Permit t./
Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 Planck/Rec. #
:ill I F , � ,,.� Permit # E ,1S" 'o ' (o
.� I Phone (503) 639 -4171 Date Issued 4 - 17 - lc
FAX (503) 684 -7297
CITY OF TIGARD TDD No. (503) 684 -2772 Issued by �---
Inspection (503) 639 -4175
1. Job Address: ��N9 �v�oN 4. Complete Fee Schedule Below:
Name of Development Development_lag Number of Inspections per permit allowed
Address I 3 / 70 S LJ Pi} CI + c H Hcoy Service included: Items Cost(ea) Sum
City /State/Zip fl CA d / O 2- 4a. Residential - per unit 4
1000 sq. ft. or less $110.00
Name (or name of business) F'l i /N' >i I 0 I Each additional 500 sq. ft. or
portion thereof $25.00 1
-
CommerciarF--- Residential ❑ Limited Energy $25.00
Each Manurd 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 N • LO PtA e 200 amps or less $60.00 2
Address v6on nt u.) 31, ST= 201 amps to 400 amps $80.00 2
City Pout d State 0e- Zip at, 7.% b 401 amps to 600 amps $120.00 2 -
P 601 amps to 1000 amps $180.00 2 -
Phone No. 2Z 7 B (0 7 Over 1000 amps or volts $340.00 2
Contractor's License No. Z 6 13 52 C. Reconnect only $50.00
Contractor's Board Reg. No. ( `I 5 6.7 4c. Temporary Services or Feeders
Installation, alteration, or relocation 2
Signature of Supr. Elec'n ` s €€ a 200 amps or less ( $50.00 S0 2
License No. 3/ 5 5 S Phone No. Z - 7 - 7 867 201 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.
4d. Branch Circuits
Print Owner's Name New, alteration or extension per panel
Address a) The fee 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
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 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 $ 5 O'er
5% Surcharge (.05 X total fees) $ 7 ,50
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 $ 'S 2_50
COMMENCED. ❑ Trust Account # $
Balance Due $ 5Z-- 5 D
woscrconxInMisoprmapp
03/30/2000 Activities for Case #: ELC95 -00346
10:11:03 AM
• Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELCC001 Application received 08/17/1995 BON RECD TMP 12/07/1995
ELCC003 Permit created 08/17/1995 BON PEND TMP 12/07/1995
ELCC730 Elect'I Service 08/17/1995 08/18/1995 MJR PASS JF 05/15/1996 ELECTRICAL SERVICE FOR
TEMP APPROVED COVER OF
2" & 1 1/2" PVC APPROVED
ELCC500 (F)Issue permit 08/17/1995 BON PASS TMP 12/07/1995
ELCC800 Case Finaled 05/15/1996 MJR YES RB 05/15/1996
•
Page 1 of 1