Permit CITY OF T I G A R D ELECTRICAL PERMIT
PERMIT #: ELC1999 -00632
sr DEVELOPMENT SERVICES DATE ISSUED: 10/25/1999
111 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S134BC-00300
SITE.ADDRESS: 12274 SW SCHOLLS FERRY RD
SUBDIVISION: . ZONING: C -G
BLOCK: LOT : JURISDICTION: TIG
Project Description: Permanent wall sign
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG: 1
LIMITED ENERGY: 401 = 600 amp: SIGNAL/PANEL:
MANF HM/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: • W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: • IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
GRUBB & ELLIS PROSIGN INC
C /OSTACEY HANSON PO BOX 1354
1000 SW BROADWAY CLACKAMAS, OR 97015
PORTLAND, OR 97205
Phone: 503 - 242 -0925 Phone: 656 - 1354
Reg #: LIC 00079230
SUP 557SIG
ELE 3- 315CLS
FEES Required Inspections
Type By Date Amount Receipt Elect'I Service
PRMT BON 10/20/199E $42.75 99- 319229 Elect'l Final
5PCT BON 10/20/199c $3.42 99- 319229
Total $46.17 ORIGINAL
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Spedalty 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 rules adopted by the Oregon Utility Notification Center. Those
rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 - 1987.
PERMITTEE'S SIGNATURE za _ ( vw, t ad ISSUED BY: g
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
Y
SIGNATURE OF SUPR. ELEC'N: O / eI II(4 �lJ\ DATE:
LICENSE NO: /
Call 639 -4175 by 7:00pm for an inspection the next business day
a,Cl - 01)(Q32--
CITY OF TIGARD Plan eck #
Electrical Permit Application Recd *I
Electrical
13125 SW HALL BLVD.
TIGARD OR 97223 Date Recd /o �� � j �'
Date to P.E.
Phone (5031639 -4171, x304 Date to DST
Inspetion (503) 639 -4175 Print of Type Permit #
Fax (503) 598 -1960 Incomplete or illegible will not be accepted Called
1. Job Address: 4. Complete Fee Schedule Below: -
Name of Development r it " ' i'MA 1 ()1)Vl ( -er Number of Inspections per permit allowed
Name (or name of busin ' CA I . ■ • k`� Service included: Items Cost Sum 4 '
31 l
Address 10 9' 1 ll<J ciko ltc, t RA, 4a. Residential - per unit
1000 sq. ft. or less $ 117.75 4
City /State /Zip t at�r / Or Each additional 500 sq. ft. or
`l portion thereof $ 26.25 1
Commercial Residential ❑ Limited Energy $ 60.00
Each Manufd Home or Modular
2a. Contractor installation only: Dwelling Service or Feeder $ 72.75 2
(Prior to permit issuance, applicants must provide contractor license 4b. Services or Feeders
information for COT da base)._ r Installation, alteration, or relocation
Electrical Contractor f 16, I , A ( g • 200 amps or less $ 64.25 2
Addres
r 1,_ •11:rtMY 201 amps to 400 amps $ 85.50 2
401 amps to 600 amps $ 128.50 2
City ire k •state or Zip I 601 amps to 1000 amps $ 192.50 2
Phone No. 0 • tp-' Sag, Over 1000 amps or volts $ 363.75 2
Job No. t G -- QQ Reconnect only $ 53.50 2
Elec. Cont. Lice. No. 3 Cl- xp.Date O 4c. Temporary Services or Feeders
OR State CCB Reg. No. EM ,9 Exp.Date 1 O I Installation, alteration, or relocation
COT Business Tax or Metro No. .y r Exp.Date 0 200 amps or less $ 53.50 2
A �,L (� r 201 amps to 400 amps $ 80.25 2
Signature of Supr. Elec'n , ) ' / A t j e 401 amps to 600 amps $ 107.00 2
Over 600 amps to 1000 volts,
License No. 1 Ex Date /0 / i /oi see "b " above.
Phone No. ` 9)3 CO -q '- New, Branch Circuits
New, alterationor extension per panel
a) The fee for branch circuits
2b. For owner installations: with purchase of service or
feeder fee.
Print Owner's Name Each branch circuit $ 5.35 2
Address b) The fee for branch circuits
without purchase of service
City State ip or feeder fee.
Phone No. First branch circuit $ 37.50
Each additional branch circuit $ 5.35
The installation is bein eon property I own which is not 4e. Miscellaneous
intended for sale, lease or rent. (Service or feeder not included)
Each pump or irrigation circle $ 42.75
Owner's Signature Each sign or outline lighting / $ 42.75 c r
Signal circuit(s) or a limited energy
panel, alteration or extension . $ 60.00
3. Plan Review section (if required): * Minor Labels (10) $ 107.00
Please check appropriate item and enter fee in section 5B. 4f. Each additional inspection over
4 or more residential units in one structure the allowable in any of the above
Service and feeder 225 amps or Per inspection $ $ 50.00 50.00
Per hour
System over 600 volts nomina In Plant $ 59.00
Classified area or struct containing special occupancy as
described in N.E. . hapter 5
5. Fees: / ,
5a. V. Surcharge total of above fees 8 � $ � o[, 75
'' Submit 2 sets of plans with application where any of the above apply. o Su (.05 X total fees) I,
Not required for temporary construction services. Subtotal $
5b. Enter 25% of line 5a for
NOTICE Plan Review if required (Sec. 3) $
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED Subtotal $
IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR / 7
WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS ❑ Trust Account # Lr _�/
AT ANY TIME AFTER WORK IS COMMENCED. Total balance Due $
is \dsts \forms \electric.doc
CITY OF TIGARD SIGN PERMIT
Aft DEVELOPMENT SERVICES PERMIT #: SGN1999 -00124
22. 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/25/1999
EXPIRATION DATE:
BUSINESS NAME: AMERICAN EXPRESS TRAVEL SERVICE PARCEL: 1S134BC-00301
SIGN LOCATION: 12274 SW SCHOLLS FERRY RD
APPLICANT /AGENT: AMERICAN EXPRESS TRAVEL SERVIC ZONE: C -G
BUSINESS TAX NO: JURISDICTION: TIG
SIGN
PERMANENT: X FREESTANDING: FREEWAY:
TEMPORARY: WALL: Y ELECTRONIC:
OTHER: BILLBOARD: BALLOON:
• SIGN DIMENSIONS: 18" X 9'
TOTAL SIGN AREA: 13 sq. ft.
WALL AREA: 375 sq. ft.
WALL FACE (DIRECTION): E •
SIGN HEIGHT: 12 ft. •
PROJECTION FROM WALL: 12 in.
ILLUMINATION: INT
DESCRIPTION OF SIGN: Installing a permanent 13 sq. ft. wall sign
MATERIALS: ALUMINUM
EXISTING SIGNS: 1
ELECTRICAL PERMIT REQUIRED: Y •
BUILDING PERMIT REQUIRED: N
ADMINISTRATIVE EXCEPTIONS: N I V
TOTAL PERMIT FEES: $ 50.00
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This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes
and all other applicable laws. All work will be done in accordance with approved plans. A sign permit shall expire 90
days from approval date. A temporary sign shall expire 30 days from approval date. A balloon sign shall expire 10
davc fmm annrnval data
APPROVED BY:
� •
PERMITTEE SIGNATURE: � �' /
DATE: 10/25/19.9
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