Permit CITY OF TIGARD ELECTRICAL PERMIT
2 - : COMMUNITY DEVELOPMENT Permit #: ELC2011 -00424
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/28/2011
Parcel: 2S110DB01700
Jurisdiction:
Site address: 15290 SW PACIFIC HWY
Project: Black Rock Coffee Shop Subdivision: 1996 -010 PARTITION PLAT Lot: 2
Project Description: (1) 200 amp service and (3) branch circuits for new commercial manufactured structure
Contractor: NIXON ELECTRIC CORP Owner: JESS WETSEL
PO BOX 68569 10110 SW NIMBUS AVENUS SUITE B -9
PORTLAND, OR 97268 PORTLAND, OR 97223
PHONE: 503 - 654 -8841 PHONE:
FAX: 503 - 345 -3403
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 07/28/2011 $100.70
Specifics: - amps or less
3 crt Branch Circuits w /Purchase 07/28/2011 $22.26
Type of Use: CMS Service or Feeder
Class of Work: NEW 1 ea 12% State Surcharge - 07/28/2011 $14.76
Electrical
Type of Const: VB 15 12% State Surcharge - 07/28/2011 $14.76
Occupancy Grp: B Electrical (manual)
123 Investigation Fee (Equals 07/28/2011 $122.96
Permit Fee)
Total $275.44
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 95 - 01 -0090. 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: 77A/ /7 7 80 )` G / Ci/ - 7 - €7 /
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.
RECEIVED
Electrical Permit Application JUL 2 7 �� FOR OrFiCEU SE ONLY
2 i
Received rj /.� - O y
City of Tigard DateB : 7 Ole i/ !;o Permit No. 00 o? ,
• 14 13125 SW W Hall Blvd., Tigard, O' ' ' • • ' `��'' 1 k i � �' • ' •
/ i t �� Plan Revie
Phone: 503.718.2439 Fax: 503'' ; 1 ? �� �' mit
1 � 6' � 1 IS I O N
Date/B : Other Per II �
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T 11 k 13 Inspection Line: 503.639.4175 Date Ready/By: il See Page 2 for
• Internet: www.tigard- or.gov Notified/Method: I Supplemental Information
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❑ New construction ® Addition/alteration/replacement Please check all that ly (submit sets of plans w /items checked below):
❑ Service or feeder 00 amps or more ❑ Building over three stories
❑ Demolition ❑ Other: where the availabl fault current ❑ Marinas and boatyards.
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= +rt ..,_,_,,.. exceeds 10,000 ps at 150 volts or Floating buildings
"y_a• ri tt , y 5 ,,• n ':Si - giix P ;' ... , s :E .- . .a .3`1�+3: •...- s ... . ._ .+1, ?:;:li .v..
s -- : t..... u r...,. „ ^ : � : _� � ` .: t,,,�y, ` _ t �. �i �'`.= s, e::::: :::r'.:::rzsJ:..:>..........._ r less to ground, or xceeds 14,000 ❑Commercial -use agricultural
❑ 1 - and 2- family dwelling ® Commercial /industrial ❑ Accessory building amps for all other,'nstallations. buildings.
❑Multi- family D Master builder 0 Other: Fire pump D Installation of 75 KVA or
.:::.• " sr•?^s:is�::x-•xox: ^r. :sty, r.....aa:.:.rJa• <:,: 'ii rililnii(j:'r.`ii'•aiii” m.
^ �, � ��� . ^�, �;,��,, Lu ,,� Y , 1 ❑Emergency system. tor load of ❑ "A" "E ", "1 - separately derived system.
=._ .: q: �+ ' qq A:e " . • k p;4t9 111:1; : is:a' =';:iJ��'�?i Addition of new o." "1 - 3”
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Job no.: 1 Job site address: 15290 SW Pacific Highway 100HPor more. occupancy.
❑ Six or more resid ntial units. ❑ Recreational vehicle parks.
City /State /ZIP: Tigard, OR 97224 ❑ Health-care facie 'es. ❑ Supply voltage for more than
❑ Hazardous locati ns.
+ 600 volts nominal.
Suite/bldg. /apt. no.: 1 Project name: Black Rock Coffee ❑ Service or feeder 00 amps or more.
1'11111. - - - - , ^ Qr
Cross street/directions to job site: Description
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Qa• I Fee I total
New residential s ngle- or multi- family dwelling unit.
Includes attache garage.
Subdivision: 1 Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'I 500 sq. ft: or portion 33.92 1
Tax map /parcel no.: , 7500 2
Limit energy, residential .
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:� r; � ATE v �=;�~ r�iil"= � ��i;' �s;:: (with above sq.
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:�.....�:,ocsm:5:> �;.. ......_.._ , .. ... ...:. ...::: .,._.::::::,;� •.: _..,..,. ....,..; "... Limited energy, m � lti- family 7500 2
New TI residential (wi above sq. ft.)
J
Services or feeders installation, alteration, and/or relocation
• 200 amps or less 1 1 100.70 . 100.70 2
W`'sa<s„' tea-.....: "� -,,,•. • -� ��-
, �..;, - a:;�:. =, =.•a �::: �:�; ..,.,.,_.. �:: l . _ ,::,.�,:• .:..........,.._... . .• ••s R <: :,,,.ti; :, mis - , .
, :t .. : .. _ :•i ,::: ;:iii amps to amps (33.56
e
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"-' llps 200.34 2 -
401 amps to 600 at
Name: 601 amps to 1,000*mps 301.04 2
Address: Over 1,000 amps di volts 552.26 2
- Temporary services or feeders installation, alteration, and /or
City /State/ZIP: relocation
Phone: ( ) 1 Fax: ( ) 200 amps or less ; 59.36 1
201 amps to 400 at'r7ps 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits new, alteration, or extension, per panel -
Owner signature: Date: A. Fee for branch Circuits with 22 26
,�..,.. �; :._: .. - . _w .u:M . -_ M .: :.,.,.. s,-:fieti: above service oi feeder fee, 3
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• s.� ..., , -: n ; ; 1 v rvc,• .,. 3 $ 4 - i F';;;__ e. ^ '= 2 2
...,_,.�. , e��,•.ri�i ,.:L -- ,• � _. ,.:. .............:.....:....._ r .... a, each branch cir�uit _ - -
Business name: B. Fee for branch ircuits without
service or feed r fee, first 56.18 2
Contact name: branch circuit
Each add'I branch circuit 1 7.42 2
Address: Miscellaneous ( ervice or feeder not included)
Each manufactured or modular 67.84 2
City / State/ZIP: dwelling, service and/or feeder
Phone: ( ) I Fax: : ( )
Reconnect only 67.84 2
Pump or irrigator circle 67.84 2
E -mail: 67.84 2
.,,__ "•, Sign or outline lighting
4
K,, fy : ; .< ; , . _>u • , .. ::•,:)> :1::-::-,':: q; =tc -:°::; :' ::; �a'rr:•,,,;igiili igi Signal circuit(s) o limited -ene
.::.� , ?. _..•�:::�,; :�� .., s at...,....,.:, y, .,,.ianr....;:�-.,s.,.:._...... ,.... :.c K �....r. gn limited-energy
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Business name: Nixon Electric panel, alteration, Cr extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: PO Box 68569 Additional inspection (1 hr min) 66.25/ hr L
Investigation (1 h} min) 66.25/ hr
City /State /ZIP: Portland, OR 97268 Industrial plant (1 hr min) 78.18/ hr _
Phone: (503) 654 - 8841 Fax: (503) 345 - 3403 / specifically fisted ( . Inspections for w ich no fee is 90.00 / hr
.� J� ' 1 h hr min) _ �wa >� ^f.�.'OtI� - _ Y -........
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X.CCB Lie.: 191508 Y/ Electrical Lic.: C655 i� � ► rv. Lie.: 3185 -5 :�:a:::: :_ „,; „�„ _ ;,_ -�_','
1 Subtotal: 122.96 ,9
Suprv. Electrician signature, required: C Plian review (25% of permit fee):
Print name: Craig Robison Date: 7/27/2011 State surcharge (12% of permit fee): jii + 7 (p ly�
TOTAL PERMIT FEE: 137.72 v J ' 3 i �f �
Authorized signature: This permit app'ication expires if a permit is not obtained th 2 % �/
dams after it has been accepted as complete. 7 e
Print name: Date: • lam f;ections per permit. 0 � L -
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