential
with above sq. ft.) 5 75,00 2
Name: Limited energy, multidkmily
residential (with above sq. ty S 75.00 2
Address: Service or feeders itstallatloo, alteration, and/or relocation
200 amps or less $ 100.70 2
Gity/smta IP: 201 amps to 400 amps $ 133.56 2
Piton
401 amps to 600 amps S 200.34 2
ties:
601 amps to 1000 amps S 301.04 2
Owner being made on property that I own which is not Over 1000 amps Or volt; , S 552.26 2
inter according to ORS 447, 449, 670, and 701 Temporary services or feeders instaliatlon, alteration. and/or
Chun Date: relocation
200 amps or less $ 5936 1
APPLICANT LJ CONTACT PERSON 201 amps to 400 amps _ S 125.08 2
401 amps to 599 amps 5 163.54 2
Business Name; Branch circuits - new, alteration, or extension, per peed
A. Fee for branch circuits with
Contact name: service or feeder fee, each
branch circuit 5 7.62 2
Addrtss: B Pee for branch circuits
without service or feeder fee.
City/State/ZIP; first branch circuit 1 S 56.18 58.18 2
Each additional branch circuit: " S 7.42 2
Phone: Pax: Miscellaneous (service or feeder not included)
E -mail: ■ Each manufactured or modular
CONTRACTOR ■! dwelling. service and or feeder S 67.114 2
Reconnect anti_ 67,114 2
Busin Name: CAPITOL ELECTRIC CO., INC. _
Pump or irrigation circle S 67,44 2
Contact name: Gary SteiOR Sign or outline lighting 3 67.84 2
Signal circuits) or limited -
Address: 11401 NE MARX ST. energy Panel, alterations, or
extension. Doscrihe: 3 75.00 2
City /State /ZIP: PORTLAND, OR 97220-1041 . _ Par 2
1503.257.7121 t
Each additional Inspection over allowable la nnv of the above
Ph 503- 255 -9488 \
3 Per inspection S 6623
yi►� Fax: 11 LO\ t lnvatigation ter hour (I hr min) 5 66.25
A$ CB Lie.: 48748 electrical Li : 26.496C Lie ' 3132 -S Industrial plant per hour v
78,18 _
r ` /9/ ." ELECTRICAL PERMIT FEES"
Suprv. Electrician signature, required: / SublOWl $ 56,18
Print Namc: Darrell MCNO:. - , tc• . 0 Plan review (25% of permit fee)
— ` � „„r5/21112 T ate L PE permit fey) S
6,74
Authorized signature: // / fC ./ L TOTAL Pa ( FEE 12e�, of $ 62.92
Print Name: Darrell M I Thu per,. .pp expires n a permit I. nor ehmlaea within leo
days after It her Uwee accepted x. enmptoe..
• Number of inspections per permit allowed.
1: 1Rullding \l'nrmi1.MTX:- PerwllAPP.dni 10/01/09 440-46157 1 11115 /COM/We1)