Permit (21) 71n CITY OF TIGARD ELECTRICAL PERMIT
g COMMUNITY DEVELOPMENT Permit#: ELC2023-00412
Date Issued: 7/19/2023
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S112DA01100
Jurisdiction: Tigard
Site address: 6600 SW CARDINAL LN
Project: Starbucks Subdivision: 1995-098 PARTITION PLAT Lot: 2
Project Description: Service upgrade for TI.
Contractor: JOHANSEN ELECTRIC INC Owner: PACIFIC REALTY ASSOCIATES LP
16869 SW 65TH AVE,SUITE 311 ATTN: N PIVEN
LAKE OSWEGO,OR 97035 15350 SW SEQUOIA PKWY#300
PORTLAND,OR 97224
PHONE: 503-747-2503 PHONE:
FAX: 503-972-1861
FEES
Quantity Description Date Amount
1 ea Services or Feeders-601 to 07/13/2023 $301.04
Soecifics:
1000 amps
1 ea Plan Review Electricial 07/13/2023 $75.26
Type of Use: COM 1 ea 12%Stale Surcharge- 07/13/2023 $36.12
Class of Work: ALT Electrical
Type of Const:
Occupancy Grp:
Total $412.42
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: 0 law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 throuoh J�2-001--0090. You /�b�_in a cone of the rules or direct auestions to OUNC by cailina 503.232.1987 or 1.800.332.2344.
Issued By: /C//G�/ / r et/Signature,
��(/ WNER INSTALLATION ONLY
The installation is being made on or iJaau l . 'ch is not' nded for sale,lease or rent. 12�3
ct
OWNER'S SIGNATURE: . , Date: �7 il
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 FoR(H rlc r. I ,l.O'1.1
illCity of Tigard DReceived /ir,�' �.
r 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Rev �� %�
I 0 Phone: 503.718.2439 Fax: 503 598 1960 Ill 9 Date/By: / �Q • Related Permit#: �-�d 7D
inspectionLme: 503.639.4175 II tN,, 2023
TIGARD - 1 " Ready Date y: :� Juris: See Page 2for
t Internet: www.tigard-or.gov ` Notified/Method:7 i/ , ii Supplemental Information
TYPE OF WOl'dlfl l t' ' r 44t44/1 PLAN REVIEW
❑New construction �[ [iddition/alteration/replaeement Please clre(all that apply(submit 2 sets of plans w/items checked):
❑Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition ❑Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
O 1-and 2-family dwelling ommercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: 0 Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
Job#: I Job site address: (o ADO ) „Sly r//h ❑100AddHP o of new motor load of system.
/Ln IOOHP or more. ❑"A","E","1-2","1-3",
City/State/ZIP: ❑Six or more residential units. occupancy.
0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: I Project name: LG' n5 ��'7/� /�. J 0 Hazardous locations. 0 Supply voltage for more than
�°✓ V• "`"!�— - ervice or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: f a 47j� FEE SCHEDULE
Description I Qty. I Each I Total I .
i New residential single-or multi-family dwelling unit.
Subdivision: I Lot#: Includes attached garage.
Tax map/parcel#: 1,000 sq.ft.or less 168.54 4
•
Ea.add'1500 sq.R or portion 33.92 I
DESCRIPTION OF WORK Limited energy,residential
I ' y� ,.yl (with above sq.ft J 75.00 2
•
ihl/��`'f S�y� Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
0 PROPERTY OWNER I 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 100.70 2
Address: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps
p 1 301.04 30),4 2
Phone:( ) I Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: 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,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signs e: Date: 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: .() A-t i Se.to E u�GT I C above service or feeder fee, 7.42 2
Cup n each branchn circuit
Contact name: T 1 r-r F^1�'(J� �( �e-� B.Fee for branch circuits without
Address: t fD O�� �(�! (Q� 3I1 service
rawn h crrcuieder fee,first t 56.18 2
City/State/ZIP: I.Akt_ psiv—O`i II hR G�7D3s- Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(503)7�i-2.503 Fax: :( ) Each manufactured or modular
-rp dwelling,service and/or feeder 67.84 2
Email: Q FF J CE 0 TDH A N)SEW&i re el+e )C . CGS) Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: SAy-•'�/') Sign or outline lighting 67.84 - 2
Address: Signal circuit(s)or limited-energy ❑ See Page 2 2
panel,alteration,or extension.
City/StatelZIP: Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( ) I Fax:( ) Investigation(1 hr min) 90.00/hr
Email: Industrial plant(1 hr min) 78.18/hr
�t Inspections for which no fee is 90.00/hr
CCB Lic.: 51 j Electrical) • 3-'2 C...I Suprv.Lie.:g3 /SS specifically listed(1/2 hr min)
Electrician signature,required. ►�/�\ - -Iv/ f Iv. ELECTRICAL PERMIT FEES
Suprv. Subtotal: 30/,Da{
Print name: �Oh C .Nc +..Y1 st't''t Date: GI (s l 202,3 0 Plan Review Required(25%of permit fee): 75.2{.
State surcharge(12%of permit fee): 34./2,
Authorized si a TOTAL PERMIT FEE: �/J2.,+/2
1 1 This permit application expires if a permit is not obtained within 180
Print name: J Date: (47 f i ri 2 3 days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:\BaildinglPermits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB