Permit .CITY OF TIGARD
ELECTRICAL PERMIT
II COMMUNITY DEVELOPMENT Permit #: ELC2013 00112
TaGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/14/2013
Parcel: 1S133AD16200
Jurisdiction: Tigard
Site address: 12700 SW NORTH DAKOTA ST 120
Project: Starbucks Subdivision: 1995 -073 PARTITION PLAT Lot: 3
Project Description: (1) branch circuit for future equipment
Contractor: LIN R ROGERS ELECTRICAL CONTRACTORS Owner: PACIFIC CREST PARTNERS SCHOLLS L
2050 MARCONI DRIVE SUITE 200 7000 SW HAMPTON ST, STE 130
ALPHARETTA, GA 30005 TIGARD, OR 97223
PHONE: 770 - 772 -3472 PHONE:
FAX: 866- 496 -7839
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 02/14/2013 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 02/14/2013 $6.74
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92 •
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 OAR 5 -001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: OAR J N'K Permiittee Signature: a).1 a - P P LI e- TiOd
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.
.IV ED
Electrical Permit Applies 4 2013 milt t1l rat 1 I .,i i>.1.)
City of Tigard
F EB 1 Received I av/ 3 - oo ( !
ty b Detc/B _ Permit No.:
; . i 13125 SW Han Blvd., Tigard, OR 97223 Dau Review.
Phone: 503.718.2439 Fax: 503.59x1 pFTIGARD I � DAB Other ryq.q Permit
t c . ,` p 1 , Inspection Line: 503.639.4175 1\ ( C` Date Ready/By: age
Internet www.tigard-or.gov BUILDING D v �+ Notified/Method: t l 6 ® See Sup plem p ental 2 ln formalioo
❑ N ew construction E Addition/alteration/ lacement Please check all that apply (submit et
ss of glare w�items choked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories_
❑ Demolition ❑ Other where the available fault current ❑ Marinas and boatyards.
CC , :.;.- .. ;2`::,''.-:,.....: - . : - ::: 1 ':";- - .-'...'=- exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
❑ 1- and 2- family dwelling i ommercial /industrial 0 Accessory building less to or enseeds ons. ❑ buildings.
mmec at n:e agricrdnual
amps for all other installations. bu
❑ Multi- family El Master builder ❑ Other ❑ Fire pump. ❑ Installation of 75 KVA or
:. , - ,::... - ,::, - - - - Emergrncy system. separately derived system
. .. - . - ........ .,. ... , . ❑Addition of new motor load of ❑'A ° E "l_T, "I_7"
Job no.: Job site address: 12700 SW North Dakota, #120 100HP or more. occupancy_
❑ Six or more residential units. 0 Recreational vehicle parks.
City/State/ZIP: Tigard, OR 97223 ❑ Health-care facilities_ ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Projectname:Sterbudts LaBoulange ❑ Service or feeder 600 amps ormore.
St arbucks Y �:
•L .
Cross street/directions to job site: tk;eri,a,a - � _ tpy Fee rota
W Scholls Ferry Rd. New residential Slagle - or multi dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea_ add'I 500 sq. ft. or portion 33.92 1
Tax map/parcel no.: 1S133AD16200
Limited energy, residential
75.00 2
, • - ..:, -. .. ., - (wiW above sq. ft.)
Install (1) 120V 20A circuit for future equi Limited energy, multi - family
75.00 2
pment. residential (with above sq. fl.)
Services or feeders installation alteration, and/or relocation
200 amps or less 100_70 2
r r 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: Starbudcs Corporation 601 amps to 1,000 amps 301.04 2
Address: 2401 Utah Avenue South Over 1,000 amps or volts 5 52.26 2
City /state/zip:
Seattle, WA 98134 Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( 206 ) 318 -1575 Fax: ( ) 200 amps or less 5936 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits — new, alteration, or extension, per panel _
. Owner signature: Date: A. Fee for branch circuits with
is ., . above service or fender fee, 7A2 2
_. .. _ ._,_. _ __ _._.. .__ . _ ._ .. •each branch circuit
Business name: Lin R. Rogers Electrical Contractors, Inc. B, Fee for branch circuits without
service or feeder fee, Suit 1 56.18 2
Contact name: Alyssa Coursey branch circuit
Each add'I branch circuit 7.42 2
Address: 2050 Marconi Drive Suite 200 Miscellaneous (service or feeder not included)
City/State/ZIP: Alpharetta, GA 30005 Each manufactured ece and/or d/ r feeler 67.84 2
_ dwelling, service and/or Eeeder
Phone: ( 770 ) 772 -3472 F ax: : ( 86p 496 -7839 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail: j
N ( , f _ r C V Sign or outline lighting 67.84 2 •
... "'' { . .. --- — cO .. Signal circuit(s) or limited-energy
panel, alteration, or extension. Page 2 2
Business name: Lin R. Rogers Electrical Contractors, Inc.
Each additional inspection over allowable in any or the abov
Address: 2050 Marconi Drive Suite 200 Additional inspection (1 hr min) 66.25/ lhr
Investigation (1 hr min) 6625/ hr
City/State/ZIP: Alpharetta, GA 30005 Industrial plant (I hr mm) 78.18/ hr
Phone: ( 770 ) 772 -3400 Fax: ( 864 496 -7839 inspections for which no fee is
. - 'fieall listed %, hr min 90.00 / hr
CCB Lic.:118038 Electrical Lic.: 37 -727C Suprv. Lic.: 4292S r; Ott '.F.f, . ._...._ .._ ..r_ . `r r' t!1!.g.
Subtotal: $56.18
Suprv. Electrician signature, required: Plan review (25% of permit fee):
Print name: Paul Howell Date: 2 -13-13 State surcharge (12% of permit fee): $6.74
Authorized signature: `/ X / 1 TOTAL PERMIT FEE: $62.92
- Th penult application expires If a permit Is not obtained within ISO
days after It has been accepted as complete.
Print name: Date: • Number of inspections allowed per permit.
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