Permit CITY OF TIGARD ELECTRICAL PERMIT
11 11 a COMMUNITY DEVELOPMEN Permit #: ELC2012 -00639
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/07/2012
Parcel: 1 S 135AB03400
Jurisdiction: Tigard
Site address: 10260 SW GREENBURG RD 900
Project: NW Mortgage Coffee Outlet Subdivision: METZGER, TOWN OF Lot: 9
Project Description: (1) branch circuit for outlet installation
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 11/07/2012 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 11/07/2012 $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 0 R 52- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.23
Issued By: 614..4. Permittee Signature: ®� 6P CAT lDa
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.
11/06/2012 14:14 5032577121 CAPITOL ELECTRIC PAGE 02/02
Electrical Per lift Application 4 - °ir.'ECE ECE1 Received MR r 1.1 tk.I': (i'1.1
,I� q�/
City of Tigard Datc/By: 1 . 11 / a Permit no,: a►LCcs¢/(.•- Js '
13125 SW Hall Blvd„ Tigard, OR 97223 NOV 0 6 2012 Plan Review
• _.:'' Phone: 503.639.4171 Pax: 501598.1960 DDate/By. Other Permit:
- r l c ; A r, n inspection Lisle: 503,639.4175 CITY OF TIGARD Date Ready/By: REINIMEM
Itstemett ava/W- tigard- or.gov NMlfled/Metnaa:
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New construction lSi Addition/alteration/replacement Please check all that apply (submit g sets of plans wfltems Checked below):
❑ Demolition ❑ Other: ❑ SoMce or feeder 400 amps or moro ❑ Building over three stories
E" " _ _ - - :i - --_ , zi%y` lT., H. : b : , 7 -= Y.61 where the available fault current ❑ Marinas and boatyards
• 1- and 2- family dwelling • Commercial /industrial U Accessory building exceeds 10.000 amps at 150 volts or ❑ Floating buildings
❑ Muhl-Tamil ❑ Master Builder ❑ Other less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
^-" dd , r is1-k. :j r; ^t i 't + i i . 1 amps for as other Ingt llstlone. buildings
Job no.: 130027 Job site address: 10280 SW Greenburg Rd ❑ Fire Pump ❑Installation of 75 I VA or
❑ Emergency system larger separately derived system.
City/State/ZIP: Tigard OR ❑ Addition of new meter toad of 0 "A ", - E", ' 1 -T, 94
100HP or more. 0 occupancy
Suitc/bldgJapt, no.: 900 Project name: NW Mortgage Coffee Outlet ❑ Six or more residential units ❑Recreational vehicle parks,
❑ Health -care facilities ❑ Supply voltage for more ilium
Cross Street/Directions to ob site: ❑ Hazardous locations 600 volts nominal,
❑ Scrvicc or feeder 600 am .s or more _ _
c Yi,"i" . : , ' •^ • -y ) _i _:. ar u :"- 4. • ...77.,'.'..a- :w - -,
Subdivision: Lot nn.: Description Qtr. Pee Tent "
Tax ma • •.s I New residential - single or multi- farolly dwelling unit.
F.77,57-• "- --- -"'L - " }^ i r•SO.;V:. - u1z- i 0f ,.A" ' i'hil. l Includes attached garage.
; iP6elC Syr.
Install dedicated 120V 20a dedicated outlet 1000 sq. ft or less $ 168.64 4
Ea Add'l 500 sq, ft or portion S 33,92 1
.' -. Ti1=•; . ; r 'tee', 1: 7,
I UL �! c:b' !sa?::n / ;!,�'",. - �.,i;� .'' , , �'ti��:� S� t:,,S"'' M �_sa�.� Limited energy residential
Name: (with above sq. ft.) 5 75.00 2
Limited energy, multi- family
Address' residential (with above sq. ft.) 5 75.00 _ 2
Service or feeders installation, alteration, and /or relocation
City /Statc/ZIP • 200 amps or less S 100.70 1 2 2 201 amps to 400 amps $ 133.56
Phone: Fax: 401 amps to 600 amps $ 200,34 2
601 amps to 1000 amps 5 301.04 2
Owner Installation: This installation is being made on property that 1 own which is not Over 1000 amps or volts $ 552.26 2
intended ihr sate, lease. rent or exchange, according to ORS 447, 449, 670, and 701 Temporary services ar feeders installation, alteration, and /or
Owner signature: Date: relocation
200 amps or leas $ 5936 I 1
r iT 71 - . 3 ,..:'.T:'.'t rI tf v . C 3wT+iy 201 amps to 400 amps [ I S 125,08 2
Business Name; 401 amps 10 599 amps S 168,54 2
Branch circuits - new, alteration, or extension, per panel _
Contact name; A, Fcc far branch circuits with
service or feeder fcc, each
Address: branch circuit S 7.42 2
B. Fee for branch circuits
without service or feeder fbc,
City/Statr%LIP: first branch circuit 1 S 56.18 56.16 2
Phone: Fate: Each additional branch circuit: $ 7.42 2
Miscellaneous (service or feeder not Included)
E -mail: Each manufectured or modular
,..;. >gaui R t? 77,:;,,r:. w ; .. z t , Yx' y dwelling, service and or feeder $ 67.84 2
Business Name: CAPITOL ELECTRIC CO., INC. Reconnect only fi 67.84 2
Pura or irrigation cir S 67.8 2
Contact name: Gary Stelert Sign or outline lighting . S 67.84 j 2
Signal circuit(s) or limited -
Address; 11401 NE MARX ST. energy panel, alterations, or
cxtenSiOn, Describe: $ 75,00 2
City/State /ZIP: PORTLAND, OR 97220 -1041 Page 2 -,
Each additional inspection over allowable in any of the above
Phone: 503. 266.9488 Fax: 503 -257 -7121 Per inspection 5 60,25
Investigatioh per hour (1 hr min) S 66.25
CCO Lie.: 48748 Electrical Lie 2G -496C IPMBEEKIE Industrial •Innt . hour S 76.18
_
1 1=1=1:1111:111111.--4111 Subtotal $ 66.18
Print Name: Darrel 1 I Noel Date: 11/06/12 ` Plan review (25% of permit Fee)
Authorized Signature; J State sutsharJoc ( 12% of permit fee) - $ 8.74
J TOTAL PERMIT FEE _ $ 62.92
Print Name: Darrell • r Thin pn+nit application atatree If it permit Is not obtained wltiOn tee
darn after It bra bent ateepted an eemptetr.
1 Number ofinspectlons per permit allowed.
1: \Dull tinaTu eiCw1.C- Pt.adtnpp. 10/0009 410- 461ST(1 1/as/COM/WEB