Permit A A. CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC98 0047
„9, DEVELOPMENT OPMENT SERV s ICES DATE ISSUED: 01/27/98
13125 SW PARCEL: 1S134BC -00300
SITE ADDRESS...:1224O SW SCHOLLS FERRY RD
SUBDIVISION • ZONING:C —G PD
BLOCK • LOT • JURISDICTION: TIG
Project Description : Sign lighting for 3 change out signs for Rite Aid.
- -- 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 • 3
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/0 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
RITE AID type amount by date recpt
12240 SW SCHOLLS FRY RD PRMT $ 120.00 DRA 01/15/98 98- 302539
TIGARD OR 97223 5PCT $ 6.00 DRA 01/15/98 98- 302539
Phone #:
Contractor:
BLAZE SIGNS OF OREGON $ 126.00 TOTAL
PO BOX 23910
REQUIRED INSPECTIONS
PORTLAND OR 97281 -3910 Wall Cover Elect'l Final
Phone #: 639 -3262 Elect'l Service
Reg #..: 000643
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Oregon 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 the rules adopted by
the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001 -0010 through OAR 952- 001 -1987. You may obtain a copy
of these rules or direct questions to OUNC by calling (503)246 -1987.
Permittee Signature: , r �, / L
(' 4 Jam+` it, sued By • ,I ,1 ' 4 /JLI y l
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 l a
SIGNATURE OF SUPR. ELEC' N : tI 6f / - - DATE: / 7 -Cb
LICENSE NO:
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
CITY OF TIGARD Electrical Permit Application Plan Check
13125 SW HALL BLVD. Rec'd By .
TIGARD OR 97223 Date Rec'd - 1 S "
Date to P.E.
Phone (503) 639 -4171, x304 Date to DST
Inspection (503) 639 -4175 Print or Type Permit # LC G YM
Fax (503) 684 -7297 Incomplete or illegible will not be accepted Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development R tT-- 4-1 n tt5 353 Number of Inspections per permit allowed
Name (or name of business) 51r►'wz': Service included: Items Cost Sum
I
Address lag Lib SC,t+o L-L-S T e 2&L Pb 4a. Residential - per unit
TIC-) F -'D 11 a-a3 Each additional it or less 5 s $110.00 4
City/State/Zip Each additional 500 sq. ft. or
Commercial Residential ❑ portion thereof $25.00 1
Limited Energy $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 Contractor - RI.-Ft - 2.& - 5 1 t�sN S Installation, alteration, or relocation �
Address Po B 0 Y ,3q t b 200 amps or less $60.00 2 -
201 amps to 400 amps $80.00 2
City Po Q,7'LP tJ1> State 82 Zip q '7 ag ) 401 amps to 600 amps $120.00 2
Phone No. 9>3/ (o?, \ - 3 a(., a ,u a ■■ 601 amps to 1000 amps $180.00 2
Job No. )5'730 Over 1000 amps or volts $340.00 2
Reconnect only $50.00 2
Elec. Cont. Lice. No. "ala 38 0 C.-L.5 Exp.Date aja /0a
OR State CCB Reg. No. to '1 S Exp.Date .,0 7/& 4c. Temporary Services or Feeders
COT Business Tax or Metro No. .2 n i ?S Exp Date t ' : Installation, alteration, or relocation
/ 200 amps or less $50.00 2
Signature of Supr. Elec'n ,ham-
• : . ; 201 amps to 400 amp
$75.00 2
401 amps to 600 amps $100.00 2
� `� Over 600 amps to 1000 volts,
0/
License No. I S S I 47 Exp.Date I // see "b" above.
Phone No. .'SA -m 4d. Branch Circuits
New, alteration or extension per panel
2b. For owner installations: a) The fee for branch circuits with
p rchase of service or
Print Owner's Name f der fee.
Address Each branch circuit $5 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 circuit $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 • '2j $40.00 I a0.00a 2
3. Plan Review section (if required):* Signal circuit(s) or a limited energy
panel, alteration or extension $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. 5. Fees: (� , 0�
Not required for temporary construction services. 5a. Enter total of above fees $
5% Surcharge (.05 X total fees) $ (, ' O 0
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 # X26 -0
Total balance Due $
I: \DSTS \ELC96.APP Rev 9/96
Page No. 1 CASE HISTORY FOR CASE NO.: ELC98 -0047
RITE AID
12240 SW SCHOLLS FERRY RD
11/02/98
Action Description Req/ Schd/ End/ Action Notes Disp By Update Upd
Code Sent Done Done Date By •
ELCC001 Application received / / / / 01/15/98 RECD DRA 01/27/98 DRA
ELCC003 Permit created / / / / 01/27/98 DONE DRA 01/27/98 DRA
ELCC400 (F)Ready to issue / / • / / 01/27/98 Need to have Myron sign the application MEMO DRA 01/27/98 DRA
form and the permit.
ELCC500 (F)Issue permit / / / / 01/27/98 DONE DRA 01/27/98 DRA
ELCC560 Permit oided / / / / 11/02/:: Project cancelled NOTE JMT 11/02/98 JT
ELCC720 Wall Cover / / / / / / • 01/27/98 DRA
ELCC730 Elect'l Service / / / / / / 01/27/98 DRA
•
ELCC799 Elect'1 Final / / / / / / 10/27/98 JT
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