Permit *`4W,/ 1/
Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 Planck/Rec. # 9.5 0 l5$7
Permit # EL 1295' - MP OA71
4. III Phone (503) 639 -4171 Date Issued 9 - s` - 9.r
0 - !- FAX (503) 684 -7297
CITY OF TIGARD TDD No. (503) 684 -2772 Issued by Cha /P r SG�i..r ; �,(1
Inspection (503) 639 -4175
1. Job Address: _4. Complete Fee Schedule Below:
Name of De elopment Number of Inspections per permit allowed
Address CizTittr SW . t kC n gr 41- 300 Service included: Items Cost(ea) Sum
City /State/Zip T; OA_ f? ZZS 4a. Residential - per unit 4
J
1000 sq. ft. or less $110.00
-
Name (or name of business) .Da 444 G 9.v yr�'fl_. ' additional 500 sq. n. or 1
portion thereof $25.00
-
Commercial ® Residential ❑ Limited Energy $25.00
Each Manufd Home or Modular 2
Dwelling Service or Feeder $68.00
2a. Contractor installation only: 4b. Services or Feeders t7 Q6 2
Installation, alteration, or relocation
Electrical Contractor k); i 1 kut fk ea ((N c- 200 amps or less .1 $60.00 2
Address f) Ans( 230 5 f)- 201 amps to 400 amps $80.00 2 -
VI h 0 .- Sta Zi 9 ? z.8-1 401 amps to 600 amps p $180.00 2
City T r� p 601 amps to 1000 amps $160.00
Phone NO. t%,Z4 - ?b Si Over 1000 amps or volts $340.00 2
-
Contractor's License No. 3y - ZkL Reconnect only $50.00
Contractor's Board Reg. No. 7S6 c ---- 4c. Temporary Services or Feeders
Installation, alteration, or relocation 2
Signature of Supr. Elec'n 7r 200 amps or less $50.00 2 -
License No. /9. 5 -s Phone No LozY -3631 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: Bee •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
`7 p Each branch circuit $5.00
Phone No. b) The tee 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
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 $ bn O
5% Surcharge (.05 X total fees) $ 3
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF Sb. 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 $ 4 7 t9f-
waswww s prn. p
•
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639 -4175 Business Phone 639 -4171
Footing Rain Drain Cover /44a FINAL:
Foundation Water Line Ceiling - Plumb.
Post/Beam Mech. Shear /Sheath Framing -Mech.
PIbg.Und /FIr /Slab Plbg. Top Out Insulation 4r6
Post/Beam Struct. Mech. Rough -in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr /Sdwlk Reins.
Other: J G
Date: ) 19 ` G 7 A.M. P.M. En ry:
Address: - 7 q O 3f
Tenant: Ste: MST:
BUP:
Con /Own: MEC:
PLM:
ELC: Vs - e )- 7C, e)
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
956 X7 e)
2/ TJ ( ,01- �S
Inspecto i l L 4 .( R Date: l 7_77
7 i
APPROVED _ DISAPPROVED /CALL FOR REINSP. QP._ CO