Permit CITY OF TIGARD ELECTRICAL PERMIT
II a.: COMMUNITY DEVELOPMENT Permit#: ELC2013-00703
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/25/2013
TIGARD Parcel: 1 S 136DA00800
Jurisdiction: Tigard
Site address: 11538 SW PACIFIC HWY
Project: Black Rock Coffee Bar Subdivision: PFAFFLE PLAZA CONDO Lot: 2
Project Description: (1)branch circuit for sign lighting.
Contractor: PARKIN ELECTRIC INC Owner: HIGH HAT RESTAURANTS, INC
14001 FIR STREET 11530 SW PACIFIC HWY
OREGON CITY, OR 97045 TIGARD, OR 97223
PHONE: 503-657-4958 PHONE:
FAX: 503-557-1059
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 11/25/2013 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 11/25/2013 $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 OAR 952-001-0090. You may obtaii a cosy• -- . - - •'ect questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: m Permittee Signature:
�
Si
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.
,,From: f9�si 11/20/2013 18:09 #094 P.002/002
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard NOV 0 2013 Received
Date/13 `• �� _ L i
4 13125 SW Hall Blvd.,Tigard,OR ''^,M'• r _ -
�� �����® Plan Review
- Phone: 503.718,2439 Fax: 503 :. I Date/B : _
TIGARD Inspection Lute: 503.639.4175 ' iIL h\G WIMP Date Ready/By: 1D See Page2 for , I
Internet: www.tigard-or.gov Notified/Method: M Supplemental Information
„ ,. 7'Yll'E 9 ,WWRK PLAN_RE3 W r'
New construction ❑Addit ion/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked below).
❑Service or feeder 400 amps or more ❑Building over three stories.
❑ Demolition ❑Other: where the available fault current ❑Marinas and boatyards.
,r.: -
;^CATE4pR'Y D `'t?ON U� exceeds 10,000 amps at 150 volts or 0 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
..:: ,- - ;, „-.. .,,.. :.. _ ❑toner enc s stem.
,.-::.::, OB:',.0. E IN1 1Ai't UAh= :I O':..:.,t,
,-,v`. ,, -;ir-^ Y Y- '
larger separately derived system.
' �`"� ' `''� � .::a"�'�-�����Y� Addition of new motor load of ID"A""E" "1-2-.1
Job no.: Job site address: 1 ' � 100H1'or Wrote,
occupancy.
�, ❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: Tip 6 r& �/� 9 7j } 3 ❑Health-care facilities. ❑Supply voltage for more than
U ❑Hazardous locations, 600 volo nominal
Suite/bldg./apt.no.: Project name: ❑Service or feeder 600 amps or more.
Cross street/directions to job site: = .-,1 . : „k'RE SC isp, ,::.i<.;.:::; , -
Description I Qty. I Fee. 1 Total ( •
New residential single-or multi-family dwelling unit.
includes attached garage.
Subdivision: Lot no.: 1,000 sq.ft.or less 168.54 4
Ea.add'I 500 sq.ft.or portion 33.92 I
Tax map/parcel no.: Limited energy.residential
• DFSCRWFLON'OF'WWORK - (with above sq.ft.) 75.00 2
j Limited energy,multi-family
C44- yl-(}I S,'�7 r 2/ 4 r residential(with above sq.ft.) _ 75.00 2
\(/ Services or feeders installation,alteration,and/or relocation
({� (L t 200 amps or less 100.70
ROPERTY OWNER+" -l TENANT= 201 amps to 400 amps 133.56 2
/ -, / r 401 amps to 600 amps 200.34 2
Name: g//‘/<- §() �C (�G1 Moe
601 amps to 1,000 amps 301.04 2
Address: i ! , �` } 2
I I s y� „� W A.(�( t)-f�i �7't,,t! Over 1,000 amps or volts 552.26
City/State/ZIP: ( /j } Temporary services or feeders installation,alteration,and/or
7(� / ll / Q/� r)3 relocation
Phone:(- ) Fax:( ) 200 amps or less 59,36 1
Owner installation:This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale,lease,rent,or exchange,according to ORS 447.449,670,and 701. 401 amps to 599 amps 168.54 2
Branch circuits-new,alteration,or extension,eer panel
Owner signature: Date: A.Fee for branch circuits with
0''** 4*t'w; COIYTAO..'.PERSON.';: ,'
above service or feeder fee,
•^ • � `' LI each branch circuit 2
Business name: B.Fee for branch circuits without /"
service or feeder fee,first
I �j
Contact name: branch circuit + 56.18 - (D• 2
Each add'I branch circuit 7.42 2
Address: Miscellaneous(service or feeder not included)
City/Sla[C/ZIP: Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Phone:( ) Fax: :( ) Reconnect only 67 84 2
E-mail:
Pump or irrigation circle 67.84
Sign or outline lighting 67.84 2
':CONTRACTOR`,; Signal circuit(s)or limited-energy
Business name:Parkin Electric panel,alteration,or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 14001 Fir Street Additional inspection(I hr milt) ' 66.25/hr '
City/State/ZIP:Oregon City,OR 97045 Investigation(I hr min) 66.25/hr
Industrial plant(I hr min) 78.18/hr
Phone:(503)657-4958 Fax:(503)557-1059 inspections for which no fee is 90.00/hr
specifically listed(th hr min)
CCB Lic.: 3515 Electrical Lic.: 34-4C Suprv-Lie,: 4241-S „ , . ;:EI ECTRICAL PERI UT;°FEES-:‘ ;:... .
Suprv.Electrician signature,required:
,�z subtotal: S(, ig
Plan review(25%of permit fee):
Print name: David B Parkin Date: State surcharge(12%of permit fee):
TOTAL PERMIT FEE:
Authorized signature:
This permit application expires if a
p pp p' permit is not obtained within 80
Print name: Date: • days after it has been accepted as complete.
Number of inspections allowed per permit.
P.ViuitdingWermus U,[LC.PcmmisApp•duc 07/11/10 44[1-4615T(11/05/COM/WEB