Permit a ELECTRICAL PERMIT V/
kI Tv OF TIGARD DATE C 08 /23/96
COMMUNITY DEVELOPMENT DEPARTMENT PARCEL: 1 S 136 DB -00201
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 839 -4171
SITE ADDRESS...: 11565 SW PACIFIC HWY
SUBDIVISION • ZONING:C -G
BLOCK • LOT •
Project Description: Hollywood Video Express
- -- RESIDENTIAL UNIT - - -- -- -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 - 600 amp • 0 SIGNAL /PANEL • 0 MANE. 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
DUANE COMPANY type amount by date recpt
PO BOX 421211 PRMT $ 40.00 JDA 08/23/96 95- 283242
5PCT $ 2.00 JDA 08/23/96 95- 283242
PORTLAND OR 97242
Phone #:
Contractor: .4 -•-
PROS I GN INC $ 42.00 TOTAL
PO BOX 1354
REQUIRED INSPECTIONS
CLACKAMAS OR 97015 Ceiling Cover Elect' 1 Service
Phone #: 656-1354 Wall Cover Elect' 1 Final
Reg #.. : 079230
This permit is issued subject to the regulations contained in the ________ L.— _ . 4ii� ) _
Tigard Municipal Code, State of Ore. Specialty Codes and all other Permittee Signat me /
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. I s s u e d
- - -• -- OWNER INSTALLATION ONL •- ___
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 : L _ DATE: __
LICENSE NO:
Call for inspection - 639-4175
4' - ._y
Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd. C % - 0S55
Tigard, OR 97223 Permit # �,�,
, �rr e it tp ` � Date Issued f(f -3 t q A
- ll Phone (503) 639 -4171
FAX (503) 684 -7297
CITY OF TIGARD TDD No. (503) 684 -2772
Inspection (503) 639 -4175
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development Fret AA .ye-r4 Number of Inspections per permit allowed
Address 1 1 V.'S' S, U). No ri c piw y Service included: Items Cost(ea) Sum
City /State /Zip T1 a xe r OR. 4a. Residential - per unit
' 1000 sq. ft. or less $110.00 4
Name (or name of business) I-oI1y VIheo Each additional 500 sq. ft. or ,
n portion thereof $25.00
Commercial u� Residential ❑ Limited Energy $25.00 1
Each Manuf'd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
4b. Services or Feeders
Installation, alteration, or relocation
Electrical Contractor Pr , S IsIJ Luc. 200 amps or less I $60.00 2
Address !04 S.E. ywy o21a 201 amps to 400 amps $80.00 2
City ('/ Ami4MAS State OR Zip 970/S" 401 amps to 600 amps $120.00 2
Phone No. (.,c -9Raa o e 1000 or volts $180.00 2
Job NO. Reconnect only $50. 2
contractor's license NO. 3 -31S CLS 4c. Temporary Services or Feeders
Contractor's Board Reg. No. ' Installation, alteration, or relocation
Signature of Supr. Elec'n ../ 200 amps or less Z
- 201 amps to 400 amps $50.00
License No. CZ c� hone o. 401 amps to 600 amps $75.00 2
Moro !,fC. if 3 yds over 600 amps to 1000 volts $100.00
. 2b. For owner installations: see "b" above.
4d. Branch Circuits
Print Owner's Name New, alteration or extension per pane
Address a) The fee for branch circuits with
City State Zip purchase of service or feeder fee. 2
y Each branch circuit $5.00
Phone No. b) The fee for branch circuits without
The installation is being made on property I own which is purchase of service or feeder fee. 2
First branch circuit $35.00 2
not intended for sale, lease or rent. Each additional branch circuit $5.00
Owner's Signature 4e. Miscellaneous
(Service or feeder not included) 2
3. Plan Review section (if required): Each pump or irrigation circle $40.00 2
Each sign or outline lighting T $40.00 !O.I9()
Signal circuit(s) or a limited energy 2
Please check appropriate item and enter fee in section 5B. panel, alteration or extension $40.00
-
4 or more residential units in one structure Minor Labels (10) $100.00
Service and feeder 225 amps or more
System over 600 volts nominal 4f. Each additional inspection over
Classified area or structure containing special occupancy the allowable in any of the above
as described in N.E.C. Chapter 5 Per inspection $35.00 -
Per hour $55.00
-
In Plant $55.00
Submit 2 sets of plans with application where any of the above
apply. Not required for temporary construction services. 5. Fees:
5a. Enter total of above fees $ YO, 00
NOTICE 5% Surcharge (.05 X total fees) $ 2.00
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $ vaa00
5b. Enter of line A for
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF Review OR WORK IS SUSPENDED OR ABANDONED FOR Plan Reeview if required (Sec.3) $
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal $
COMMENCED. wordlcnmde wow- ❑ Trust Account #
$
prm.app
Balance Due $
O I � TYOFTIGARD
SIGhI PERRIIT
COMMUNITY DEVELOPMENT DEPARTMENT PERMIT it: 5GN96 -0117
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 639 -4171
DATE ISSUED ° 00/23/96
EXPIRATION DATE: 4/ 427 /q4
\ PARCEL : 1S136DB -00201
- LONE ° C --G
BUSINESS NAME..: HOLLYWOOD VIDEO
SIGN LOCATION..: 11565 SW PACIFIC HWY
APPLICANT /AGENT: PROSIGN, INC.
_BUSINESS TAX NO:
__. ._ .
SIGN:
PERMANENT (X) FREESTANDING ( ) FREEWAY ( )
TEMPORARY ( ) WALL (Y) ELECTRONIC (Y)
OTHER ( ) BILLBOARD ( ) BALLOON ( )
SIGN DIMENSIONS. a .. . a : 5' X 9'5"
TOTAL SIGN AREA ° 47 sq.ft.
15 2
WALL AREA a,.�cc sq.ft.
WALL FACE (DIRECTION): E
SIGN HEIGHT 0 ft.
PROJECTION FROM WALL.: 13 in.
ILLUMINATION INT
DESCRIPTION OF SIGN: Hollywood Video Express
MATERIALS STEEL /PLEXIG
EXISTING SIGNS ° 1
ELECTRICAL PERMIT REQUIRED: Y
BUILDING PERMIT REQUIRED. °: N
ADMINISTRATIVE EXCEPTIONS.: N/A
, ' '\
PERMIT FEE: $ 50.00
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APPROVED BY:
PERMITTEE SIGNATURE : :-- "^����L____ ______ _.
DATE: 08/23/96
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