Permit 1/
Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 Planck/Rec. #
Permit # ELC 55 b
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.� � I Phone (503) 639 -4171 Date Issued g � l rp -
� -"' FAX (503) 684 -7297
CITY OF TIGARD TDD No. (503) 684 -2772 Issued by ,l, ll�0�l.fitr
Inspection (503) 639 -4175
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development MO D U L A R OFFICE FEEDER Number of Inspections per permit allowed
Address q R q a s _w TIGARD AVENUE Service included: Items Cost(ea) Sum
City /State/Zip 4a. Residential - per unit 4
1000 sq. ft. or less $110.00
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Name (or name of business) P O L Y C A S T Each additional 500 sq. ft. or
portion thereof $25.00 1
Commercial ® Residential ❑ Limited Energy $25.00 - Each Manul'd Home or Modular 2
W.0.# 5 51 1 1 Dwelling Service or Feeder $68.00
2a. Contractor installation only:
4b. Services or Feeders
Installation, alteration, or relocation 2
Electrical Contractor F R A H L E R E L E C T R I C C O. 200 amps or less 1 $60.00 60.00- 2
Address 11860 S W G R E E N B U R G ROAD 201 amps to 400 amps $80.00 2
City TIGARD State 0 R Zip 9 7 2 2 3 401 amps to 600 amps $120.00 2
•7 p 601 amps to 1000 amps $180.00 2 -
Phone No. 639-4627 Over l000 amps or volts $340.00 2
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Contractor's License No. 34-13 C Reconnect only $50.00
Contractor's Board Reg. No. 3 7 41 0 4c. Temporary Services or Feeders
Installation, alteration, or relocation 2
Signature of Supr. Elec'n /t✓a-t !r ✓ 200 amps or less $50.00 2
License No. 1816$ Phone No. 639-4627 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.
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 withou
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
-
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 inspectio $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 $ 60.00
5% Surcharge (.05 X total fees) $ 3 _ 0 n
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. RETURN ORIGINAL ❑ Trust Account # $
APPLICATION Balance Due $ 63.00
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CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec-O-Phone): 639 -4175 Business Phone: 639 -4171
Inspection: /J' (°_2(4J l )
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.
Date Requested: 9 5 Time: AM PM
Address: /�
BuilderR: -a-- Q/J '4 6 ., (i6 c7 Permit #:
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Ins ector: ��_� � � Date:Y
• PPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Rein p.
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