Permit q CITY OF TIGARD ELECTRICAL PERMIT
' * COMMUNITY DEVELOPMENT Permit #: ELC2011 -00201
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/19/2011
Parcel: 2S102CC00500
Jurisdiction: Tigard
Site address: 13560 SW PACIFIC HWY
Project: Starbucks Subdivision: Lot: 0
Project Description: (1) branch circuit.
Contractor: CASCADE ELECTRICAL LLC Owner: 13500 PACIFIC CORP
PO BOX 160 BY CAPOZZOLI ADVISORY FOR
BRUSH PRAIRIE, WA 98606 PENSIONS INC
21500 HAGGERTY ROAD, SUITE 100
NORTHVILLE, MI 48167
PHONE: 360- 518 -0905 PHONE:
FAX: 360 - 666 -0135
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 04/19/2011 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 04/19/2011 $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 •52- 001 -0090. You ma •btain a • • • • - - questions to OUNC by calling 503.27 or 1.800.332.2344. _
Issued B. _ 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' 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.
Apr, 15, 2011 11:48AM 360- 666 -0135 No, 2271 P. 2
Electrical Permit Application ,� FOR OFFICE USE ONLY
Received /�
City of Tigard � DateB . f/ permit No.: „ - od, I
't 13125 SW Hall Blvd., Tigard, OR 9Ak °
• Plan
Review +
i P 503.718.2439 Fax: 503.5 1 %\\ DateB Other Permit:
T i CPA R O Inspection Line: 503.639 , Ca Q Date Ready/By: RI See Page 2 for
Internet: www.tigard•or. PQ � ` ( ' , otificdthdelhod: . / r Supplemental Information
New co 'l!7t'1P , PL'0# ` � rfj. l t s ' +t ,
❑ nSl1 UCROn ®AdditiOn/allerallpn ti nt Please check all that apply (submit 2 se of plans w /ueoa checked below):
1,111��� ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: R)` where the available fault current ❑ Marinas and boatyards.
exceeds 10,000 amps as 150 volts or ❑Floating buildings.
1=1 I- and 2-family El Commercial/industrial /i l ❑ Ac
less to ground, or exceeds 14,000 ❑ Commercial -tae agricultural
y dwelling Accessory building amps for all other installations, buildings.
Multi- family ['Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
QRd Ql`ATION ,
„ ❑Imergencysystem. larger separately derived system.
J'UB Sir'1fiE YYF IArI?CQi�! AIVJD Y; �
❑Addiuoo of new motor load of ❑ "A ", "E" ° °I -2" °I -3"
Job no.: C501 I Job site address: 13560 SW Pacific Hwy Ioo11P or mare. occupancy.
❑ Six or more residential units. El Recrearional vehicle parks.
City /Slate /ZIP: Tigard, OR 97223 ❑ Health -care Ihcilities. ❑ Supply voltage for more than
❑ hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: Starbucks Coffee - C501 ❑ Service or feeder 600 amps or more.
i ' ,j c+ •1CgE, $C' bJLE ;
Cross street/directions to job Site: NE or SW McDonald St, on Pacific Hwy 99 Description I Oro. I Foe I 'rotas I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. R. or less 168.54 4
Ea add'I 500 sq. 11 or portion 33.92
Tax map/parcel no.:
Limited energy, residential
p p l,, + ,? DES 1'IOPi oP'. W 'CIF: (with above sq, 0) 75.00 2
Limited energy, multi- family
• residential with above sq. ft.) 75.00 2
1 - altered circa[[
Services or feeders Installation, alteration, and /or relocation
200 amps or less 100.70 2
pKOPERTY Ol ,; , i jl I p � E1, + i;` 201 amps lo 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name. 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City /State /ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on properly that I own which is not 401 amps to 599 amps 16$.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits— new, alteration, or extension, punnet
Owner signature: Date: A. Fee for branch circuits wrrh 7
above service or feeder fee,
0 41PfLICAiVT + I . El CozfrA 1 Ti,;. ' 7.42 2
each branch circuit
Business name: B. Fee for branch circuits vi /horn
service or feeder tee, first 1 5613 56.13 2
Contact name: branch circuit
Each add'I branch circuit 7.42 ,, 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular
City /Stale /ZIP: dwelling, service and/or feeder 67.84 2
Phone: ( ) I Fax: : ( ) Reconnect only 67,84 2
Pump or irrigation circlo 67.24 2
'E 2
CO,,,iY T1lACT0 Sign or outline lighting 6 B
f 7. d
R . ' .' , Signal Circuit(S) or limited -energy
Business name: Cascade Electrical, LLC panel, alteration, or extension. Page 2 2
Each additional Inspection over allowable in any of the above
Address: PO Box 160 Additional inspection (I hrrnia) 66.25/ hr
City /State /ZIP: Brush Prairie, WA 98606 Investigation (I hr min) 66.25/ hr
Industrial plant (1 hr nun) 78.18/ hr
Phone: (360) 518 - 0905 Fax: (360) 666 - 0135 Inspections for which no fee is 90.00 / hr
specifically listed ('Y he min) •
CCB Lie.: 158047 Electrical Lie.: 37 -1027C Suprv. Lie.: 4730S F,,. „ 'i.', ,, EL)3CTRICAL PEIZ1tfIT Ttri& 'a'
,n Suprv. Electrician signature, required: ���t�`+ Subtotal 56.18
Plan review (25% of permit fcc):
Print name: Dan Lindberg Date: 04/15/2010 State surcharge (12% of permit fcc): 95 ; vi
i � TOTAL PERMIT FEE: „.,..7,043,-- (19- �l Authorized Signature: T hi s permit application expires if a permit is not obtained within 180
days after It has been accepted as complete.
Print name: Don Lindberg bate: 04115/2010
■ Number of inspections allowed per parade
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