Permit CITY OF TIGARD ELECTRICAL PERMIT
1111
I . COMMUNITY DEVELOPMENT Permit #: ELC2013 00109
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/14/2013
Parcel: 1 S136DB02500
Jurisdiction: Tigard
Site address: 11636 SW PACIFIC HWY
Project: Starbucks Subdivision: AZOIC TERRACE Lot: 1
Project Description: (1) branch circuit for future equipment
Contractor: LIN R ROGERS ELECTRICAL CONTRACTORS Owner: KESSLER, JULES
2050 MARCONI DRIVE SUITE 200 6501 SW OAK ST
ALPHARETTA, GA 30005 PORTLAND, OR 97223
PHONE: 770 - 772 -3472 PHONE:
FAX: 623 - 516 -7396
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 wit 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 952- 001 -00 0. 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: atA__ JU rJ Permittee Signature: A r R-1 ` A - Flo �)
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.
Elec Permit A li t>I I
PP �' I ( It UFFIt I. I . I. U I.l
•
City of Tigard FEB 14 2013 ryes � PermitNo.: r� 1 3= 00 /v
• 13125 SW Hall BIvd, Tigard OR 97223 n ,,
Phone: 503.718.2439 Fax: 503.5981i'9TV/ OF TIGA r „ Other Permit:
T t , . -, , , , • Insp tine: 503.639.4175 V 1 ' Date Ready/By: /� ®See P 2 for
Intemel www.tigardor.gov BUILDING DIVISION Notified/Method: 1�' C. sappl�mW lnformatior
1. i 3 •r <, _ , s 1 . -_.> , s }:e,,e g _I a of 7. - '.• YT _
- ❑ New construction ® Addition/alteration/replacement Please check all that apply (submit a sets of p wfitems checked below)
[3 Demolition ❑ Other: ❑ Service or feeder 400 amps or more ❑ Building over three stories.
exceeds 10 000 amps acid° volts or Monies and
' . - _ .' t r F . ? I P ❑Floatingbuiltlmga.
n ercial/mdustrial ❑ Accessory building less 10 ground or a exceeds 14.000 ❑ t:o di t rse agricultural 1- and 2- family dwelling f ...
�Y g amps for all oilier ieerattntie • bmldinp.
❑ Multi-family ❑ Master builder ❑ Other ❑ Fire pump. ❑ Installation of75 KVA or
t - - ❑ Emergeaey system largo separately derived system. -
. • x :.c •- .. , . . . Additi orrrcw motor load of ❑ °A ". ,.E.71.2., °1-3
Job no.: Job site address: 11636 SW Pacific Hwy mote or more. occupancy.
❑ Six or more residential horns. ❑ Recreational vehicle parks.
City /Stare/ZIP: Tigard, OR 97223 ❑ Heahh-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldgJapt.no.: Project name:StarbuCksLaBoulange ❑ Service or feeder 600 ampsor more.
Startlucl(S ?': A�i j - 1, �; 3k'r't.` i.0: k. .1
Cross Street /drrectlons to job site: ae,rr{pp Qp. Fns.. • ToLI •
SW 72ND Ave New residential single- or multi -family dwelling unit -
includes attached garage.
Subdivision: Lot no.: 1,000 sq. R or less 168.54 4
Ea. add'! 500 sq. ft or portion 33.92 1
Tex map /parcel no 1 S 136DB02500 .r •d
/ a r 75.00 2
s Limited energy, residential
. -; ' z__ -..:_ •e.• ... , .:ac __.. j' r a r � e ; ' . (with abo
Limited energy, multi- family 75.00 2
Install (1) 120V 20A circuit for future equipment. residential (with above sq. ft)
Services or feeders irWallatlon, ake atian, and/or relocation
200 amps or less 100.70 2
,r . + A s 'r` 4 ';'..'';'T T r , 201 amps to 400 amps 13336 2
401 amps to 600 amps 20034 2
Name. Starbudes Corporation 601 amps to 1,000 amps 301.04 2
Address: 2401 Utah Avenue South Over 1,000 amps or vets 55226 2
Seattle, WA 98134 Temporary services or feeder Installation, alteration, and/or
City/State/ZIP: relocation
Phone: ( 206) 318 -1575 Fax: ( . ) 200 amps or less I 5936 1
201. amps to 400 amps I ( 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 16834 2
intruded for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch dreaits - new, alteration, or extension, per panel
Owner signature: Date: k Fee for branch circuits with
y
{ N ` y ? above service or feeder fee, 7.42 2
Y
: ^._ . . _.... ... . i ..: . __.1 .:.4:.. ti , .:j.. . :...:_ each branch circuit
Business name: Lin R. Rogers Electrical Contractors, Inc. B. Fee for branch circuits without
service or feeder fee, first 1 56.18 2
Contact name: Alyssa Coursey branch circuit
Each add'! branch circuit 7.42 2
Address: 2050 Marconi Drive Suite 200 Aftscellaneous (service or feeder not included)
City/State/ZIP: Alpharetta, GA 30005 wel
d manufactured or modular 1 67.84 2
dwelling, service and/or feeder
Phone: ( 770 ) 772-3472 • Fax: : ( 86¢ 496 -7839 _Reconnect only 67.84 2
E -mail: ' um [�� Pump or irrigation circle 67.84 2
#xr s , `, E , Fc u . { r ' i 3 F ti s Sign or outline lighting 67.84 2
_ ) .. - , :'. r i _ . i __, Signal circuits) or limited-energy
Business Lin R. R • •ens Electrical Contractors, Inc. panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the abov
Address: 2050 Marconi Drive Suite 200 Additional inspection (1 hr min) 6625/14
City/State/ZIP: Alpharetta, GA 30005 Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr mm) 78.18/1u
Phone: (770 ) 772 -3400 Fax: ( 864 496 -7839 Inspections for which no fee is
- 'fica11 listed %r hr min 90.00 / hr
CCB Lic- :118038 Electrical Lic.: 37427C Suprv. Lic.: 4292S O -' ;` ! i ;c,:'32....,`j1: k`_ SI'V ,__._
Subtotal: $58.18
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
TOTAL PERMIT FEE: $62.92
Authorized signature: - IPFJFIIPIIINMS
This puma application expires if s permit is not obtained within !an
days after it has been accepted as complete.
Print name: ' Date: • Number of inspections allowed per permit ,
1: 1BwldmgwerminIEl.C- remthAppeoe 07/D1/10 44n /W
4615T111/as/COMEa •
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