Permit Ai CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
A i l I DEVELOPMENT I�r SERVICES � 639 -4171 DATE ISSUED: 10/25/01
- 13125 SITE ADDRESS: 13560 SW PACIFIC HIGHWAY STARBUCKS PARCEL: 2S102CC -00500
SUBDIVISION: ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
Project Description: Tenant Improvement - Burglar Alarm
Job No.083- 14003 -01
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: : HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
STARBUCKS COFFEE COMPANY ADT SECURITY SERVICES, INC
2401 UTAH AVE S 2815 SW 153RD DR
SEATTLE, WA 98134 BEAVERTON, OR 97006
Phone: 206 - 318 -1575 Phone: 503 - 469 -7244
Reg #: LIC 59944
ELE 26- 209CLE
FEES Required Inspections
Type By Date Amount Receipt Ceiling Cover
PRMT CTR 10/25/01 $75.00 2720010000 Wall Cover
Elect'I Final
5PCT CTR 10/25/01 $6.00 2720010000
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Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes
and all other applicable laws. 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 than 180 days. ATTENTION: Oregon law
requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules, are set forth in OAR
952 - 001 -0010 through OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -1987.
Issued by Permittee Signature W
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 639 -4175 by 7:00 P.M. for an inspection needed the next business day
10/23/2001 16:19 FAX 5034697110 ADT SECURITY 1j001
Electrical Permit Application • 1
41611 Date received: Permit no. :t e?l of -00 2-6 V
,,,...4, City of Tigard RECEIVED Project/appl.no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: I Receipt no.:
Phone: (503) 639 -4171 OCT 2 . 200
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: COMMUNITY DEVELOPMENT
TYPE OF PERT TIT
❑ 1 & 2 family dwelling or accessory Ii9 Commercial/industrial 0 Multi- family ❑ Tenant improvement
0 New construction /3.5'6, 0 0 Addition/alteration/replacement Cl Other. 0 Partial
JOB SITE INFORMATION i
Job address; S(g) 'Au' l GL>1L! Bldg. no.: Suite no.: Tax map /tax lot/account no.: ;
Lot: 'Block: Subdivision: •
Project name: S.I.As6ocir4 , grCC I Description and location of work on premises: Bu Ab
Estimated date o completion/inspection:
CONTRACTOR APPLICATION FEE SCHEDULE '
• Job no: on. 14003.91i i Fee Max
Business name: A� smut', Ty Description Qty.. (ea.) Total no.insp
New resklential- single or nudti-famlly per
Address: 2815 &a3 153rd divellingimit Includes attached garage. -
C ity : Ilduomerfa State: art ZIP :' Q7004 Senloelndudeb •
Phone s9 j.f 7 d Fax= illibp -mail: 1000 sq. ft. or less • 4
CCB no.: l9 4 I Elec, bus. lie. no: Z 6'?04C LF Each additional 500 sq rt or portion thereof
Limited energy, residential 2
City /me. r c. no.: Limited energy, non-residential 2
a t•. Each manufactured home or modular dwelling
Signa i of su. ing electrician (required) Date •�•� Service and/or feeder 2
Sup. elect name (print): License no:
Servteeser feeeiers— Iastallatfoa,
alteration or relocation:
200 amps or less •. 2
Name (print): 201 amps to 400 amps 2
Mailing address: 401 amps to 600 amps • 2
601 amps to 1000 amps 2 •
City: I State: I ZIP: Over 1000 amps or volts 2
Phone: I Fax: I E-mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services or feeders -
which is not intended for sale, lease, rent, or exchange according to installation, alteration, orrelocattom
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 :...s 2
ENGINEER Brand circuits - new, alteration, .
Name: or extension per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: I State: I ZIP; • B. Fee for branch circuits without purchase
Phone: Fax E-mail: of service or feeder fee, first branch circuit: 2 • .
Each additional branch circuit:
PLAN REVIEW (Please check all that appl)) Mice (Service or feeder not Included): •
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O Service over 225 amps- commercial Cl Health -care facility Each pump or irrigation circle 2
O Service over 320 amps - rating of 1&2 0 Hazardous location Each sign or outline lighting 2 -
family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
O System over 600voltsnominal • more residential units in one structure alteration, or extension' 2
Cl Building over three stories O Feeders, 400 amps or more *Description:
0 Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable hi any of the above:
❑ Egress/lightingplan O Other.
Per inspection
Submit sets of plans with any of the above. . • Investigation fee I • I `. , I •
The above are not applicable to temporary construction service. Other /y�
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Not all jurisdictions accept credit cord& please call Jurisdiction for m= info/madam Notice: This permit application Permit fee $ .7S . W
O Visa 0 MasterCard expires if a permit is not obtained Plan review (at %) $
Credit card numbs: / / within 180 days after it has been State surcharge (8%) $ •
Expires accepted as complete. TOTAL $ _ OO
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440-4615 (6J00/COM)
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