Permit /`fW "“" A"e 17r
al fgITY OF TIGARD Electrical Permit Application Plan Check
1425 S HALL BLVD.
Rec'd By
'.TIGARD OR 97223 `JUL 0 61999 Date Rec'd 1 -4 -r1
Date to P.E.
Phone (503) 639 -4171, x304
pi OI �,I L�'I'PA Date to DST
Inspection (503) 639 - y. Print of Type Permit# (L ` 0 D(
Fax (503) 598 - 1960 Incomplete or illegible will not be accepted Called
P 1(1°
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development Number of Inspections per permit allowed
Name (or name of business) ' ..24- •` (3- . Service included: Items Cost Sum 1 '
T O
Address I 07 S (AD k Yt rb r-- �/ 4a. Residential - per unit
City/State /Zip �i C core / a 9 7 c,C 1000 sq. ft. or less $ 117.75 4
4 / Each additional 500 sq. ft. or
portion thereof $ 26.25 1
Commercial ❑ Residential a Limited Energy $ 60.00
Each Manufd Home or Modular
2a. Contractor installation only: Dwelling Service or Feeder $ 72.75 2
(Prior to permit issuance, applicants must provide contractor license 4b. Services or Feeders
information for COT data ba e). Installation, alteration, or relocation
Electrical Contractor �#,. 11 . _rag r� ' 200 amps or less $ 64.25 2
Address � /O- (,e_ .r 201 amps to 400 amps $ 85.50 2
City 1 .. • ' of /ii' State Zip y7.2.0a/ 401 amps to 600 amps $ 128.50 2
601 amps to 1000 amps $ 192.50 2
Phone No. . - 53 � Over 1000 amps or volts $ 363.75 2
Job No. /I / Reconnect only $ 53.50 2
Elec. Cont. Lice. No., - -/ Exp.Date l0 9 . 4c. Temporary Services or Feeders
OR State CCB Reg. No. . Exp.Date 00 Installation, alteration, or relocation
COT Business Tax or Metro No0000 /3/ a Exp. e 3/ 00 200 amps or less $ 53.50 2
201 amps to 400 amps $ 80.25 2
Signature of Supr. Elec'n .1 ?i _ e , 401 amps to 600 amps $ 1 07.00 2
Over 600 amps to 1000 volts,
see "b" above.
License No. 104 104 Exp.�ate /D /0/ •
// 4d. Branch Circuits
Phone No. n� '7 fP - ' � I New, alteration.or extension per panel
a) The fee for branch circuits
2b. For owner installations: with purchase of service or
feeder fee.
Print Owner's Name Each branch circuit $ 5.35 2
b) The fee for branch circuits
Address without purchase of service
City State Zip or feeder fee.
Phone No. First branch circuit ! $ 37.50 - -- j 7
Each additional branch circuit / $ 5.35
The installation is being made on property I own which is not 4e. Miscellaneous
intended for sale, lease or rent. (Service or feeder not included)
Each pump or irrigation circle $ 42.75
Owner's Signature Each sign or outline lighting $ 42.75
Signal circuit(s) or a limited energy
panel, alteration or extension $ 60.00
3. Plan Review section (if required): * Minor Labels (10) $ 107.00
Please check appropriate item and enter fee in section 5B. 4f. Each additional inspection over
4 or more residential units in one structure the allowable in any of the above
Service and feeder 225 amps or more Per inspection $ 50.00
Per hour $ 50.00
System over 600 volts nominal In Plant $ 59.00
Classified area or structure containing special occupancy as
described in N.E.C. Chapter 5 5. Fees: ¥
5a. Enter total of above fees $ .
* Submit 2 sets of plans with application where any of the above apply. 5% Surcharge (.05 X total fees) $ 3 j i�
Not required for temporary construction services. Subtotal $
5b. Enter 25% of line 5a for
NOTICE Plan Review if required (Sec. 3) $
- Subtotal - $ - - - -
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED
IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR 1 I 5
WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS ❑ Trust Account # IS `�
AT ANY TIME AFTER WORK IS COMMENCED. Total balance Due $
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