Permit CITY OF TIGARD ELECTRICAL PERMIT
II al
• COMMUNITY DEVELOPMENT Permit#: ELC2015-00115
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/05/2015
Parcel: 1 S135BD00200
Jurisdiction: Tigard
Site address: 9785 SW SHADY LN
Project: Starbucks Subdivision: ASHBROOK FARM Lot: 5
Project Description: Sign lighting for(5)wall signs and(1)menu board.
Contractor: TUBE ART SIGNS&SPORTS DISPLAYS Owner: MAJ SBUX TIGARD LLC
4243-A SE INTERNATIONAL WAY NLCS LLC
MILWAUKIE,OR 97222 300 WEST 15TH ST, STE 200
VANCOUVER,WA 98660
PHONE: 503-653-1133 PHONE:
FAX: 503-659-9191
FEES
Quantity Description Date Amount
6 ea Sign or Outline Lighting 03/05/2015 $407.04
Specifics:
1 ea 12%State Surcharge- 03/05/2015 $48.84
Electrical
Type of Use: COM
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $455.88
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 th= -- adopted by the Oregon Utility Notifica •n Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You ma obtain a copy of the r - or. - • tions to OUNC by calling 32.1987 or 1.800.332.2 44.
Issued By: �� Permittee Signature:
Ilk 4111I■
/
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.
Electrical Permit Applica MISInIO ONIOlIfl9 FOR OFFICE 1 SF 0\1.1
Cl of Tigard Od Y OIL AO kLIO Received J nC�� Permit No.:
71 ■ 13125,SW Hall lvd.,Tigard,OR 972aj n� Plan Review O`J `�� C. -a
i Phone: 503.718.2439 Fax: 503.598.144* g 83� DateB : Other Permit:
I I G n lz a Inspection Line: 503.639.4175 Date Ready/By: Juris. ® See Page 2 for
Internet: www.tigard-or.gov CPA I a O u R Notified/Method: Supplemental Information
TYPE OF WO —~f a PLAN REVIEW
0 New construction ❑Addition/alteration/replacement Please check all that apply(submit 1 sets of plans w/items checked below):
❑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 ❑Floating buildings.
less to ground,or exceeds 14,000 ❑Commercial-use agricultural
❑ 1-and 2-family dwelling ,,21'Commercial/industrial ❑Accessory building amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system.
❑Addition of new motor load of ❑"A","E","I-2","1-3",
Job no.:S i. I�Z Job site address: "I l g �j 5`.� 1 L.� Six or or more. occupancy.
1 ❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: -1—I K�D o R., q,yti3 ❑Health-care facilities. ❑Supply voltage for more than
El Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name: Sik apuCILS ❑Service or feeder 600 amps or more.
Cross street/directions to job site: W q�� o C FEE SCHEDULE
J ^� rjU Description I Qty. I Fee. I Total
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no..qtr.. ,g 1,000 sq.ft.or less 168.54 4
Tax map/parcel no.: 1 S 13 5 B D 0010 0 Li Limited ner y, es ft.or portion 33.92 1
Limited energy,residential 75.00 2
DESCRIPTION OF WORK (with above sq.ft.)
Limited energy,multi-family 1' _ ''^w � 00,-U 75.00 2
I csi5rAl-l- S 1 I1 tx t1 i R�'1�-(J� S t ah S residential(with above sq.ft.) —
Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
❑ PROPERTY OWNER I ❑ TENANT 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Name: flflLL x Cp 401 amps to 600 amps 200.34 2
Address: F. 0 . g e?C -I y 0 2.71 601 amps to 1,000 amps 301.04 2
''II Over 1,000 amps or volts 552.26 2
j
City/State/ZIP: }-R�./ INA 98 124 - to 481 Temporary services or feeders installation,alteration,and/or
Phone:( ) Fax:( ) relocation
200 amps or less _ 59.36 1
Owner installation:This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 599 amps 168.54 2
Owner signature: Date: Branch circuits—new,alteration,or extension,per panel
❑ APPLICANT ❑ CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee,
Business name: ��-136 / ji -r 6/2.4-14 each branch circuit
7.42 2
B.Fee for branch circuits without
Contact name: D(�,a,(6 service or feeder fee,first
be iv, branch circuit 56.18 2
Address: 47_3 —A 56 1 f rr Q—N•:f104 WALL Each add'l branch circuit 7.42 2
City/State/ZIP: N I L w.tt c` 0 R. qi i" Miscellaneous(service or feeder not included)
Each manufactured or modular 67.84 2
Phone:(503) to 53 3 Fax:•(SO 3) 1p 57- 9/q/ dwelling,service and/or feeder
Reconnect only 67.84 2
E-mail: d-F I @ 4 .b car- In I Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 6- 67.84 ilea 0fl 2
Business name: -rutg'E S psi& Signal circuit(s)or limited-energy
panel,alteration,or extension. See
Page 2 2
Address: 42-43-45F_ I t--('f D/)/r1 w ky Each additional inspection over allowable in any of the above
City/State/ZIP: M I LJ I.I v1.(.-I / 0p__ (1-7 2 ( Additional inspection(1 hr min) 66.25/hr
Z� Investigation(1 hr min) 66.25/hr
Phone:(�j93,) 53- 1133 Fax:( ) Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lie.: 10 q 5 to Electrical Lic.:3-7 S 5 i-i Suprv.Lic.: 3I A, Si ' specifically listed(Vs hr min)
ELECTRICAL PERMIT FEES >�
Suprv.Electrician signature,required: Subtotal: T�7."/
Print name: kt-7■1 S c4 u L-r7_ Date: 2- 1'2_-/fir Plan review(25%of permit fee): -----'
State surcharge(12%of permit fee): 4/8• Sf4/
Authorized signature: A9-07,a_-Fa _ TOTAL PERMIT FEE: yS5.e
This permit application expires if a permit is not obtained within 180
Print name: u g- Date: /... II '75 days after it has been accepted as complete.
• Number of inspections allowed per permit.
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•
'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 Description I Qty. I Fee I Total
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
n Audio and Stereo Systems* 15.01 to 25 kva 20034 2
n Burglar Alarm Wind generation systems in excess of 25 kva:
25.01 to 50 kva 301.04 2
n Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance with 552.26 2
111 Heating,Ventilation and Air Conditioning OAR 918-309-0040)
System* Solar generation systems in excess of 25 kva:
Each additional kva over 25 7.42 3
n Vacuum Systems* >100 kva—no additional charge 0.0 3
TiEach additional inspection over allowable in any of the above:
Other: Each additional inspection is 6625/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:
(SEE OAR 918-309-0000) Plan review,if required(25%of permit fee):
State surcharge(12%of permit fee):
Check Type of Work Involved: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
❑ Audio and Stereo Systems days after it has been accepted as complete.
• Number of inspections allowed per permit.
❑ Boiler Controls
Ti Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
n HVAC
Ti Instrumentation
❑ Intercom and Paging Systems
Ti Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
n Outdoor Landscape Lighting*
n Protective Signaling
n Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
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