Permit ' II CITY OF TIGARD ELECTRICAL PERMIT
- 1 : COMMUNITY DEVELOPMENT Permit #: ELC2010 -00679
1 3125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/16/2010
TIGARD Parcel: 2S 102CC00500
Jurisdiction: Tigard
Site address: 13560 SW PACIFIC HWY
Project: Starbucks Subdivision: - Lot: 0
Project Description: (2) exterior fascia signs for drive - through.
Contractor: TUBE ART SIGNS & SPORTS DISPLAYS Owner: 13500 PACIFIC CORP
4243 -A SE INTERNATIONAL WAY BY CAPOZZOLI ADVISORY FOR
MILWAUKIE, OR 97222 PENSIONS INC
21500 HAGGERTY ROAD, SUITE 100
NORTHVILLE, MI 48167
PHONE: 503 - 653 -1133 PHONE:
FAX: 503 - 659 -9191 .
FEES
Quantity Description Date Amount
2 ea Sign or Outline Lighting 12/16/2010 $135.68
Specifics: 1 ea 12% State Surcharge - 12/16/2010 $16.28
Electrical .
Type of Use: COM
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $151.96
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 ' ' suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility No 1 -tion Center — rules are set forth in OAR
952 - 001 -0010 through OAR 952- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 50 32.1987 or r r -
Issued By: .�,Q
�GA, 41,t, 4_1 P ermittee Signature: A�. _� /��
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.
1
Electrical Permit Application r
p � . FOR OFFICE USE ONLY , .
City of Tigard I Date Received i Permit No.: ^
'1 13125 SW Hall Blvd., Tigard, OR 97223 � ��� � �
g Plan Review
11 1 Phone: 503.639.4171 Fax: 503.598.0 ® 2 010 Date/B Other Permit:
TIGARD Inspection Line: 503.639 DateReadyBy: lial 0 See Page2 for
Internet: www.tigard or.gov Notified/Method: Supplemental Information
C!TV ter- TI(ARD
TYPE9T 111 O,IPK`1rN(; FER]NG PLAN "REVIEW
® New construction ®Addition /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: SIGN where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ 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
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 - ", "1 - ",
Job no.: 115260/1 Job site address: 13560 SW Pacific Hwy 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: Tigard, OR ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: Starbucks #3366 ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: East side of 99w, north of McDonald Description 1 Qty. 1 Fee. 1 Total j
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'l 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential 67.84 2
DESCRIPTION OF WORK (with.above sq. ft.)
Limited energy, multi - family 67.84 2
Install (1) exterior fascia signs reading "Drive Thru" residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2 _
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
City/State /ZIP: Temporary services or feeders installation, alteration, and /or
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, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee,
7.42 2
each branch circuit
Business name: Tube Art Group B. Fee for branch circuits
Contact name: Dan Osterman without service or feeder fee, 56.18 2
first branch circuit
Address: Each add'l branch circuit 7.42 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular
dwelling, service and /or feeder 67.84 2
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
E -mail: dosterman @tubeart.com Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 2 67.84 135.68 2
Signal circuit(s) or limited -
Business name: Tube Art Group
energy panel, alteration, or
Address: 4243 -A SE International Way extension. Describe: Page 2 2
City/State /ZIP: Milwaukie, OR 97222 Each additional inspection over allowable in any of the above
Per inspection 66.25
Phone: (503) 653.1133 Fax: (503) 659.9191 Investigation per hour (1 hr min) 66.25
CCB Lic.: 70956 Electrical Lic.: 37554CLS Su.rv. Lic.: 366SIG Industrial plant per hour 78.18
ELECTRICAL PERMIT FEES
Suprv. Electrician sit ature, required: � _ imp Subtotal: / .5.---. (Pd'
Print name: Ken Schult. Date: 1 6/10 Plan review (25% of permit fee):
4 ) , State surcharge (12% of permit fee): / (y . 4'
Authorized signature: / 4 ' ' , ,-, TOTAL PERMIT FEE: 1 51 _ 'l,
This permit application expires if a permit is not obtained within 180
Print name: Dan Oster MT Date: 12/6/10 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC - PermitApp.doc 10/01/09 440- 4615T(11 /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined .. $67.84
Check Type of Work Involved:
n Audio and Stereo Systems*
n Burglar Alarm
n Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
LI Vacuum Systems*
n Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $67.84
system
(SEE OAR 918 309 - 0000)
Check Type of Work Involved:
n Audio and Stereo Systems
1 Boiler Controls
n Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
n Instrumentation
n Intercom and Paging Systems
n Landscape Irrigation Control*
n Medical
n Nurse Calls
n Outdoor Landscape Lighting*
n Protective Signaling
Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I:\Building\Permits\ELC- PermitApp.doc 10/01/09