Permit (3) CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2023-00138
Date Issued: 4/24/2023
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S115AB01900
Jurisdiction: Tigard
Site address: 16200 SW PACIFIC HWY J1
Project: Chipotle Mexican Grill Subdivision: 1994-028 PARTITION PLAT Lot: 2
Project Description: Electrical for TI:(2)feeders with(102)branch circuits.
Contractor: GREEN RIVERS ELECTRIC INC owner: SN PROPERTIES PARTNERSHIP
PO BOX 1325 1121 SW SALMON ST
JEFFERSON, OR 97352 PORTLAND, OR 97205
PHONE: 541-327-2042 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 04/24/2023 $100.70
Specifics: amps or less
1 ea Services or Feeders-201 to 04/24/2023 $133.56
Type of Use: COM 400 amps
Class of Work: ALT 102 crt Branch Circuits w/Purchase 04/24/2023 $756.84
Type of Const: Service or Feeder
Occupancy Grp: 1 ea 12%State Surcharge- 04/24/2023 $118.93
Electrical
1 ea Plan Review Electricial 04/24/2023 $247.78
Total $1,357.81
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, Slate 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 r uires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 throuuh R 952-0 00 . You may o 'n a co of the rules or direct auestions to OUNC by calling 503.23 . 87 or 1.800.332.2344.2. ,I
Issued By: 1,! Permittee Signature: aV <G `iti
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 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.
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard RECEIV tved I rl t3?.,--- Permit#: E! go)?_co ay
..eB . WI/
p7fJ �V KiJ Ir
r 13125 SW Hall Blvd.,Tigard,OR 97223 q 9 Plan Review` //Y
Phone: 503.718.2439 Fax: 503.598.1960 MAR 1 2023 Date/By: , / V 3 Related Permit#/54JQ 8--- v�
T I G ARD Inspection Line: 503.639,4175 Ready Date/By �yy �)` runs See Page 2 for
Internet. svww.tigard-orgov Nonfied/Method r//� 1,3
--hi Supplemental Information
TYPE:OF WORK CITY Of TkGAf ( $:ra—w 4++� tPIAY REVIEW
❑New construction .Addition/altzration/reWIG D1VISIO Please check all that apply(submit 2 sets of plans w/Hems checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition ❑Other:
T _ where the available fault current 0 Marinas and boatyards.
1 .541f 4.Et,ORY OF CONST1.0 TION = exceeds 10,000 amps at 150 volts or 0 Floating buildings,
I] I-and 2-family dwelling III Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: 0 Fire pump. 0 Installation of 150 KVA or
,j' f: �° .I$B SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
Job#: I Job site address: 16200 SW PACIFIC HW IOOHP or more.
Y. ❑Addmon o for load of system.
�
City/State/ZIP: TIGARD, OR 97224 0 Six or more residential units. occupancy.
0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: SUITE J1 I Project name: CHIPOTLE MEXICAN GRILL ❑Hazardous locations. 0 Supply voltage for more than
0 Service or feeder 600 amps or more. 600 volts nominal-
Cross street/directions to job site: FEE SCHEDULE ``
Description I Qty. I Each L. Total I a
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
Tax map/parcel#: 2S115AB01900 1,000 sq.ft.or less 168.54 4
Ea.add'I 500 sq.ft.or portion 33.92 I
DESCRIPTION OF WORK Limited energy,residential 75.00 2
Alteration of an existing freestanding building for new fast casual dining restaurant.Scope of (with above sq.ft.)
work includes electrical panelboard(s),roof top HVAC equipment.site power,general lighting, - Limited energy,multi-family 75.00 2
general power for dining area and specialty power for kitchen and preparation areas. residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
Il PROPERTY OWNER ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: SN INVESTMENT PROPERTIES, LLC 200 amps or less f 100.70 /00.7 1 2
Address: 1121 SW SALMON ST. STE 500 201 amps to 400 amps 1 133.56 133.56 2
401 amps to 600 amps 200.34 12
City/State/ZIP:PORTLAND, OR 97205 601 amps to 1,000 amps 301.04 2
Phone:( 503) 450-0806 Fax:( ) Over 1,000 amps or volts 552.26 2
Email: SCOTTA@SCHNITZERPROPERTIES.COM Temporary services or feeders installation,alteration,and/or
relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease, r t,o exch angel according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: L�r J3� Date: 1/11/2023 401 amps to 599 amps 168.54 2
® APPLICANT I ❑ CONTACT PERSON
Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name:INTERIOR ARCHITECTS above service or feeder fee, 102 742 756.84 2
each branch circuit
Contact name: MELISSA STONIKINIS B.Fee for branch circuits without
service Address: 1217 SANSOM STREET, FLOOR 8 branch otrcfeeder fee,first
uit 56.18 2
City/State/ZIP:PHILADELPHIA, PA 19107 Eachadd'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone: ( 267)439 4887 Fax: :( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: M.STONIKINIS@INTERIORARCHITECTS.COM Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: GREEN RIVERS ELECTRIC INC. Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy ❑ See Page 2 2
Address: PO BOX 1325 panel,alteration,or extension. g
City/State/ZIP:JEFFERSON, OR 97352 Each additional inspection over allowable in any of the above
Additional inspection(I hr min) 66.25/hr
Phone:( 541) 327 2042 Fax:( 541)327 2042 Investigation(1 hr min) ' 90.00/hr
Industrial plant(1 hr min) 78.18/hr
Email: lance.weight@greenriverselectric.com Inspections for which no fee is
CCB Lic.: 1895114.'r1 Electrical Lic.: C581 1 J���1y� Suprv.Lic.: 3145S
specifically listed(/hr min)
90 00/hr
Suprv.Electrician signature,required: + 3 ELECTRICAL PERMITbt FEES
P g q l �� q 1
Subtotal .,r8"''"' �uV i-.r(.b
Print name: LANCE WEIGHT Date: ❑Plan Review Required(25%of permit fee): ,60 �V7 V
,��// State surcharge(12%of permit fee): $106.85 )i 613
Authorized signature: /{ /A-14_`?f-ri,r.�v,2w TOTAL PERMIT FEE: $1219.85 i $L
This permit application expires if a permit is not obtained within 180
Print name: M E LISSA STON I KI N I S Date: 1/6/23 days after it has been accepted as complete.
* Number of inspections allowed per permit.
1 1Bailding1PermiusELC_PermitApp_ELR_ERE.doe Rev 06/17/2015 440.4615T(11/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2-Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDETLE
Description I Qty. I Each I Total I "
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 00 70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
❑ Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
❑ Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva-no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ Other Each additional inspection is 66.25/hr
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically�listed CA hr min)
L5-7-41
COMMERCIAL WORK ONLY: Subtotal(Enter on Page 1):
Fee for each commercial system: $75.00 • 'Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
n Data Telecommunication Installation
Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
n Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I-llauild,ng\Permils\ELC_PermltApp_ELR_ERE.doc Rev 06'I7/2015