Permit _ 7
as 7 1
Co Development ELECTRICAL PERMIT APPLICATION
1 it 13125 SW Hall Blvd.
Tigard, OR 97223 Planck/Rec. #
Permit # fLC q5'- D 5L4
t iiill Phone (503) 639 -4171 Date Issued ' /"' / - 1S'
FAX (503) 684 -7297 r �
CITY OF TIGARD TDD No. (503) 684 -2772 Issued by I1/I,c,(,I �i1Ql<,Afv�
Inspection (503) 639 -4175
l 1. Job Address: 4. Complete Fee Schedule Below:
Name of Development O:. n -Q-O Or\., `) Number of Inspections per permit allowed
Address I "1 d I ) 1 -.)- rt./ Service included: Items Cost(ea) Sum
2- 2 4a. Residential - unit 4
City/State/Zip 7 C CL ice{ (U � � � ,, per
1000 sq. ft. or less I $110.00 11 --
Name (or name of business) 9 04! ) I Or ROC JC Each additional 500 sq. ft. or 1
l portion thereof 3 $25 00
Commercial ❑ Residential !:a Limited Energy $25.00
Each Manuf'd Home or Modular 2
Dwelling Service or Feeder $68.00
2a. Contractor installation only: 4b. Services or Feeders
• Installation, alteration, or relocation 2 .
Electrical Contractor '- A _.,Q_ -E.0 AL - 200 amps or less $60.00 2
Address * `P) a-1 0.4 , cc-I-. 201 amps to 400 amps $80.00
City 14- ; 1 Sj t-1N) State d12 Zip 2
401 amps to 1000 amps $120.00 2
Ci
•7 I l � � I � 601 amps to 1000 amps $180.00 2 -
Phone No. Over 1000 amps or volts $340.00 2
Contractor's License No. I ) ` - )q i,c, Reconned only $50.00
Contractor's Board Reg. No. LE 34?_sd 4c. Temporary Services or Feeders
Installation, alteration, or relocation 2
Signature of Supr. E1ec'n e c o 200 amps or less $50.00 2
License No.
��ii P . Z - �S�1Cl 201 amps to 400 amps
401 amps to 600 amps $75.00
$100.00 2
c `� S h e
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 fee for branch circuits with
City State Zip purchase of service or feeder fee. 2
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 $560
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 o r more residential units in one structure Mi nor 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:
NOTICE 5a. Enter total of above fees $ ) iC
5% Surcharge (.05 X total fees) $ 1.
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 $ I liii- Z
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CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec -O- Phone): 639 -4175 Business Phone: 639 -4171
Inspection: /'_P/\ J -C-e-_,L, �—
Footing Susp. Ceiling Sprink. Rough -in Appr /Sdwlk
Foundation Plbg. Underslab Mech. Rough -in Fireplace
Post /Beam Struct. Plbg. Top Out c . oc Ruq�� FINAL:
Post /Beam Mech. San. Sewer Gas Line -Bldg.
Plbg. Underfloor Rain Drain Framing - Plumb.
Alarm Water Line Insulation -Mech.
Underflr. Insul. Shear Wall Gyp. Bd. - Elect.
Date Requested: 7751975 Time: AM PM
Address: / 7 0 / 1.
Builder:T -1- m l (( 6 ,5" Permit #:-6l C 5:5 0 I ..5
THE FOLLOWING CORRECTIONS ARE REQUIRED:
/, ze 57'� (r s 114 — R c1 Ai
/
4 C il' O f Ie cl, N
7/-e-. .... . r r C 7 _.. 1 1 --
4 P. 7 i r : 7 / -- ____C - 11 r ,
c. r i 'q 7 S- - 61 C -7°
Cy/c‘ cZ, e., -65t v 4
Inspector: l CAGY r / jalc:// Date: 7"
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
_Call For Reinsp. Ee.../4
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 Elec. Rough -in FINAL:
Post /Beam Mech. San. Sewer Gas Line =Bldg.
Plbg. Underfloor Rain Drain Framing - Plumb.
Alarm Water Line Insulation -Mech.
Underflr. Insul. Shear Wall Gyp. Bd. dOW
i
Date Requested: / U 3 / ( C f S Time: AM PM
Address: r �� I / j
Builder 4 1 6 7 r S � � f c � Permit #.$ L S ( 5 j
THE FOLLOWING CORRECTIONS ARE REQUIRED:
57 u, 6 9PcY -e D/5e6S641-Q /e
eAa/
Ole
Inspector: � /� Date:/16b 7�
PPROV D DISAPPROVED APPROVED SUBJECT TO ABOVE
_Call For Reinsp.