Permit ..
� e• -nt La U - & :n =. .. • . ELECTRICAL PERMIT
/
. • o ri. In r - • A . - . ; -
lip
1 � -12 APPLICATION
• F- A -, � �
H Is. • o, O re• • 24
Information: (503) 640 -3470 Fax: (503) 693 -4412
PLEASE PRINT Permit
Please complete all sections, 1 through 5. Number F . ! . . C , C 15 - il l ? ' Date `7 I ! I
1. Location of installation,0 4. Complete Fee Schedule below
Address 1 3 7 6 3 S w 513 C Number of inspections per permit allowed
Building
City . 1 . / nq 4..,n Suite No. q Rio Service included: Items Cost(ea.) Sum
Tenant Name A. Residential - per unit ) (if commercial) ) 1000 sq. ft. or less $110.00 �° 4
Map No. 7- 5 I O-i (F)-o Tax Lot R- YVl o09 Each additional 500 sq. ft ) S
or portion thereof $25.00
Thomas Map Book: Page: Section: Each Energy $25.00 1
P 9 Each h Manuf'd Home or Modular
Directions Dwelling Service or Feeder $68.00 2
Commercial El Residential, ® B. Services or Feeders
Installation, alterations or relocation
200 amps or less $60.00 2
2a. Contractor installation only. 201 amps to 400 amps $80.00 2
Contractor 401 amps to 600 amps $120.00 2
Electrical Co �p n rn ` � d e� �' N L 601 amps to 1000 amps $180.00 2
Address U N. e 4 t.lvwJ. sj S..7" Over 1 000 amps or volts $340.00 2
City 119 , I/1 b.t-1. -a Stated - ZIP 1 ) /d, 7 Reconnect only $50.00 2
Date Job Number ,
Property Owner rr Al M 4144/ C. Temporary Services or Feeders
Contractor's License No. 3 y- f Li 6 c Installation, alteration or relocation
Contractor's Board Reg. No. (p -Z174.z2$' 200 amps or less $50.00 2
201 amps to 400 amps $75.00 2
Si Signature of Su r. Elec'n 401 amps to 600 amps $1 00.00 2
g pr. l Over 600 amps to 1000 volts see "B" above
License No. .,23( Phone No. 0 -/ 5%b
D. Branch Circuits
2b. For owner installations: New, alteration or extension per panel
a) The fee for branch circuits with
Print Owner's Name Phone No. purchase of service or feeder fee.
Each branch circuit $5.00 2
Address b) The fee for branch circuits without
purchase of service or feeder fee.
City State Zip First branch circuit $35.00 2
Each add'nl branch circuit $5.00 2
The installation is being made on property I own E. Miscellaneous (Service or Feeder not included)
which is not intended for sale, lease or rent. Each pump or irrigation circle $40.00 2
Owner's Signature Each sign or outline lighting $40.00 2
9 Signal circuit(s) or a limited
energy panel, alteration
3. Plan Review section (if required) or extension $40.00 2
Please check appropriate item and enter fee in section 5121. F. Each additional inspection over the allowable
4 or more residential units in one structure in any of the above
Per inspection • $35.00
Service and feeder, 800 amps or more Per hour $55.00
System over 600 volts nominal In Plant $55.00
Classified area or structure containing special N
occupancy as described in N.E.C. Chapter 5 5. Fees �� 0
Submit 2 sets of plans with application where any of the A. Enter total of above fees $ N
above apply. Not required for temporary construction 5% Surcharge (.05 X total fees) $
services. Subtotal $ y
This permit becomes null and void if the work authorized by the permit Is B. Enter 25% of line A for (j�
not commenced within 180 days from date of issuance of such permit or Plan Review if required (Section 3) $
if the work authorized is suspended or abandoned at any time after work Subtotal $
Is commenced for a period of 180 days. Electrical Permits are non- ❑ $
refundable and non - transferable. Trust Account
AC
For inspections call
_ _ Balance Due $ i q y W.
24-hour recorder, one working day in advance of need BL 28 • siss
5/24/00 Activities for Case #: ELC95 -00181
2:08:07 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELCA001 Application received 7/19/95 SUE RECD TMP 12/5/95
ELCA003 Permit created 7/19/95 SUE RECD TMP 12/5/95
ELCA799 Elect'I Final 7/19/95 10/12/95 MJR PASS JF 6/10/96
ELCA500 (F) Issue permit 7119195 SUE PASS TMP 12/5/95
ELCA800 Case finaled 6/10/96 JF 6/10/96
•
Page 1 of 1
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 Wa I I Gyp. Bd. - Elect.
p
Date Requested: D 2 Z f s Time: AM PM
Address: 13 7 6 3
Builder:7Y Fes, ( " ( f 6 5 Permit #: gi
THE FOLLOWING CORRECTIONS ARE REQUIRED:
Z - .
Inspector: ./ Date: Z
APPROVED _DISAPPROVED IZAPPROVED SUBJECT TO ABOVE
_Call For Reinsp.
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. CrES
Date Requested: /0 / /- S 5 Time: AM PM
Address: /3 7 6 3 L-C�
i
Builder:1 (l 5 (S/f Permit #: C'5 0 I $/
THE FOLLOWING CORRECTIONS ARE REQUIRED:
-e 5 GP ro c. .-,— / ®c.c / 9 s
2 , r^ ,- - 6-- �: c pidPce 4,� 4?'
----; \ a ct 7
Inspector J 7'"1
P � r / -- – � D ate: /D �eZ—
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
_ Call For Reinsp. p/}55