Permit (75) ` .
CITY OFTIGARD
�a ., DEVELOPMENT SERVICES ELECTRICAL PERMIT
a 1 L 13125 SW HaII Blvd., Tigard, OR 97223 (503) 6394171 PERMIT #: E LC 97 -0129
DATE ISSUED: 03/04/97
• PARCEL: 2S115AB- 01900
° SITE ADDRESS...: 16200 SW PACIFIC HWY #B -2
SUBDIVISION • ZON I NG : C - -G
BLOCK........,. LOT -
Pr Description: ELECTRICAL PERMIT FOR NEW WALL SIGN
• - -- RESIDENTIAL UNI "r - - -- -- -TEMP SRVC /FEEDERS - - -- MISCELLANEOUS
1000 SF OR LESS....: 0 0 - 200 amp • 0 PUMP /IRRIGATION . 0
EACH ADD'L 500SF..•: 0 201 - 400 amp • 0 SIGN /OUT LINE LTG..: 1
LIMITED ENERGY • 0 401 - G00 amp.......: @ SI9NAL /PANEL.•. ....: 0
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
PAYLESS DRUG type amount by date . c•ecpt
• 16200 SW PACIFIC HWY PRMT $ 40.00 JMH 03/04/97 97- 291002
5PCT $ 2.00 JMN 03/04/97 97- 291002
TIGARD OR 97224
Phone #:
Contractor: - -- - - -- - - - - - -- --
BLAZE SIGNS OF OREGON $ 42.00 TOTAL
PO BOX 23910
-- - - -- -- REQUIRED INSPECTIONS
PORTLAND OR 97281- -3910 Ceiling Cover Elect'1 Service
Phone #: 503- 639 -3262 Wall. Cover Elect'l Final
Reg #..: 64325
/ ' •
This permit is issued subject to the regulations contained in the a / /�,� i' ,.j �� L - /,
Tigard Municipal Code, State of Ore. Specialty Codes and all other Perm f- ee Si gnat u •e
applicable laws. 411 work will be done in accordance with
approved plans. This permit will expire if work is not started N j / e , ( 'L / / t— l
within 180 days of issuance, or if work is suspended for more k� /� ;��
than 180 days. »sued By
,. ---..-..-------..--___-.__- .-- .."_.-- ..____.----- _- OUJNER INSTALLATION ONLY-- _---- - - - -.- .-
. The installation is being made on property I own which is not intended for
sale, lease, or rent. /'
OWNER'S SIGNATURE: i/ 4_4.4S ! i� ' DATE : 42:7/q 7
' / , , ,
--- - - - - -- CONTRACTOR INSTALLATION ONLY -- ------------------
SIGNATURE OF SUPR. ELEC' N : Vple DATE: /a
LICENSE NO:
Call for inspect io ,, 639 -4175
i
CITY OF TIGARD Electrical Permit Application Plan Check# WA
.,
13125 SW HALL BLVD: Rec'd By . 4'.. u Ay
TIGARD OR 97223 : e Pgg1 0� Date Rec'd / �ff19
11��7 �� �,�/� �/ Date to P.E. i
Phone (503) 639 -4171, x304 �l " � or Date to DST . ��BL�'
Inspection (503) 639 -4175 Print or Type
Incomplete or illegible will not be accepted Permit # '� n Fax (503) 684 - 7297 Called �
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development Number of Inspections per permit allowed
Name (or name of business) f Ji1ezd ) P Service included: Items Cost Sum
I
Address r / / / . L. `∎ s. 4a. Residential - per unit
J / / f 1000 sq. ft. or less 5110.00
City/State/Zip 'AA Gt Each additional 500 sq. ft. or 4
portion thereof $25.00 1
Commercial Residential ❑ Umited Energy 525.00
Each Manufd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
(Attach copy of all rrent licenses) 4b. Services or Feeders
Electrical Contractor / ¢ Installation, alteration, or relocatio i
Address P0 X a 3 / 200 amps or less - 560.00 2
201 amps to 400 amps - 580.00 2
City State ZJp 7a / ,0 401 401 amps to 600 amps - $120.00 2
Phone No. (-5/53) 39 - D--- 601 amps to 1000 amps - 5180.00 2
Job No. 3o.s- ,3 jj r Over 1000 amps or volts - $340.00 2
Reconnect only - $50.00 2
Elec. Cont. Lice. No. .4 6 - -3foci S Exp.Date /o/./17
OR State CCB Reg. • . . Exp.Date - _ o-d 4c. Temporary Services or Feeders
COT Business Tax • r Metro 4 o. ., 0/ Exp.Date / Installation, alteration, or relocation
0-40 I' 200 amps or less 550.00 2
-- II' 201 amps to 400 amps
Signature of Supr. Eisen `/ 401 amps to 600 amps - $75.00
100 00 2
3 lJ � 5:1--- Over 600 amps to 1000 volts,
License No. Exp.Date see "b" above.
Phone No. (e'r3) G., 39- 3.)...Z, ..a.- 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 Owners Name feeder fee.
Address Each branch circuit 55.00 2
b) The fee for branch circuits
City State Zip 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 55.00 2
intended for sale, lease or rent. 4e. Miscellaneous
(Service or feeder not included)
Owner's Signature Each pump or irrigation circle 540.00 2
Each sign or outline lighting $40.00 y0 2
i 3. Plan Review section (if required):* Signal circuit(s) i or a limited energy
panel, alteration or extension 540.00 2
Minor Labels (10) - $100.00 1
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 555.00
* Submit 2 sets of plans with application where any of the above apply.
5. Fees:
Not required for temporary 5a. Enter total of above fees
req porary construction services. 5 % Surcharge (.05 X total fees) 5 ac-'
NOTICE Subtotal 5 a_ p U
5b. Enter 25% of line 5a for 5
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 Subtot 5
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY 0 Trust Account # S'
TIME AFTER WORK IS COMMENCED. , YU D
Total balance Due 3
i 'DSTS'a . :36 APP Rev 998 -
Page No. 1 CASE HISTORY FOR CASE NO.: ELC97 -0129
PAYLESS DRUG
16200 SW PACIFIC HWY Unit: D
06/16/98
Action Description Reg/ Schd/ End/ Action Notes Disp By Update Upd
Code Sent Done Done Date By
•
-- -- --- - --- - --- - --
BLCC001 Application received 03/04/97 / / 02/27/97 RECD JMH 03/04/97 J *H
ELCC003 Permit created 03/04/97 / / 03/04/97 JMH 03/04/97 J *H
ELCC500 (F)Iesue permit / / / / 03/04/97 PASS JMH 03/04/97 J *H
ELCC700 Ceiling Cover 03/04/97 / / / / 03/04/97 J *H
BLCC720 Wall Cover 03/04/97 / / , / / 03/04/97 J *H
ELCC730 Elect'l Service 03/04/97 / / / / 03/04/97 J *H
ELCC799 Elect'l Final 03/04/97 / / / / 03/04/97 J *H
•
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CITY OF TIGARD BUILDING INSPECTION DIVISION u/ MST
g(y"J
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested AM PM BLD
Location `6 f/2 , %FFl.! Suite MEC
Contact Person V Ph PLM
Contractor 642. Ph SWR
BUILDING Tenant/Owner e#4.42J ELC / 7- o(_ 9
Retaining Wall ELR
Footing
Foundation Acc FPS
Ftg Drain _ NOT REQUESTED t)) p'bk. SGN
Crawl Drain Ins FOUND DURING RESEARCH c G N II
Slab -- NO INSPECTION(s) IN FILE }'� l SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing UY ail
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
__PASS FAIL
twECG TF e l
ICAL
Rough In
UG /Slab
Low Voltage
Fire Alarm
iF a
S PART FAIL
Backfill /Grading
Sanitary Sewer
Storm Drain [ I Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk
Other Date // /� - 1.� Inspe _��,, E
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.