Permit 1./
Community Development ELECTRICAL PERMIT APPLICATION
._ 13125 SW Hall Blvd.
Tigard, OR 97223 Planck/Rec. #
i i *r' I i\
Permit # �L�', Cam - ayis
.� �( Phone (503) 639 -4171 Date Issued 4 �S'�
� FAX (503) 684 -7297 >
CITY OF TIGARD TDD No. (503) 684 -2772 Issued by
Inspection (503) 639 -4175
1. Job Address: CAJ 12C)° Q S'r} 4. Complete Fee Schedule Below:
9 \\ D
Name of Development / 3 O �� w 'mac I � ) C 4IAPY Number of Inspections per permit allowed
Address �` Service included: Items Cost(ea) Sum
r
City /State/Zip 1 li� / � C) K 4a. Residential - per unit 4
C owl loco ay. ft. or less $110.00
-
Name (or nam usiness) Each additional 500 sq. ft. or
portion thereof $25.00 1 -
Commercial Residential ❑ Limited Energy $25.00
- . Each Manul'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 Li CO 200 amps or less $60.00 2
Address 73(/0 c L 201 amps to 400 amps $80.00 2
I 401 amps to 600 amps $120.00 2
City / , , �, P[ .,�/ 4 State t Zip 601 snips to 1000 amps $180.00 2
Phone I46. /p 2.4o - � -O Over 1000 amps or volts $340.00 2
-
Contractor's License No. 2.0-14o GLS Reconnect only $50.00
- Contractor's Board Reg. No liGY 4c. Temporary Services or Feeders
Installation, alteration, or relocation 2
Signature of Su r. I n 200 amps or less $50.00 2
License N X5lr Phone No. 201 amps to 400 amps $75.00
401 amps to 600 amps $1 00.00
Over 600 amps to 1000 volts
2b. For owner installations: see 'b' above.
Print 4d. Branch Circuits
rint Owner's Name
New, alteration or extension per panel
Address a) The lee 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 $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 72710
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 inspection $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 $ �� • 1�
5% Surcharge (.05 X total fees) $ '
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 $
94 -------d ) :3 9 I
03/30/2000 Activities for Case #: ELC95 -00415
10:11:20 AM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELCC001 Application received 09/26/1995 JIM RECD TMP 11/29/1995
ELCC003 Permit created 09/26/1995 JIM RECD TMP 11/29/1995
ELCC500 (F)Issue permit 09/26/1995 JIM PASS TMP 11/29/1995
ELCC800 Case Finaled 05/22/1996 MJR YES MJR 05/22/1996
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