Permit •
Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 Planck/Rec. # 95- ?7/6GO
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I Permit # E1C9s S- o's
'I � �\
Phone (503) 639 -4171 Date Issued /o-/S- 96
FAX (503) 684 -7297
CITY OF TIGARD TDD No. (503) 684 -2772 Issued by (1,�� /ter ���,
Inspection (503) 639 -4175
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development Ham 0 a k s Number of Inspections per permit allowed
Address 6655 S . W . H a m p t o n Suite 210 Service included: Items Cost(ea) Sum
- rl K
City /State/Zip - 131.,, 0 R 97223 4a. Residential - per unit 4
1000 sq. ft. or less $110.00
Name (or name of business)
Curran-McLeod Each additional 500 sq. ft or
( ) portion thereof $25.00 1
Commercial ® Residential ❑ 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 E l e c t r i c a l C o n t r ' s D e s i g n 200 amps or less $60.00 2
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Address 1 5 0 NE Victory Suite "A" 201 amps to 400 amps $80.00 2
City Gresham State 0 R Zip 9 7 0 3 0
401 amps to 1000 amp $120.00 2
`' p 601 amps to 1000 amps $180.00
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Phone No. 666 -9358 Over t 00 ver 100 only amps or volts $50.00 $340.00 2 - - 0
Contractor's License No. 26-466C.
Contractor's Board Reg. No. 47712 4c. Temporary Services or Feeders
Installation, alteration, or relocation 2
Signature of Supr. Elec'n�6- 200 amps or less $50.00 2 -
License No. 18 8 2 S Phone No. 66 -9358 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.
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4d. Branch Circuits
Print Owner's Name New, alteration or extension per panel
Address a) The fee for branch circuits with
City State ZI purchase of service or feeder fee. 2
p Each branch circuit $5.00
Phone No. b) The lee 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 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 ins $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 $ 65.00
5% Surcharge (.05 X total fees) $ 3. 2 5
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $ 68.25
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 $ 68 =z S
COMMENCED. ❑ Trust Account # $
Balance Due $ 68.25
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CITY OF'_TIGAIRD BUILDING INSPECTION NOTICE
Inspection Line: 639 -4175 Business Phone: 639 -4171
Footing Rain Drain Cover /Service FINAL:
Foundation Water Line Ceiling - Plumb.
Post/Beam Mech. Shear /Sheath Framing -Mech.
PIbg.Und /FIr /Slab Plbg. Top Out Insulation Elec
Post/Beam Struct. Mech. Rough -in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr /Sdwlk Reins.
Other:
Date: A.M. P.M. Entry:
Address: • i :.�41� i!� -.Sib di
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Tenant: Ste: 0 MST:
p BUP:
Con /Own: � —� e- .� 0 Ct — 3 L o g MEC:
Q Q PLM:
C ELC: 7
THE FOLLOWIN CORRECTIONS ARE REQUIRED: ELR:
r
Inspector: — t Date _X
*APPROVED DISAPPROVED /CALL FOR REINSP. CO
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