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Permit 1../ E .. _ . Community Development ELECTRICAL PERMIT APPLICATION 13125 SW Hall Blvd. Tigard, OR 97223 Planck/Rec. # r � :: Permit # 4. 4:-LL q - ---ova /.c;> Phone (503) 639 -4171 Date Issued ) (j- 6' - 4 ` S - / .'; ? "" FAX (503) 684 -7297 Issued by �~ CITY OF TIGARD TDD No. (503) 684 -2772 Y • Inspection (503) 639 -4175 f 1. Job Address: ,/� 4. Complete Fee Schedule Below: Name of Development � ( 1.-- 1.-- 1 &I F -r K Number of Inspections per permit allowed Address / 7 I) AL iS q.. -- , Service included: Items Cost(ea) Sum City/State/Zip 4a. Residential - per unit /�� 4 1000 sq. ft. or less 1 $110.00 / Name (or name of business) Each additional 500 sq ft or .3 -FS 1 portion thereof $25.00 Commercial ❑ Residential VI Limited Energy $25.00 Each Manuf'd Home or Modular 2 Dwelling Service or Feeder $68.00 2a. Contractor installation only: 413. Services or Feeders �� N) /j / Y! 7 1 I alteration, or relocation 2 Electrical Contr, cto (/1/ / ✓ C/ 1 V � ( s Gv//Cit 200 amps or less $60.00 2 Address ii 7 2 o' 6 A, b D , 7 r-I k D. 201 amps to 400 amps $80.00 2 / i � - 401 amps to 600 amps $120.00 2 • City %' 11 2.T$ /� State DID zip 601 amps to 1000 amps $180.00 2 - Phone No. fci tFb '5c2/ . Over 1000 amps or volts $340.00 2 - Reconnect only $50.00 Contractor's License No. a rm,,3 Con Board Reg. No. '-_-° /5 3 • 4c. Temporary Services or Feeders C- Installation, alteration, or relocation 2 Signature of Sy1$$.r,, Elec'_ ,�,,,// /1" „r _ i 200 amps or less $50.00 2 - License No. 775 2 Phone No fc. 0 J ; 201 amps to 400 amps $75.00 2 - 401 amps to 600 amps $100.00 • Over 600 amps to 1000 volts 2b. For owner installations: see 'b' above. 4d. Branch Circuits Print Owner's Name New, alteration or extension per panel Address a) The tee for branch circuits with purchase of service or feeder fee. 2 City State Zip 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 $40.00 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 M inor 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 inspectio $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: I < NOTICE 5a . Enter total of above fees $ _____,�� 5% Surcharge (.05 X total fees) $ 4 7,'s PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $ AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5b. Enter 25% of line A for CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Plan Review if required (Sec.3) $ A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal $ COMMENCED. ❑ Trust Account # $ Balance Due $ ov-/ - c C wa Pcomdev\eMcprm.app ` / 5 CITY OF TIGARD BUILDING INSPECTION NOTICE Inspection Line: 639 -4175 Business Phone: 639 -4171 Footing Rain Drain Cover /Service FINAL: Foundation Water Line Ceiling 1;, I�j'.Y Post/Beam Mech. Shear /Sheath Framing -Mech. PIbg.Und /FIr /Slab Plbg. Top Out Insulation Post/Beam Struct. Mech. Rough -in Gyp. Bd.'ei, San. Sewer Gas Line Appr /Sdwlk Reins. Other: Date: S11 I , / �P A.M. P.M. Entry: S E W Address: / ;^Lo L ISs 7s 144---- Tenant: Ste: MST: 5 C)3 T 1 ` / BUP: ero )..-0 `[ 'C /Own: 62 U — c9--1 MEC: PLM: ELC: —a.C- THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR: L Gy e d[c ©© ( / / S �ir � = �r ,,,„frf P /7.3 ; rt e r Lc-keel ,-- .. , -e c e s /- _ !mil /t Inspector 6' 4% .■ i Date:" / —% APPROVED FOR , P'f' oVED /CALL FOR REINSP. CO CITY OF TIGARD BUILDING INSPECTION NOTICE Inspection Line (Rec -O- Phone): 639 -4175 Business Phone: 639 -4171 Inspection: Footing Susp. Ceiling Sprink. Rough -in Appr /Sdwlk Foundation Plbg. Underslab Mech. Rough -in Fireplace Post /Beam Struct. Plbg. Top Out lec. Rough-i FINAL: Post /Beam Mech. San. Sewer Gas Line e ----111-12-11--- -13Idg. Plbg. Underfloor Rain Drain Framing - Plumb. Alarm Water Line Insulation -Mech. Underflr. Insul. Shear Wall Gyp. Bd. - Elect. Date Requested: 1, `ZZ\ (p � TTime: AM PM Address: 1 0—C) 45 7s + -- , -t.1�� Builder G £, � ,j �e�mit' #: 91 J� 635 'LC- ? y 5 THE FOLLOWING CORRECTIONS ARE REQUIRED: ,; tC /E1` 7 /? C 41.,1.4 p kfe;f I -. .e - P/ L p�4 ►'--�� t4 , j / 4? 5,�ip ra / fie- i,r d{e 4 / / /- .� 14/!, S>vt- / 7 Cd 17-ife, e-ezi 5-4.? 4 ) e cS 4 a -e , Inspector: �,c= _ Date: //0 _APPROVED _DISAPPROVED ' PPROVE D SUBJECT TO AB V �J Z Call For Reinsp. �(/` ( e.e AB , � ��"