Permit ,
CITY OFJIQARD EtC?7 cv 33
� l DEVELOPMENT V X 33 -
13125 SW Hall Blvd., Tigard, OR 9? (S0 9M4f5/9
PARCEL: 1S135DD -03301
SITE ADDRESS...:11945 SW PACIFIC HWY 0210
SUBDIVISION :HOFFARBER TRACTS NO.1 ZONIN6:C -6
BLOCK • LOT :2 JURISDICTION: TI6
Project Description: Electrical permit for installation of one permanent, mall
sign, constructed of sheet metal & plastic, to read: °The Carpet Place°.
- -- RESIDENTIAL UNIT - - -- -- -TEMP SRVC /FEEDERS - - -- MISCELLANEOUS
1000 SF OR LESS • 0 0 — 200 amp • 0 PUMP /IRRIGATION • 0
EACH ADD' L 5O0SF...: 0 201 — 400 amp • 0 SIGN /OUT LINE LTG..: 0
LIMITED ENERGY : 0 401 — 600 amp • 0 SIGNAL /PANEL • 1
MANF. HM/ SVC /FDR..: 0 601 +amps -1000 volts.: 0 MINOR LABEL (10)...: 0
- - -- SERVICE /FEEDER - - -- - - -- BRANCH CIRCUITS -- -ADD'L INSPECTIONS-- -
0 — 200 amp • 0 W /SERVICE OR FEEDER: 0 PER INSPECTION • 0
201 — 400 amp • 0 1st W/O SRVC OR FDR.: 0 PER HOUR • 0
401 — 600 amp : 0 EA ADD'L BRNCH CIRC: 0 IN PLANT • 0
601 — 1000 amp • 0 PLAN REVIEW SECTION
1000+ amp /volt • 0 > =4 RES UNITS > 600 VOLT NOMINAL..:
Reconnect only : 0 SVC /FDR >= 225 AMPS..: CLASS AREA /SPEC OCC.:
Owner: FEES
THE CARPET PLACE type amount by date recpt
TIGARD PLAZACO ST PRMT $ 40.00 DRA 04/07/97 97- 292815
11945 SW PACIFIC HWY STE 210 5PCT $ 2.00 DRA 04/07/97 97- 292815
TIGARD OR 97223
Phone #:
Contract or:
HIGHLIGHT SIGN CORP. $ 42.00 TOTAL
8430 SW 37TH
REQUIRED INSPECTIONS
PORTLAND OR 97219 Elect'1 Service
Phone #: 503 -245 -0342 Elect'1 Final
7
Reg #..: 010459
This permit is issued subject to the regulations contained in the 1/4—A.Q,4_ , C 16-."
Tigard Municipal Code, State of Ore. Specialty Codes and all other Permittee i nature
9 Pa + P Y 9
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 ..& _4. ,ml L _ I
than 1: days. ed By
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: DATE:
LICENSE NO:
Call for inspection — 639 -4175
CITY OF TIGARD Electrical Permit Application PlanChlr
13125 SW HALL BLVD. Recd
Date Rec'd 4-, -97
TIGARD OR 97223
Date to P.E.
Phone (503) 639 -4171, x304 Print or Type Date to DST
Inspection (503) 639 4175 Incomplete or illegible will not be accepted Permit # Ec-C Q 7 - Oa33
Fax (503) 684 -7297 Called
1. Job Address: � 4' N'' 4. Complete Fee Schedule Below:
_ �
Name of Development •/ / r, L l`.- Number of Inspections per permit allowed
Name (or name of business)' g /-2 L6 � . L / - � -_ Service included: Items Cost Sum
Address (1945 Sw u /ac I F tc. 1 }(w T 4a. Residential - per unit -
City/State/Zip 1000 sq. ft. or less $110.00 4
CI
p I ' �? 6 2 ' O ? 1 Each additional 500 sq. ft. or
Commercial ® Residential El portion thereof $25.00 1 • Limited E nergy $25.00
Each Manuf'd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only: .
(Attach copy of all current licenses ((�' 4b. Services or Feeders
Electrical Co tractor LICE (� � i W a. ' . I alteration, or relocation
Address '430 -* 200 amps or less $60.00 2
201 amps to 400 amps $80.00 2
City State 6 Zip _ '7Z I 401 amps to 600 amps $120.00 2
Phone No. 4 9-5-77.-t 601 amps to 1000 amps $180.00 2
Job No. Al p il Over 1000 amps or volts $340.00 2
Elec. Cont. Lice. No.26 $$'GL' Exp.Date • -- f -- q-7 v Reconnect only $50.00 2
OR State CCB Reg. No. S Z ' Exp.Date _ - - 'k: C' (kc. Temporary Services or Feeders
COT Business Tax or Metro N• _ , . ..Date / - 4. Installation, alteration, or relocation
200 amps or less $50.00 2 -
201 amps to 400 amps 75.00 Signature of Supr: Elec'n /t. / / � 401 amps to 600 amps $100.00 2
Over 600 amps to 1000 volts,
License No. Exp.Date 10 - - see "b" above.
Phone No. 1 (55 -z_(
4d. Branch Circuits
New, alteration or extension per panel
2b. For owner installations: a) The fee for branch circuits with
purchase of service or
Print Owner's Name feeder fee.
Address Each branch circuit $5.00 2
City State Zip b) The fee for branch circuits
ty p without purchase of
Phone No. service or feeder fee.
First branch circuit $35.00 2
The installation is being made on property I own which is not Each additional branch circui $5.00 2
intended for sale, lease or rent. 4e. Miscellaneous
(Service or feeder not included)
Owner's Signature Each pump or irrigation circle $40.00 2
Each sign or outline lighting $40.00 2
3. Plan Review section (if required):* Signal circuit(s) or a limited energy ° U
panel, alteration or extension /
�d' $40.00 2
Minor Labels (10) $100.00
Please check appropriate item and enter fee in section 5B.
4 or more residential units in one structure 4f. Each additional inspection over
Service and feeder 225 amps or more the allowable in any of the above
System over 600 volts nominal Per inspection $35.00
Classified area or structure containing special occupancy Per hour $55.00
as described in N.E.C. Chapter 5 In Plant $55.00
* Submit 2 sets of plans with application where any of the above apply. S. Fees: uu 0 o
Not required for temporary construction services. 5a. Enter total of above fees $ L v
5% Surcharge (.05 X total fees) $
NOTICE • Subtotal $
5b. Enter 25% of line 5a for
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review if required (Sec.3) $
NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK Subtotal $
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY
TIME AFTER WORK IS COMMENCED. ❑ Trust Account # $ p
q Z
Total balance Due
I: \DSTS \ELC96.APP Rev 9/96
•
Page No. 1 CASE HISTORY FOR CASE NO.: ELC97 -0233
THE CARPET PLACE
11945 SW PACIFIC HWY Unit: 210
09/23/98
Action Description Req/ Schd/ End/ Action Notes Disp By Update Upd
1 Code Sent Done Done Date By
4
- - -- - -- -- -- - - -- - --
ELCC001 Application received / / / / 04/07/97 RECD DRA 04/15/97 DRA
ELCC003 Permit created / / / / 04/15/97 PASS DRA 04/15/97 DRA
ELCC500 (F)Issue permit / / / / 04/15/97 PASS DRA 04/15/97 DRA
ELCC799 Elect'1 Final 04/15/97 / / 04/17/97 SIGN APPROVED PASS MJR 04/25/97 KAS
ELCC800 Case Finaled / / / / 04/17/97 PASS MJR 04/25/97 KAS