Permit CITY OF TIGARD ELECTRICAL PERMIT
"1111 1 COMMUNITY DEVELOPMENT Permit#: ELC2018-00724
Date Issued: 2/9/2022
T[GAR 17 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S110AC01101
Jurisdiction: Tigard
Site address: 11290 SW BULL MOUNTAIN RD
Project: Jacksons Food Stores 530 Subdivision: None Lot: None
Project Description: Construct new convenience store,canopy,recycle enclosure,site lighting,and reconnection of the existing tank
equipment to new electrical equipment.
Contractor: COUNTRYSIDE ELECTRIC INC Owner: PACWEST ENERGY LLC
PO BOX 397 3450 COMMERCIAL CT
JEFFERSON, OR 97392 MERIDIAN, ID 83642
PHONE: 208-888-6061
PHONE: 541-974-6415
FAX:
FEES
Quantity Description Date Amount
6 ea Services or Feeders-200 01/18/2022 $604.20
Specifics: amps or less
1 ea Services or Feeders-201 to 01/18/2022 $133.56
Type of Use: SF 400 amps
Class of Work: NEW 2 ea Services or Feeders-401 to 01/18/2022 $400.68
Type of Const: 600 amps
12 crt Branch Circuits w/Purchase 01/18/2022 $89.04
Occupancy Grp: Service or Feeder
2 ea Sign or Outline Lighting 01/18/2022 $135.68
1 ea 12%State Surcharge- 01/18/2022 $163.58
Electrical
Total $1,526.74
Required Items and Reports(Conditions)
This permit is issued sublect 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 throuah OAR 952-001-0090. in the rules or direct auestions to OUNC by callina 503.232.1987 or 1.800.332.2344.
Issued By: �y �r4.2:7 — Permittee Signature: FG�C�Y-]���`— � yf,--
OWNER INSTALLATION ONLY 7
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 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.
r ,•
El• ectrical Permit Application � FOR OFFICE USE ONLY
City o Tigard
'� • 13125 SW Hall Blvd.,Tigard,OR 97223 p�Review I
M ' Phone: 503.718.2439 Fax: 503.598.1960 ty�U 1, ,i• 2018 D./By: l(Misr/• � f�'(/I/t���
_ Inspection Line; 503.639.4175 Ready DateBy: r Jam I ® See Page 2 for
f II,ARD Internet: www.tigard-or.gov (`* °•yr t-'- . NotiRed/Method: /����j�l Supplemental Information
TYPE OF INORiic rrT4M"' truattrai�rrs,., r441 /.f- PLAN REVIEW
® New construction ❑Addition/alteration/replacement �v f I t I Please cheek all that apply(submit 2 sets or plans w/intros checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
❑ Demolition E Other:
where the available fault current 0 Marinas and boatyards.
CATEGORY,OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑ 1-and 2-family dwelling ®Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑commercial-use agricultural
snips fur all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
' 0 Addition of new motor load of system.
Job#:BCE#17858 Job site address:11290 SW Bull Mountain Rd 100HP or more. ❑"A","E","1-2","1-3",
Ci !State/7.IP:Ti and OR 97224 ❑Six or more residential units. occupancy.
ty g ° 0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name:Jacksons No.530 0 Hazardous locations. 0 Supply voltage for more than
®Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site:Pacific Hwy FEE SCHEDULE
Description I Dtv. I Each I Total
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#:2S110AC01101 Ea.add'1 500 sq.ft.or portion 33.92 I
DESCRIPTION OF WORK Limited energy,residential
Construct new convenience store,canopy, (with above 50.ft.) 75.00 2
recycle enclosure,site lighting and
Limited energy,malti-family 75.00 2
reconnection of the existing tank equipment to new electrical equipment residential(with above sq.ft.)
/1 PROPERTY OWNER El TENANT Renewable Energy 0 See Page 2
Services or feeders installation,alteration,and/or relocation
Name:PacWest Energy,LLC dba Jacksons Food Stores,Inc. 200 amps or less 6 100.70 604.20 2
Address:3450 E.Commercial Ct 201 amps to 400 amps I 133.56 133.56 2
i
401 amps to 600 amps 2 200.34 400.68 2
. City/State/ZIP:Meridian,Idaho 83642 601 amps to 1,000 amps 301.04 2
.( Phone:(208)888-606I Fax:(208)888-3585 Over 1.000 amps or volts 552.26 2
`'' 1 Temporary services or feeders installation,alteration,and/or
Email: relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
\� _t APPLICANT 1 ' CONTACT PERSON "' Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name:Barghausen Consulting Engineers,Inc. above service or feeder fee, 12 7 42 934.92 2
"` each branch circuit
Contact name:Ms.Caryl J.Pinner BF., .Fee for branch circuits without
Address: 18215 72nd Ave S service or feeder Yee,tits( 56.18 2
branch circuit
City/State/ZIP:Kent,WA 98032 Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
•t Phone:(425)656-1063 Fax: :(425)251-8782 Each manufactured or modular
�` dwelling,service and/or feeder 67.84 2
L Email:spinner@barghausen.corn Reconnect only 67.84 2
1 CONTRACTOR Pump or irrigation circle 67.84 2
'\r
Business name:TBD /' _ s.i J✓ Sign or outline lighting 2 67.84 135.68 2
C.
Signal circuit(s)or limited-energy
Address: A(J- �f,� 3q,- panel,alteration,or extension. 0 See Page 2 2
City/State/ZIP: Each additional inspection over allowable in any of the above
T yr Cl/a 17 3 Additional inspection(1 hr min) 66.25/hr
Phone:( ) Fax:( ) Investigation(1 hr min) 90.00/hr
Email: Industrial plant(1 hr min) 78.18/hr
Inspections For which nu fee is /
• CCB Lie.: Electrical Lic.: Suprv.Lie.: specifically listed('/hr min) 90.00, hr
4 ELECTRICAL PERMIT FEES
uprv.Electrician signature,required: Subtotal: 2209
Print name:sik
Date: ®Plan Review Required(25%of permit fee): 552.26
State surcharge(12%of permit fee): 265.08
T. TOTAL PERMIT FEE: 3026.4
Authorized signature: ',
This permit application expires if a permit is not obtained within 180
Print name: Caryl J. Firmer I Date: 10/31/2018 days after it has been accepted as complete.
* Number of inspections allowed per permit.
l:J3uilding1Permils'ELC_PermitApp ELR_ERE.doc Rev 06/17,2015 440-4615T(11/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Fee for all residential systems combined: $75.00 l ul I F,°" Total I Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 00.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 1s.o1 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
n Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
❑ Garage Door Opener* >100 kva(fee in accordance
552.26 2
with OAR 918-309-0040)
❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System*
Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva-no additional charge 0.0 3
Each additional inspection over allowable in an of the above:
❑ Other: Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(%hr min)
COMMERCIAL WORK ONLY:
ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00 Subtotal(Enter on Page ):
* Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
® Audio and Stereo Systems
n Boiler Controls
❑ Clock Systems
® Data Telecommunication Installation
❑ Fire Alarm Installation
® HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
® Landscape Irrigation Control*
n Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems: 4
*No licenses are required. Licenses are required for all
other installations
IABuilding\Permits\ELC_PermilApp_ELR_ERE.doc Rev 06/17/2015
I
J
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard Received
a;e s
Permit#:
• 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/ : Related Permit#:
Inspection Line: 503.639,4175 Ready Date/By: tuns. ® See Page 2 for
TIGARD Internet: www.tigard-or.goy Notified/Method: Supplemental Information
TYPE OF WORK t "'", PI NTR 4R7f, ' rst -
,Kcw (submit construction ❑ Addition/alteration/replacement Please check all that apply(subt 2 sets of plans w/items checked):
//-- \\ 0 Service or feeder 400 amps or more ❑Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑ 1-and 2-family dwelling `KC..C'.ommercial/industrial E Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑ Multi-family E Master builder ❑ Other: ❑Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
0 Addition of new motor load of system
Job#: I Jobs'te address:`l)�O6(,J }hP ouJeA.J 100HPormore.
❑`A","E","1-2","1-3",
II El Six or more residential units. occupancy.
City/State/ZIP:.."
s1 C'V �0 El Recreational vehicle parks.
-' ❑Health-care facilities-J
Suite/bldg./apt.#: roject name: ❑Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or Inure- 600 volts nominal.
Cross street/directions to job site: FEE,SCHEDULE
Description I Qty. I Each I Total I
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'I 500 sq.ft.or portion 33.92 1
DESCRIPTION OF.WORK Limited energy,residential
�,��C^\ L ' n 1 ' (,,� p (with above sq.R.) 75.00 2
NS �i W �, v C` Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
❑..PROPERTY OWNER -'. El TENANT Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 100,70 2
- -- 201 amps to 400 amps 133.56 2
Address:
401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: relocation
Owner installation: This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
0 APPLICANT - El CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: above service or feeder fee, 7 42 2
each branch circuit
Contact name: B.Fee for branch circuits without
service or feeder fee,first 56.18 2
Address: branch circuit
City/State/ZIP: Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: C U N I'yv�( e }rO V , 'c Sign or outline lighting 67.84 2
� t� 3C6� 1.,. I Signal circuits)or limited-energy 0 See Page 2 2
Address panel,alteration,or extension.
J e,r I /'� , 97 2Q Each additional inspection over allowable in any of the above
City/State/ZIP: V v Additional inspection(1 hr min) 66.25/In
Phone:( ) Fax:( ) Investigation(1 hr min) 90.00/hr
Email: O l-e+ Q.O U )it —deel- ;c ccif-,\ industrial plant(1 hr min) 78.18/hr
`6 Inspections far which no fee is 90 00/hr
CCB Li .: 111.471C1 Electrical Lie.: —, n Suprv.Lie.: Ll 0 DOC �ecincauy hsied(/r hr mint _
C t 00 ELECTRICAL PERMIT FEES
t
Suprv.Electrician signature,required:-� lb-j ^ Subtotal:
'I•/��R, .�f Date: `_/ O� ()� ❑Plan Review Required(25%of permit fee):
Print name. If ' [ G�) ¢� ` �`^
State surcharge(12%of permit fee):
TOTAL PERMIT FEE:
Authorized signature:
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
• Number of inspections allowed per permit.
I.t13uilding4PermitstELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(I I/05/COM/WEB
Dianna Ornelas
From: Mark VanDomelen
Sent: Monday, September 13, 2021 4:49 PM
To: #Building Permit Technicians
Cc: Tom Hochstatter; Walter Barnett
Subject: Re: 11290 SW Bull Mountain Rd - Jacksons Food Store & Fuel Station
Follow Up Flag: Follow up
Flag Status: Completed
Categories: Dianna
I will accept the 2018 permits.
Thanks,
Mark
Get Outlook for iOS
From:#Building Permit Technicians<TigardBuildingPermits@tigard-or.gov>
Sent: Monday, September 13, 20214:17:16 PM
To: Mark VanDomelen<markv@tigard-or.gov>
Cc:Tom Hochstatter<TomH@tigard-or.gov>; Walter Barnett<walter@tigard-or.gov>
Subject: 11290 SW Bull Mountain Rd -Jacksons Food Store & Fuel Station
Hi Mark,
We have multiple permits submitted in 2018 for this site to demolish and rebuild a new food and fuel canopy (see
attached file). The majority of permits have been reviewed and are ready to issue.
The site work and building permits were approved/not released by permit coordinator due to ODOT requirements that
had not been met. A recent case MMD2021-00026 was approved to modify the ODOT condition #24 of the land use
case CUP2017-00005, but they still have some other outstanding condition land use and engineering conditions that are
not met.
A contractor is asking about obtaining permits. Will you approve use of the 2018 permits, or will you require that they
submit new permits/plans to be reviewed under the new code?
Thank you.
Dianna L. Ornelas
Building Division Services Supervisor
City of Tigard I Community Development
13125 SW Hall Blvd I Tigard, OR 97223
503-718-2430 Direct 1503-718-2439 Permits
DISCLAIMER: E-mails sent or received by City of Tigard employees are subject to public record laws. If requested, e-mail
may be disclosed to another party unless exempt from disclosure under Oregon Public Records Law. E-mails are retained
by the City of Tigard in compliance with the Oregon Administrative Rules"City General Records Retention Schedule."
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