Permit '• Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 Planck/Rec. # 95 - 72. V
, M . Permit # /: /-C9.s'- o y96
il�� I';
All .� � I Phone (503) 639 -4171 Date Issued / 0 - P . 7 - 9 5
'".. FAX (503) 684 -7297 1
CITY OF TIGARD TDD No. (503) 684 -2772 Issued by Char /es S�L,m h/7
Inspection (503) 639 -4175
1. Job Address: /y 4. Complete Fee Schedule Below:
C Name of Development G S f �e.- /,4// Number of Inspections per permit allowed
Address / 377 j) S(,J 1--i ueh Service included: Items Cost(ea) Sum
City /State/Zip 1 15 arDL- '1742423 4a. Residential - per unit 4
/
1000 sq. It. or less i $110.00 o . op
Name (or name of business) un l�Iirss��P � m� 9 Each additional 500 sq fl or 3 $25.00 n S up 1
portion thereof J /
Commercial ❑ Residential 131 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
` r Installation, alteration, or relocation 2
Electrical / /!
Contractor (2( G Ie r e..... ; 200 amps or less $60.00 2
Address » /3 D 50 7.1 : vv.t ', �l e..._ 201 amps to 400 amps $80.00 2
City Pit yr to h State _a& /� Zi Q
401 amps to 1000 amps $120.00
h �� P 9 70� g 601 amps to 1000 amps $180.00 2
Phone No. (, q t -T7O 12-- Over 1000 amps or volts $340.00 2
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Contractor's License No. A 6 -.24.9 9 Reconnect only $50.00
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Contractor's Board Reg. No. i-1)--ii 2- 4c. Temporary Services or Feeders
Installation, alteration, or relocation 2
Signature of Supr. Elec' 200 amps or less $50.00 2
201 amps to 400 amps $75.00 2
License No. 3 5 9aS Phone No. lay/ - Rol 401 amps to 600 amps $100.00
Over 600 amps to 1000 volts
2b. For owner installations: see if above.
4d. Branch Circuits
Print Owner's Name New, alteration or extension per panel
Address a) The lee for branch circuits with
purchase of service or feeder fee. 2
City State Zip Each branch circuit $5.00
i . Phone No. b) The fee for branch circuits withou
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 ciccuit(s) or a limited energy 2
Please check appropriate item and enter fee in section 5B. panel, alteration or extension $40.00
1 4 or more residential units in one structure Minor Labels (10) $100.00
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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
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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: p�
NOTICE 5a. Enter total of above fees $ x05.0
5% Surcharge (.05 X total fees) $ - 9
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF Sb. 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'S Subtotal $
COMMENCED. ❑ Trust Account # $
Balance Due $ Mi4■
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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. 42210
\
Date Requested: \ Time: AM PM
Address: ) 73 '7 l Q
Builder: #: S cyc:=1:,
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspector: low ,�
X APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
A ll For Reinsp. Q 6
5