Permit CITY OF TIGARD ELECTRICAL PERMIT
0 , COMMUNITY DEVELOPMENT Permit #: ELC2010 -00487
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/09/2010
Parcel: 2S102CC00500
Jurisdiction: Tigard
Site address: 13560 SW PACIFIC HWY
Subdivision: Lot: 0
Project: STARBUCKS
Project Description: Electrical for TI. 11/2/10, add to scope of work: disconnect and reconnect 400A service with late
night inspections (5 hrs).
Owner: FEES
13500 PACIFIC CORP Quantity Description Date Amount
BY CAPOZZOLI ADVISORY FOR, PENSIONS
INC, 21500 HAGGERTY ROAD, SUITE 100 15 crt Branch Circuits 09/09/2010 $160.06
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 09/09/2010 $19.21
Electrical
Contractor: 1 ea Services or Feeders - 201 to 11/02/2010 $133.56
CASCADE ELECTRICAL LLC 400 amps
PO BOX 160 5 hr Hourly Electrical Rate 11/02/2010 $450.00
BRUSH PRAIRIE, WA 98606 0 ea 12% State Surcharge - 11/02/2010 $16.02
PHONE: 360 - 518 -0905 Electrical
FAX 360-666-0135 54 da 12% State Surcharge - 11/02/2010 $54.01
Electrical
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $832.86
Required Items and Reports (Conditions)
This permit is issued sub'ect 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 rdance with roved 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. A NTION: Oregon law requ' you to follow the rules adopted by the Oregon Utility Notification C - rter. Those rules are set forth in OAR
952 -001- 010 through OAR 952 -001- 0. Yo m. • !lain a copy of the rules or direct questions to OUNC by c: • r.� =6699 or 1.800.332.2344.
Y 4.• �,� �'l Issu d By: Permittee 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' C �� Ge-7 Date:
LICENSE NO. -
Call 503.639.4175 by 7:00 a.m. for an Inspection that business day.
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.
CITY OF TIGARD ELECTRICAL PERMIT
e • COMMUNITY DEVELOPMENT Permit #: ELC2010 -00487
T [GAR D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/09/2010
Parcel: 2S 102CC00500
Jurisdiction: Tigard
Site address: 13560 SW PACIFIC HWY
Subdivision: Lot: 0
Project: STARBUCKS
Project Description: TI
Owner: FEES
13500 PACIFIC CORP Quantity Description Date Amount
BY CAPOZZOLI ADVISORY FOR, PENSIONS
INC, 21500 HAGGERTY ROAD, SUITE 100 15 crt Branch Circuits 09/09/2010 $160.06
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 09/09/2010 $19.21
Electrical
Contractor:
CASCADE ELECTRICAL LLC
PO BOX 160
BRUSH PRAIRIE, WA 98606
PHONE: 360 -518 -0905
FAX: 360- 666 -0135
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $179.27
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 •AR 952- 001 -0100. You may obtain e rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
/ 1
Issued By — Permittee Signature: cz: R- - -P �ai'�✓'��r-
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 503.839.4175 by 7:00 a.m. for an inspection that business day.
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.
•
Nov. 1. 2010 0: 43AM 360 - 666 -0135 No. 9210 P. 2
Electrical Permit Application FOR OFFICE USE ONLY
• City of Tigard Date/8 : /�
;DECEIVE 1 Received Permit No.: E/ / . eTO
1.1 a,
4 13125 SW Hall Blvd„ Tigard, OR 9
Plan Review
n Phone: 503.718.2439 Fax 503.598-1960 DatefB . Other Permit:
T I Ill) Inspection Line: 503.639.4175 NOV 1 2010 bate Ready/By. kris: ® See Page 2 for
Internet www.tigard- or.gov Notified/Method: Supplemental Information
I ........ ................... . ..... lati i'rry' , Q : :.. : :_..... ..... ..... : :. - -- - „1,1
❑ New construction ❑ Addition/aIrUtiIL J c f i Please check all that apply (submit a sax of plans sr/items chedred below):
❑ Demolition Other: 400A Service ❑ Service or feeder 400 amps or more ❑ Building over three stories.
_.,.,.. r. :,l :. Other :.. 400 .... ..... . rvi . ... .. __ ....... :....,, : ,, ds.
?, t r' _:;= F " - : € : : `; I ;_;,- I TE.. . . j :: ri ;i:,; ;,,;. ! ; ; .i:i; _ =.., :: ' e x ceeds 10 000 available fault current
vote or Marinas and
tt .l ;li. .... _ o t , :. ORII : ; .,!,i, ! ,r.._.... : .,:.. _, ::.:: ; amps oleo Floating build gs
building amps for other installations. ❑commercial -age agricultural
❑ 1- and 2-family dwelling 0Commercial/industrial ❑Accessory g amps for all other mslalladons buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or •
.; „ ,5u:; > :19i{ :J , : : : :- -... _ „ Emer en system. larger ale] d1-3''. erived
:_ .,:,1,igii; i A;. :' :• : :J'0Di5LT VFQRNIAT Q,N:' .:. : : :LQ C ATION::_ q;' !��al ?:; .iin:i;i -, "A". .. ' "
...:.. ...
..... s... - .., . :. ._..............,. ...� ........,... .r. ,.................,... ❑ A d d r llonofnewmotorload of ❑ " . I - .
Job no.: C501 Job site address: 13560 SW Pacific Hwy
laoH e. occupancy.
ID Six or more ore r icesidential units. O Recreational vehicle pads.
City/State /ZIP: Tigard, OR 97223 ❑Health -care 1acibues. ❑ Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: I Project name: Starbucks Market Place El Service orfeeder6OOampsormore.
P ',';i-fi iiK''.:: :T.. R: ;. _':::L.EE SCLIZD.rr '1LEE' ;.'ii l 4f t i ,.1. :...,._.. sg :.:4
Cross street/directions to job site: South of SW Park St. on SW Pacific Hwy. naalp,lon I on- I Pee I Total I •
New residential single or multi - family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. R. or less 168.54 4
Ea. add'I 500 sq, ft. or portion 33.92 1
Tax map /parcel no.:
Limited energy. residential
.,. ; 'I..!:!-__ &r i :: ;ti,` : : i 1r= te - :';.i.:N .. . ... . . 1 t. Illy':! : :: : :.4' :: _...__.............. : :_: 7 ?
.
!v ....:::::.., _....,.. �., IN S,....(... ... . . . _. : )f'1(p ,,0 �, ,,..:.,, . - - With above sq. ft.)
..1 ...:.....:..........:.. ... .... ii ;:a.:..: " : : :'•� :� :' :.. ................,._...._ ., . , , ...._4.,, r, �,.. ",1111 • .. ,.., 1 ; :::.:_3.:!r- '_ :
:�: : : :. : :.: i ......:_ ; :. � :- _:_: : ::
Limited energy, multi family
75.00 2
Disconnect and reconnect 400A service with late night inspection. residential (with above sq. R.)
Services or feeders installation, Iteration , and/or relocation
200 amps or less 100.70 2
.......
:... R OPERTX- QWtVEF ∎ ∎,. ! _ .. i ;I�, ,. i( 400 amp 133.56 2
...........
,:. _
; .r, ..................... .a , : , ;; a ,! ic , 1, era:`: �.;:;. �? �"' a:'-s� • '`�I" 1- 1; :� �l� "It{ 201 ampsto4 1 133.56
401 amps to 600 amps 200.34 2
Name. 601 amps to 1,000 amps 301,04 2
Address: Over 1,000 amps or volls 552,26 2
Temporary services or feeders installation, alteration, and/or
City /Statc/ZIP: relocation
Phone: ( ) I Pax: ( ) 200 amps or less 59.36 I
Owner Installation: This installation is being made on properly that 1 own which is not 201 amps to 400 amps 168 54 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, per panel
Owner signature: Date: A. Fee for branch circuits iri/h
�...... ;i,ii1 y ,„ n,.,, .. .. ..:: : : :,;.,, ""` °'Ir:rr': ervice e,
7
®A>i 1 T . .i
• , . . , ; ,1;- t. C'U Ti " � above s .42 2
::... ....,..,. .._ .._ . .... tech branch c e er ee rcuit
Business Warne: 0. Fee for branch circuits without
service or feeder fee, fast 56.18 2
Contact Herne: branch circui •
' Each add'' branch circuit 7.42 2
Address: • Miscellaneous (service or feeder not Included)
City/State/ZIP: Each manufactured or modular
67.84 2
dwelling service and/or feeder
Phone: ( ) I Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail: '
,; ',';eq-ili :i :; ;;i'!: : : : : _ ., .......:.. ... ... .-' : ;.,. s.:_.. -- _ 67.84 2
+ : is ! 1 . :- . 1 + 1J1:: . CON'1?RAl' 1 OIt . .. , , ! s , {t, , t ti _ :{4. , ..: ............. .. .
t o outline lighting
Signal circuit(s) or limited<nergy
Business name: Cascade Electrical, LLC panel, alteration, or extension. Page 2 2
Each additional Inspecdon over allowable in any of the above
Address: PO Box 160 Additional inspection(' hr min) 66,25/lir
Investigation (1 hr min) 66.25/ hr
City /State/ZIP: Brush Prairie, WA 98606 meuslri5l plant (I hr min) _ 78.18 / hr
Phone: (360) 518 - 1539 1 Fax: (360) 666.0135 Inspections for which no fee is 90.00 / hr 450.00
specifically Iisted('ri hr min) _
COI Lie.: 158047 I Electrical Lie.: 37 -1027C I Su rv. Lic.: 4730-S ;a! :.;G'!;ll ; _ECilc . ii.Y 00 JE 0'1 Y1El $ H,,',i ?1j y }? _ :. '' i 0
subtotal! jaseitrg 3
Suprv. Electrician signature, required: J Plan review (25% of permit fee): 3
O
Print name: Dan Lindberg Date: 11/01/2010 State surcharge (12 % of'permit fee): .20,63 70•
iu TOTAL PERMIT FEE: -85615 5
Authorized signature: �( Thls permit application aspires if a permit is not obtained within 1806s;
days after It has been Accepted as tonrpleIe.
Print name: Dan Lindberg I Date: 11/01/2010 • Number of ins tons allowed
�- pi-permit,
I:\Building\Perm 1, Fr- C- Pennt.App.1oe 07101/10 .401615T(t 1/OSICORUWEB
•
Sep. 9. 2010 9:07AM 360-666-0135 No. 8081 P. 1
Electrical Permit ApplicationV,C,VA • 1. 01 USE ()IV
C f 'rd co 0 , '") .° `
0 Received
D .. I" , alp Penni1No.: Zi .... 4 '
. ..- 13 SW Hall Blvd. — ■
c'' ity oigar Tigard, OR 97223 C-c.\ ,,
)..
III c „ . ' Attn Review
Other Permit:
; 2 • • Phone: 503.639.4171 Fax: 503.598.1960 s •
'r 1 G A nil ,.,.0 '1,k.” ' e t iiVete/BT
hupection Line: 503.639.4175 Ti l.) NINW Date Ready/By: kris:
fil See Page 2 for
Internet: www.tigard-orgov CX x lsCID Notified/Method: 'Err 9 Supplemental Information
4
11) ,,\Nci ) ' .. ...........
'.. &'...a4.:40e0*i?.....g0iiN4V,i.M.;v97.i,:
0 New conStruction NET,Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w/items checked below):
0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
at..;n1.&:§:Edifitdi meads 10, amps at 150 volts or 0 Floating buildings.
'"'" :::::7-..- •:"- - • — - • • - — _----- - .. • • • • '"'"" ' - . • • .` '' ' ' r '' • ' ''" • " ''' .‘ • ''' less to ground. or exceeds 14,000 0 Commercial-use agricultural
0 1 - and 2-family dwelling ai 0 Accessory building amps for all other installations. buildings.
0 Multi-family 0 Master builder 0 Other: °Fire pump. 0 Installation of 75 KVA or
larger separately derived syste.
m
%;2 1■ ,tA t ,*X4.0.4.t0 . 5, -- : , .?: , : , , , . , ....2 -. .':: . , :':f::: 0 Addition of new motor lOad of 0 "A", "E"."1-2". "1-3".
Job no.: C 1 1 Job site address: 13 5-4 6 iv p ....,j 1001# OT MOIL.
ask or more residential units. 0 occupancy.
Recreational vehicle parks.
C -1 ity/State/Z1P: 1 0 , 1 ,4 r)e._ 5 7,919-3 0 Healih-are facilities. 0 Supply voltage for MOM than
0 fluaulous locations. 600 volts nominal.
Suite/bldg./apt, no.: ) Project name: 5 _F .J oft , . D Service or feeder DO or more. ....... ........._ ... . .
W•Niii:',i)Igg
Cross street/directions to job site: Denriotfoo i Off. I' Fte. 1 Toial II •
New residential single- or multi-(amily dwelling unit.
N or +E as+ 0 Q Ii.) ciiiS s on itA)1 9° /f/ Includes attached garage. ,
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
EL adri 500 sq. ft or portion 33.92 1
Tax map/parcel no.: Limited energy, residential
75.00 2
,. •:: : :11•:: : t:g; f -i :. ! , . : 'N' : ,:P. : 1:. : Z : r,: 1:.: .W - •:t Vt#01 MOlt.iCigtd (with a ls' ve s q . RI
"" •• Limited energy, multi-lbmily
75.00
t4.0 lie I ty vFj 0. a ((ft rel ePfZt.0 k residential (with above sq. ft.) 2
Services or feeders installation, alteration, and/or relocation
. 200 amps or less 100.70 • 2
jD iiiiAititititi 06/1■W.1Aliteiikit.g2:.;:', 201 amps to 400 amps 133,56 2
......• ..,......,. . ,' ,: ,... ....:7.;-:, i: .. . :::i.::::.:7•::1:• ... : : ... ........,....
Name: 401 amps to 600 amps 200,34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Teniporary services or feeders Installation, alteration, and/or
City/State/ZIP: relo eadon
Phone: ( ) I Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
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, per panel
Owner signature: Date: A. Fee for branch Circuits with
r feeder ke
): 'q.W;ir:T.".;:ii1 ' PERSON Ozi:q:!& ith°ve Service . , 742 2
Business name: B. Fee for branch circuits withola 1
service or feeder fee, first 1 56.18 5;0/ 2
Contact name: branch circuit
Each addi blanch circuit if 7.42 f�3 01 2
Address: Miscellaneous (service or feeder n t included) .
Each mantikaured or modular
City/State/ZIP: dwelling,. service and/or feeder 67.84 2
Phone: ( ) I Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E-mail: Sign or outline lighting 67.84 2
:f!,:',•:;;:r:'...:••iff::::..•,;:.::•.::.:yi:D]iff...::::' iit';';',.•".;;Itp:',.:::::: . . . , .. . .
:::•:•2::::. . ::::::•.:::•: • -:-.•••:::••. ... : .. :.:-. .. :: - !.. . . .. .. .. ,.. .i-0 ,,, ;,,,,,,,,,,, ......... Signal ClICUO,(S) Of itmaeariergy
panel, alteration. or extension. Pagc 2
Business name: .. O rl so sii ‘ E ( ,-i- L c
' Each additional inspection over allowable in any of the above 2
Address: Po 0 \ [ ( 0 . Additional inspection (I hr mitt) 66.25/ hr
, . investigation (1 hr min) 6625/ hr
City/State/ZIP: 2 0A . \_, ? \IQ i q 8 k fel . Industrial plant (1 hr min) 78.18/ hr
Phone: (3 ) 5-/ 8 ._0 -0s- I FL (3g9 "36 6 135 Inspections for which no fee is
4h) 90.00/ hr
specifically listed (u rola
CCB Lic.: cz. • ........,.
Electrical Lic.:37 ... t z. • Suprv. Lic.: Z/67 0 s 5 - ggy mi ................................................................
,
0 bit 13 Subtotal: /
Suprv. Electrician st gni Mr , required: /4 rour
Plan review (25% of pennit (ee): ...------
Print name: ) ovrs L 1 ., \-. / ' ate: 917/ / 0 State surcharge (12% of permit fee): 19 _.1-
i TOTAL PERMff FEE: / ?
,
Authorized signature: / 0 - .-4IL This permit a ppitration expires it ii permit Is not °Melee within 180
/ days after it has been accepted as complete.
Print name: l ' . ) r . g l . I Date: ,, . Number of inspection; allowed per permit.
'. , -- 1
TABuildiasTermiu1ELCVermitApp.doo 07/01/10 440-1615T(11/05/COMAVEB