Permit CITY OF TIGARD ELECTRICAL PERMIT
2 COMMUNITY DEVELOPMENT Permit #: ELC2012 -00343
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/05/2012
Parcel: 1 S136DB02500
Jurisdiction: Tigard
Site address: 11636 SW PACIFIC HWY
Project: Starbucks North Tigard Subdivision: AZOIC TERRACE Lot: 1
Project Description: (4) branch circuits to relocated pantry case
Contractor: CASCADE ELECTRICAL LLC Owner: KESSLER, JULES
PO BOX 160 BY KAREN LILLEBO
BRUSH PRAIRIE, WA 98606 6312 SW CAPITOL HWY #443
PORTLAND, OR 97239
PHONE: 360 - 518 -0905 PHONE:
FAX: 360 - 666 -0135
FEES
Quantity Description Date Amount
4 crt Branch Circuits wo /Purchase 06/05/2012 $78.44
Specifics: Service or Feeder •
1 ea 12% State Surcharge - 06/05/2012 $9.41
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $87.85
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: Ore n 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 OA 95 001 -009 You may o tain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. `�] A / ( r
Issued By: � Permittee Signature: 0 A 0.• .3 - ` 23 k / �'
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 503.639.4176 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.
c,
Jun. 1. 2012 2:03PM 360-66 . • v ..„„ . No. 2619 P. 1 5f 0
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, Electrical Permit Application titb,..1. FOR OFFICE USE ONLY iP
.
.. I , phonc: 503.718.2439 Fax: 503.598.1960m Du : , : c l e tefi eis ivtd . : to S' f." P"mitgle---€9090% _
. il City of Tigard, OR 97223
IN Plan Review
Other Permit:
I . I. ci A RD Inspection Line: 503.639.4175 1 lunil L Date Rea■iy/By: NM El See Page Z for
Internet: wvAv.tigard-or.gov BUILDING I)IVISIn "'c'eth°& Supplemental Information
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f=1 New construction 21 Addition/alteration/replacement Please check all that apply (submit 2 sets of plans wiilems checked below):
0 Service or feeder 400 amps or more 0 Building over three stories.
D Demolition 0 Other;
where the available fault current 0 Marinas aodboatwids.
l'i.:ii'.-i P-A
l tFE n o'0111ri , For zniisiRucnow
14 exceeds 10,000 amps al 150 volts or 0 Floating buildings.
.__j___,,. . less to ground. or exoeeds 14.000 EI Commercial-use agricultural
Li 1- and 2-family dwelling El Commercial/industrial ID Accessory building amps for all other instalha ions. buildings.
0 mai-finily 0 Master builder 0 Other: . ['Fire pump. ['Installation of 75 KVA or
brger separatety derived system.
e,.•".' i °Emerge/ Wier".
i.u...1.!%1W0■11 El Addili o f now mo l o f 0
Job no.: C665 I Job she address: 11636 SW Pacific Highway 10010 or more. . occupancy.
0 Six or mote residential nails, ()Recreational vehicle partes.
City/State/ZIP: Tigard, OR 97233 DRealth-cmc facilities. • 0 Supply voltage for more than
Cl Reunions locations. • 600 volts nominal.
Suite/bldg./apt. no.: I Project name: Storbucks North Tigard 0 Service or feeder 600 amps ar mors.
f; .............................
Cross street/directions to job site: SW of SW 12° Ave. on SW Pacific Highway Datreiptton I Orr. I I'm 1 row I •
New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. edd'I 500 sq. ft. or portion 33.92 1
Tax map/parcel no.: ......... ..... .. Limited energy, residential
75.00 2
,r;!t]•:• with above 501.)
Tc...i':••ei..41o.). :. . ;the me.,..,... ,:...t.:.:=:.....zz==..n • • er
Limited energy, multi-family
75.00
Relocate pastry case, minimal lighting upgrades, 1 - track light residential (with above sq. ft.) 2
Services or feeders installation, alteration, and./or relocation
200 amps or less 100.70 2
N 0
ry7-1ttiEWAPtirlIV1J,:fqi:T,..4:lift,teagg.ofv1,.,Atil‘,Ivip..,t I at to 400 amps 13356 2
00. ri....,.... ... ,..... .-.r: ;'.1.;; ?.;11r.g..1■. ■!*.t ntr....,..,.....,........0%.:,:-.P.1;.ce;:
Name: 401 amps to 600 amps 200.34 2
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: ( ) I 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 1 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 eireuils - new, alteration, or extension, Leer panel •
Owner signature: Dalt: A. Fee for branch circuits with -
. , t( .... • , .. ,, v.. ■ • . . ■ ,....,.... ,
Pii,Ag11(4.3i. CliAtelleAtiEllta.:ii::;.i.M[j.?it4141:11CONT.eActig*A.S,.011 above service or feeder fee
EdITgii: each b ranc h d itt i t 742 2
Business name: B. Fee for branch circuits without
service or feeder fee, first I 18 56.18
Contact name: branch circuit 56. 2
Each add'I branch circuit 3 7.42 _ 22.26 2
Address: Aliseellaneone (service or feeder not included)
Each manubcnned or modular
City/State/ZIP: dwelling, service and/or feeder 67.84 2
Phone: ( ) I Fax: : ( ) Reconnect only 67.84 2
Pump m irrigation circle 67.84 2
E
.....
::!.... ................................................................................................................................................................. ........ Sign or outline lighting 67.84 2 si c or ii m i te d_ enew
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 (1 hr min) 66.25/ hr
Investigation (1 hr min) 6625/ hr
City/State/ZIP: Brush Prairie, WA 98606 .
_ _ Industrial plant (1 hr min) 78.18/ hr
Phone: (360) 518.0905 <4 N. 0 I Fax: (3 6;75 Inspections for which no leo is
A •
90.00/ hr
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CCB Lie.: 158047 V: I Electrial .. 37 prv. L' .. 4730S WAtii,!!!,1;iitagOillt tyftripitE,torAfr:0441
Subtotal;
Suprv. Electrician signature, required: A
Plan review (25% of pennit fee): 78.44
Print name: Dan Lindberg Date: 5/01/12 State surcharge (12% of permit fee): 9.41 '
TOTAL PERMIT FEE: 87.86
Authorized signature: ) . .
This permit application expires if a permit is not obtained within 180
Print name: , Lik,JEiiiiiiii Date: ' ( (. days after it has been accepted as complete. sr .
• Number of inspections allowed per permit.
anal - . JIL
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