Permit CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
:` %J�li DEVE ICES 639 -4171 DATE PERMIT #:
: ELR2001-00247
- 13125 SITE ADDRESS: 13560 SW PACIFIC HIGHWAY STARBUCKS PARCEL: 2S102CC -00500
SUBDIVISION: ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
Project Description: Installation of (2) cable drops for cash registers.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: X NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: • HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
STARBUCKS COFFEE COMPANY DATATEC INDUSTRIES, INC.
2401 UTAH AVE S 37453 SOLSO DR
SEATTLE, WA 98134 SANDY, OR 97055
Phone: 206 - 318 -1575 Phone: 503 - 826 -8745
Reg #: LAC 146022
ELE 3- 499CLE
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT CTR 10/4/01 $75.00 2720010000 Elect'I Final
5PCT CTR 10/4/01 $6.00 2720010000
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. 7
Issued by AP(/ �i �
Permittee Signature
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
. A. Electrical Permit Application
Date received: i /0 / Permit no.: / — Ce /7
��tL 1r City of Tigard Project/appl.no.: . Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By :� I Receiptno.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory -,Commercial/industrial ❑ Multi - family ❑ Tenant improvement
;,t New construction Addition /alteration/replacement ❑ Other: ❑ Partial
JOB SITE INFORMATION
Job address: 62") ,ja) ��L; ' ,J.. // U,J S/ Bldg. no.: Suite no.: Tax map /tax lot/account no.:
' Lot: IBlock: ISubdivision:
Project name: ; j h./412 -.5 -# Description and location of work on premises , ,¢b /E A,/en Fe/ __,A15,t1 Zee/5 �O'
Estimated date of completion/inspection: ./:y — 3 / - p /
CONTRACTOR APPLICATION FEE SCII
Job no: .,-� Fee Max
Business name: Off ?fb/C � Z�dci.5 Ti�JI� Description Qty. (ea) Total no. imp
New residential - single or multi- family per
Address: 37453 & /.5 D✓ dwelling milt. Includes attached garage.
City: S Ot zid Y' I State:04 ZIP: g 70rr • Serviceincluded:
Phone:, 22.6 09'31 , fax: I E -mail: 1000 sq. ft. or less 4
CCB no.: . ,qt I Elec. bus. lic. no: _ /99 e/ F. Each additional 500 sq. ft. or portion thereof
Limited energy, residential 2
c____
City/metrolic. no.: s Sdrr,� (1„E� Limited energy, non-residential 2
/ Q a v Each manufactured home or modular dwelling
V/
7 Signature of supervising electrician (required) -r FpT - Service and/or feeder 2
Sup. elect. name (print): License no: Services or feeders — installation,
alteration or relocation:
PROPERTY OWNEII 200 amps or less 2
Name (print): / /s !4'L / �, - , -� 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address: 601 amps to 1000 amps 2
City: 'State: I ZIP: Over 1000 amps or volts 2
Phone". ,40,S 14 0 0I 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,orrelocation:
200 amps or less 2
ORS 447, 455, 479, 670, 701.
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 am s 2
Branch circuits - new, alteration,
or extension per panel:
Name: 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
of service or feeder fee, first branch circuit: 2
Phone: Fax: E-mail: Each additional branch circuit:
' PLAN REVIEW' (Please check all that apply) Misc. (Service or feeder not included):
O Service over 225 amps - commercial ❑ Health -care facility Each pump or irrigation circle 2
❑ Service over 320 amps -rating of 1&2 0 Hazardous location Each sign or outline lighting 2
family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
O System over 600 volts nominal more residential units in one structure alteration, or extension* I 2
❑ Building over three stories 0 Feeders, 400 amps or more *Description:
❑ Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
❑ Egress/lightingplan 0 Other. Per inspection I I I
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $ 7 7
0 Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $ _7l'
Credit card number: • / / within 180 days after it has been State surcharge (8 %) $
Expires accepted as complete. TOTAL $ • 9/ ,9d
Name of cardholder as shown on credit card
$
Cardholder signature Amount r / ti c (..._. 440 -4615 (6/00/COM)
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES:
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
p Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total 4, Check Type of Work Involved:
Residential - per unit
1000 sq. ft or less $145.15 4 ❑ Audio and Stereo Systems
Each additional 500 sq. ft. or
portion thereof $33.40 1 ❑ Burglar Alarm
Limited Energy $75.00
Each Manufd Home or Modular
Dwelling Service or Feeder $90.90 2 ❑ Garage Door Opener
Services or Feeders ❑ Heating, Ventilation and Air Conditioning System*
Installation, alteration, or relocation
200 amps or less $80.30 2
201 amps to 400 amps $106.85 2 ❑ Vacuum Systems
401 amps to 600 amps $160.60 2
601 amps to 1000 amps $240.60 2 ❑ Other
Over 1000 amps or volts $454.65 2
Reconnect only $66.85 2
Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY
Installation, alteration, or relocation Fee for each system $75.00
200 amps or less $66.85 2 (SEE OAR 918 -260 -260)
201 amps to 400 amps $100.30 2
401 amps to 600 amps $133.75 2 Check Type of Work Involved:
Over 600 amps to 1000 volts,
see "b" above. ❑ Audio and Stereo Systems
Branch Circuits ❑
New, alteration or extension per panel Boiler Controls •
a) The fee for branch circuits
with purchase of service or ❑ Clock Systems
feeder fee.
Each branch circuit $6.65 2 Data Telecommunication Installation •
b) The fee for branch circuits
without purchase of service ❑
or feeder fee. Fire Alarm Installation
First branch circuit $46.85
Each additional branch circuit $6.65 • ❑ HVAC
Miscellaneous ❑ Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40
Each sign or outline lighting $53.40 ❑ Intercom and Paging Systems
Signal circuit(s) or a limited energy
panel, alteration or extension / $75.00 / ❑ Landscape Irrigation Control
Minor Labels (10) $125.00
Each additional inspection over ❑ Medical
the allowable in any of the above
Per inspection $62.50 ❑ Nurse Calls
Per hour $62.50
In Plant $73.75 ❑ Outdoor Landscape Lighting
Fees: ❑ Protective Signaling
Enter total of above fees $ 75
n Other
,
8% State Surcharge $ K.lK./e Number of Systems
25% Plan Review Fee
See "Plan Review" section on $ * No licenses are required. Licenses are required for all other installations
front of application.
Fees:
Total Balance Due $
- Enter total of above fees $
❑ Trust Account # `6 /. t✓e •
8% State Surcharge $
Total Balance Due $
All New Commercial Buildings require 2 sets of plans.
i:\dsts \forms \elc- fees.doc 08/30/01
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested /0 ` 3 / AM PM BLD
Location t * 35 G. f 7/. . Suite MEC
•
Contact Person , 4 IP Ph 3 0 7 71- 12 9g PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC '
Retaining Wall ELR c � U/ U 6 a `7 7
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL /
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
11 PART FAIL
SI E
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
•
Otheoach /Sidewalk Date / 2/�/ /o/ Inspector EXt
Final V
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.