Permit Electrical Permit Application
Date received: /d�3/ G/ Permit no.: E t o / —oog 70
'...t i 11,
1 � . - City of Tigard Project/appl.no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: 1 Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ommercial/indusuial ❑ Multi- family ❑ Tenant improvement
❑ New construction 0 Addition/alteration/replacement ❑ Other: ❑ Partial
.I011 SITE INFORMATION
Job address: /3 S7.o S`J :1471fS J Bldg. no.: Suite no.: Tax map /tax lot/account no.:
• Lot: I Block: 'Subdivision:
Project name: 6 f�6 4 I Description and location of work on pre ises:
Estimated date of completion/inspection: /i9(y C , //J T /1 C r p o c-1 J
CON7'RACTOR APPLICATION FEE SCHEDULE
Job no: Fee Max
Business name: /t/ /a 24:IL 4/.-4-- Description Qty. (ea.) Total no. insp
Address: /2y0 y /t/r �/12
New residential -single or multi- family per
dwellinganit. includes attached garage.
City: X
Y 00%L�11,,� I State:Q/_ I ZIP: ?'?„2.54 • Serviceincluded:
Phone:,5a3 -2., 9i— I Fax: I E -mail: 1000 sq. ft or less 4
CCB no.: /4 2 ? e I Elec. bus. lic. no: . 24 — /oSTeLL Each additional 500 sq. ft. or portion thereof
Limited energy, residential 2
City /me, o,� . I • .: /419014/34/ Limited energy, non - residential j 2
/ / A � ,,_'— /OA Each manufactured home or modular dwelling •
_/- Si, r . f :•- - - - . • - required) Date Service and/or feeder 2
Sup. elect. name (print): License no: Services or feeders — installation,
alteration or relocation:
PROPERLY OWNER 200 amps or less 2
Name (print): 201 amps to 400 amps • 2
Mailing address: 401 amps to 600 amps 2
601 amps to 1000 amps 2
City: 'State: I ZIP: Over 1000 amps or volts 2
Phone: I Fax: I E -mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services or feeders -
which is not intended for sale, lease, rent, or exchange according to htstalladon , alteration, orrelocation:
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps to 400 amps 2
Owner's signature: Date: 401 to600am.s 2
ENGINEER Branch circuits - new, alteration,
Name: or extension per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: I State: I ZIP: ' B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: 2
Phone: Fax: E -mail: Each additional branch circuit:
PLAN REYIES%' (Please check all that apply) Misc. (Servlce or feeder not lncluded): _
O Service over 225 amps - commercial ❑ Health -care facility Each pump or irrigation circle 2
❑ Service over 320 amps- rating of 18t2 O Hazardous location Each sign or outline lighting 2
family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
❑ System over 600 volts nominal more residential units in one structure alteration, or extension' 2
❑ Building over three stories ❑ Feeders, 400 amps or more *Description:
❑ Occupant load over 99 persons 0 Manufactured structures or RV park Each additional Inspection over the allowable In any of the above:
❑ Egress/lightingplan ❑ Other. Per inspection I
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $ 7,'�' a
❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at _ %) $ c o
Credit card number. / / within 180 days after it has been State surcharge (8 %) $ ea
Expires accepted as complete. TOTAL $ /' ap
Name of cardholder as shown on credit card
$
Cardholder signature Amotmt 440 -4615 (6g00/COM)
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES:
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
p Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total 4, Check Type of Work Involved:
Residential - per unit
1000 sq. ft or less $145.15 4 ❑ Audio and Stereo Systems
Each additional 500 sq. ft. or
portion thereof $33.40 1
Limited Energy $75.00 ❑ Burglar Alarm
Each Manufd Home or Modular
Dwelling Service or Feeder $90.90 2 ❑ Garage Door Opener
Services or Feeders ❑ Heating, Ventilation and Air Conditioning System"
Installation, alteration, or relocation
200 amps or less $80.30 2
201 amps to 400 amps $106.85 2 ❑ Vacuum Systems
401 amps to 600 amps $160.60 2
601 amps to 1000 amps $240.60 2 ❑ Other
Over 1000 amps or volts $454.65 2
Reconnect only $66.85 2
Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY
Installation, alteration, or relocation Fee for each system $75.00
200 amps or less $66.85 2 (SEE OAR 918 -260 -260)
201 amps to 400 amps $100.30 2
401 amps to 600 amps $133.75 2 Check Type of Work Involved:
•
Over 600 amps to 1000 volts,
see "b" above. ❑ Audio and Stereo Systems
Branch Circuits
New. alteration or extension per panel ❑ Boiler Controls
a) The fee for branch circuits
with purchase ofservlce or ❑ Clock Systems
feeder fee.
Each branch circuit $6.65 2 ❑ Data Telecommunication Installation
b) The fee for branch circuits
-without purchase of service El or feeder fee. Fire Alarm Installation
First branch circuit $46.85
Each additional branch circuit $6.65 ❑ HVAC
Miscellaneous ❑
Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40
Each sign or outline lighting $53.40 ❑ Intercom and Paging Systems
Signal circuit(s) or a limited energy
panel, alteration or extension $75.00 ❑ Landscape Irrigation Control
Minor Labels (10) $125.00
Each additional inspection over ❑ Medical
the allowable In any of the above
Per inspection $62.50 ❑ Nurse Calls
Per hour $62.50
In Plant $73.75 ❑ Outdoor Landscape Lighting`
Fees: ❑ Protective Signaling
Enter total of above fees $ I I Other
•
8% State Surcharge $
Number of Systems
25% Plan Review Fee
See "Plan Review" section on $ * No licenses are required. Licenses are required for all other installations
front of application.
Fees:
Total Balance Due $
Enter total of above fees $
❑ Trust Account # 8% State Surcharge $
Total Balance Due $
All New Commercial Buildings require 2 sets of plans.
i:\dsts\forms\elc- fees.doc 08/30/01
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
2441our Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested t -0/ /6 1 AM PM BLD
Location k j (a- 0 \!G �C - \ Suite MEC •
Contact Person Pfd PLM
Contractor Ph SWR
BUILDING Tenant/Owner =-- S ELC
Retaining Wall sc , a/41 7d
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes: ,� S Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING -
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
Service
Rough In
UG /Slab
ow Volta. -
ire • arm
tai s
e tta PART FAIL
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk �Q/ D /Q l Inspector 3 Ins ector _L. . t.► �,� Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.