Permit •
CITY OF T I GA R D ELECTRICAL PERMIT -
RESTRICTED ENERGY
I ;� DEVELOPMENT SERVICES PERMIT #: ELR2001 -00205
�� '�' I- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 08/08/2001
SITE ADDRESS: 13560 SW PACIFIC HIGHWAY STARBUCKS PARCEL: 2S102CC -00500
SUBDIVISION: ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
Project Description: Installation of sound and data telecommunication systems.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: X 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: 2
Owner: Contractor:
STARBUCKS COFFEE COMPANY ST JOHNS ELECTRIC INC
2401 UTAH AVE S 4415 NE MINNEHAHA
SEATTLE, WA 98134 VANCOUVER, WA 98661
Phone: 206 - 318 -1575 Phone: 360- 693 -5100
Reg #: LIC 43135
SUP 3024S
ELE 37 -350C
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT CTR 08/08/2001 $150.00 2720010000 Elect'l Final
5PCT CTR 08/08/2001 $12.00 2720010000
Total $162.00
This Permit is issued subject to the regulations contained in the Tigard Muniapal 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 thro gh OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -1987. ,
Issued by ., , / , g Permittee Signature (TA ap,p_b_,(,Brfi/Iri
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: 6 Chap(, . DATE:
LICENSE NO: - 30 c 1.,4 C j
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
. . .
Electrical Permit Application
ECEIVEv
• Datereceived 7 I Permit no.:ag2Q)/ G62-05- t iy City g C1 of Tigard Project/appl. no.: Expire date:
.....
City of Tigard Address: 1 3 6Wfr Il "'yd, Tigard, OR 97223 Date issued: By: I Receipt no.:
Phone: (503) 639 -4171 u 1 !
Fax: (5f8 960 C ase file no.: Payment type:
' " ,t
Land use approval:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ACommercial/industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Other: ❑ Partial
JOB SITE INFORMATION
Job address:13500 SW Pacific HWY Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: 1Block: 'Subdivision: Bldg. Permit # BUP 2001 -00258
Project name: 'Description and location of work on premises: •
Estimated date of completion/inspection: •
CONTRACTOR APPLICATION FEE SCHEDULE
Job no: Fee Max
Business name: St. Johns Electric, Inc. Description Qty. (ea.) Total no.insp
New residential - single or multi- family per
Address: 4415 NE Minnehaha St. dwellingunitlncludesattachedgarage.
City: Vancouver 'State: WA I ZIP: 98661 Service included
Phone:3 6069 35100 1 Fax699 -1345 ' E -mail: 1000 sq. ft. or less 4
Each additional 500 sq. ft. or portion thereof
CCB. no.: 43135 ' Elec. bus. lie. no: 37 -350C Limited energy, residential 2
City /metro no.: • • 004119 Limited energy, non- residential 2
4 • � / Each manufactured home or modular dwelling
Signature of supervise trician (required) Dat6 / Service and/or feeder 2
Services or feeders — installation,
Sup. elect name (print): I ean R. B • u r License no:3 0 2 4 S alteration or relocation:
PROPERTY OWNER 200 amps or less 2
201 amps to 400 amps 2
Name (print): 401 amps to 600 amps 2
Mailing address: 601 amps to 1000 amps 2
City: 'State: 'ZIP: Over 1000 amps or volts 2
Phone: 1 Fax: 1E-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, alteratioa , 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 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: - l 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:
1 PLAN REVIEW (Please check all that apply) MIsc . (Service or feeder not Included):
- O Service over 225 amps 0 Health- carefacility Each pump or irrigation circle 2
' ❑ Service over 320 amps- rating of 1 &2 O Hazardousiocation Each sign or outline lighting 2
a family dwellings ❑ 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' 2
❑ Building over three stories ❑ Feeders, 400 amps or more *Description:
❑ Occupant load over 99 persons O Manufactured structures or RV park Each additional Inspection over the allowable In any of the above:
O Egress/lightingplan ❑ Other Per inspection I I 1
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 $ / S'J '
mo
O Visa O MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number. / / within 180 days after it has been State surcharge (8%) .... $ /y
Ex accepted as complete. TOTAL $ //D 1i'
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440-4615 (6100/(.'OM)
Electrical Permit Fees: Limited Energy Fees: ,
TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Complete Fee Schedule Below: ) Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items - Co0 Total 4, Check Type of Work Involved:
Residential - per unit
1000 sq. ft. or less $1.5.15 4 ❑ Audio and Stereo Systems
Each additional 500 sq. ft. or
portion thereof . 33.40 1 ❑ Burglar Alarm
Limited nergy $75.00
Each M ti nuf'd Home or Modular Garage Door Opener`
Dwelling Service or Feeder $90.90 2 El
Services Feeders ❑ Heating, Ventilation and Air Conditioning System*
Installation\ alteration, or relocation
200 amp less 2- $80.30 /6646. 2 Systems*
201 amps to 400 amps $106.85 2
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 Service or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY
Installation, alteration, 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 Check Type of Work Involved:
401 amps to 600 amps $133.75 2 yp
Over 600 amps to 1000 v. ts,
see' "b" above. Audio and Stereo Systems
Branch Circuits Controls
New. alteration or extension p: • • nel
a) The fee for branch circa ❑
with purchase of sere' a or Clock Systems
feeder fee.
Each branch circuit 405 $6.65 4/3,7, ,2 2 (�] Data Telecommunication Installation
b) The fee for branch ci uits s�
without purchase .. service ❑ Fire Alarm Installation
or feeder fee.
First branch circuit $46.85 HVAC
Each additional b : nch circuit $6.65 El
Miscellaneous ❑ Instrumentation
(Service or feeder not ncluded)
Each pump or irrigation circle $53.40 Intercom and Paging Systems
Each sign or outline ' ghting 53.40
Signal circuit(s) or . limited energy
panel, alteration .r extension Z $ , .00 /SD. D/) 0 Landscape Irrigation Control
Minor Labels (10) $125: 0 ❑
Medical
Each additiona inspection over
the allowable i any of the above Nurse Calls
Per inspection $62.50
Per hour $62.50 El Plant $73.75 Outdoor Landscape Lighting
Fees: C El Protective Signaling
Enter total . f above fees S9 09 . al $ ,,-.4■1 ❑ Other
r r
u
8% State rcharge 7 1, 3 i $ ,..„27 Number of Systems
25% Plan - eview Fee ` No licenses are required. Licenses are required for all other installations
See - P n Review" section on $
front application.
Fees:
Total = alance Due 4, 31. 43 $ 1,_.i Enter total of above fees $ /S v
❑ st Account # 8% State Surcharge $ /,.
Total Balance Due $ /6 P . 07
iNists\forms\elc- fees.doc 10/09/00 •