Permit Community Development ELECTRICAL PERMIT APPLICATION A 13125 SW Hall Blvd. i)167 95-0//3
Tigard, OR 97223 Planck/Rec. #
h �; Permit # ACC RS - 0/7 .
�l
_, i Phone (503) 639 -4171 �° • . to Issued l / e/ S
"�"'°'� FAX (503) 684- 7297 `` '
CITY OF TIGARD '� i ' 3 =' by s. W 1�...n -c-��
TDD No. (503) 684 -2772
Inspection (503) 639 -4175
I 1. Job Address: 4. Complete Fee Schedule Below:
Name of Development /', � Number of Inspections per permit allowed
Address / 7 700 6 /�3�5 ' V7 `) Service included: Items Cost(ea) Sum
City /State/Zip C cA./L.CL Q G� / 7 a cP3 4a. Residential - per unit 40 4
` J 1000 sq. ft. or less $110.00 I/O,
Name (or name of business) nems) Each additional 500 sq. ft. or _ OD
13
portion thereof .72? $25.00 / 25, 1
Commercial ❑ Residential Limited Energy $25.00
` Each Manufd Home or Modular 2
Dwelling Service or Feeder $68.00
2a. Contractor installation only:
r 4b. Services or Feeders
IL -r-(14--C. Installation, alteration, or relocation 2
Electrical Contractor Gil_ Gil_ K 200 amps or less $60.00 2
Address - �� - 201 amps to 400 amps $80.00 iaL 2
City .. _ State 4.c Zip -7191L, ' 401 amps to 600 amps $120.00 2
601 amps to 1000 amps $180.00 2
Phone No. ' Y(7 c C 5Ir Over 1000 amps or volts $340.00 2
Contractor's License No. ■ 7t, L Reconnect only $50.00
- Contractor's Board Reg. No. , 4c. Temporary Services or Feeders
�� Installation, alteration, or relocation C�aJ 2
Signature of Supr. Elec'n � ,±A � �� 200 amps or less $50.00 c}r�. 2
License No 3 Phone No. G • s-5- $75.00 2 - 201 amps to 400 amps { amps to 600 amps $100.00
` .
6� Over 600 amps ps to 1000 volts
2b. For owner installations: see "b" above.
Print 4d. Branch Circuits
rint Owner's Name
New, alteration or extension per panel
Address a) The fee 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
not intended for sale, lease or rent. First branch circuit $35.00 2
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 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: 0
5a. Enter total of above fees $ 225. D ' -
NOTICE 5% Surcharge (.05 X total fees) $ / I. ZS
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $ 2_c/9. Z5
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 $ Z ? ° f
worcPcomd,Ngicpm app
05/30/2000 Activities for Case #: ELC95 -00177
10:51:31 AM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELCA001 Application received 07/18/1995 SUE RECD TMP 01/25/1996
ELCA003 Permit created 07/18/1995 SUE PEND TMP 01/25/1996
ELCA730 Elect'I Service 07/18/1995 TMP 01/25/1996
ELCA799 Elect'I Final 07/18/1995 01/20/1996 GS DIS GES 03/20/1996 SEE BLD THIS DATE
ELCA500 (F) Issue permit 07/18/1995 SUE PASS TMP 01/25/1996
ELCA580 Expired by limitation 03/05/2000 HAP DONE No Hold AKJ 03/05/2000
EXPIRED
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