Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00276
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503118.2439 Date Issued: 05/10/2012
Parcel: 1 S133AD16200
Jurisdiction: Tigard
Site address: 12700 SW NORTH DAKOTA ST 120
Project: Starbucks Subdivision: 1995 -073 PARTITION PLAT Lot: 3
Project Description: Reconnect (1) sign lighting.
Contractor: TUBE ART SIGNS & SPORTS DISPLAYS Owner: PACIFIC CREST PARTNERS SCHOLLS L
4243 -A SE INTERNATIONAL WAY 7000 SW HAMPTON ST, STE 130
MILWAUKIE, OR 97222 TIGARD, OR 97223
PHONE: 503 - 653 -1133 PHONE:
FAX: 503 - 659 -9191
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 05/10/2012 $67.84
Specifics:
1 ea 12% State Surcharge - 05/10/2012 $8.14
Electrical
Type of Use: COM
Class of Work: OTR
Type of Const:
Occupancy Grp:
Total $75.98
Required Items and Reports (Conditions)
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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 accord: . _ . ' h approved plans. This permit will expire if work is not started within 180 days o issuance, or if work is suspended for more the 180
days. ATTENTI - : Oregon :w requires you to follow the rules adopted by the Oregon Utility Notifi :tion Center. Those • _ are set forth in OAR
952- 001 -0010 t roue OAR 952-0:1-s • • 0. o ay obtain a copy of the rules or direct questions to OUNC by calling 51' 2 .•1987 or 1.800
" � ( / P i /t �� L.. /_ �
Issued By:
OWNER INSTALLATION ONLY NIP y ermlttee Signature:
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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.
Electrical Permit ApplicaticRECEIVED Folz OFFICE USE ONLY
City of Tigard F r'3 Date/B. C) to MI Permit No.: GLtdl 66 p(
13125 SW Hall Blvd., Tigard, OR 9723 1 0 2012 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/8 : Other Permit:
T 1 G n It D Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: Jens: ® See Page 2 for
Internet: www.tigard - or.gov '" 1IIrD DIVISION Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
® New construction ❑ Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more El Building over three stories.
El Demolition ❑Other: SIGN
where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
❑ 1 - 2 dwelling less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
y g ® Commercialindustrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND VOCATION ❑ Addition system. larger separately derived system.
�) ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 °, "I -3 ",
Job no.: SB0447 Job site address: 12700 SVIa 1001IP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /"LIP: Tigard, OR 97223 ❑ Health -care facilities. ❑ Supply voltage for more than
IN) ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: l N) Project name: Starbucks Coffee #447 ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: south side of Scholls Ferry Rd ammo.. I Qty. I Fee. I Total I •
New residential single- or multi - family 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.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family
Reconnect 48" diameter exterior logo sign residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 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
City/ State/ZIP: Temporary services or feeders installation, alteration, and/or
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 property that I own which is not
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
® APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: Tube Art Group B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: Dan Osterman branch circuit
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
E -mail: dosterman @tubeart.com Pump or irrigation circle 67.84 //'. 2
CONTRACTOR Sign or outline lighting 1 67.84 (127 Y9 2
Signal circuit(s) or limited energy
Business name: Tube Art Group panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 4243 -A SE International Way Additional inspection (I hr min) 66.25/ hr
City /State/ZIP: Milwaukie, OR 97222 Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 653 -1133 Fax: (503) 659 -9191 Inspections for which no fee is 90.00 / hr
specifically listed ('A hr min)
CCB Lic.: 70956 Electrical Lic.: 37554c1s Suprv. Lic.: 366sig ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required : ✓ j
? Subtotal: C _
" �� �J1I ��� Plan review (25% of permit fee): ��
Print name: Ken Schultz ate: 5/8/12 State surcharge (12% of permit fee): $ ,)
fAitivir TOTAL PERMIT FEE: 75 .9
Authorized signature: /
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1. / '
This permit application expires if a permit is not obtained within 180
Print name: Dan Osterm. / Date: 5/8/12 days after it has been accepted as complete.
• Number of inspections allowed per permit.
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
[ WORK ONLY:
Fee for all residential systems combined .. $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
p Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY: 7
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
El Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations