Permit v
t`,.. ' ~ Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 Planck/Rec. # 9S 1 7, / 99
Permit # b76 osni
/4 I- ,.. Jl Phone (503) 639 -4171 Date Issued /0- 27- 95
FAX (503) 684 -7297
• CITY OF TIGARD TDD No. (503) 684 -2772 Issued by Clay /ter Sc�iniolt
Inspection (503) 639 -4175
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development ¢, Number of Inspections per permit allowed
Address I / 5Id Upper 500n YS f&r1 Ta • Service included: Items Cost(ea) Sum
City/State/Zip a,tr.,1 �t 4a. Residential - per unit 4
9 ) 1000 sq ft or less $110 00
Name (or name of business) merjca /� Each additional 500 sq ft or -
( ) A 1 portion th ereof $25 00 1 .
Commercial Residential ❑ Limited Energy $2500
Each Manuf'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 Coontract r .1V/ 4AfSE'il E.LE( .IC 200 amps or less $60 00 2
Address J/l7 NE 17Ll tb At/e- 201 amps to 400 amps $80 00 2 - 401 amps to 600 amps $120 00 - City VD1171-ANr State fR. Zip q'1/7T) 601 amps to 1000 amps $18000 2
Phone No. pQ, - La gl Over 1000 amps or volts $340 00 2 -
Contractor's License No. Reconnect only $5000 -
Contractor's Board Reg. No. 5(5 4c. Temporary Services or Feeders
^ � Installation, alteration, or relocation 2
Signature of Supr. Elec'n ( K / 200 amps or less $50 00 2 -
License No �o t - 3- S Phone o . 9 - gg 1 201 amps to 400 amps $75 00
-
401 amps to 600 amps $100 00
Over 600 amps to 1000 volts
2b. For owner installations: see le 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 lee. 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 i 4. $5 00 7
Owner's Signature 4e. Miscellaneous
(Service or feeder not included) 2
3. Plan Review section (if required): Each pump or irngation 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 $ I b 5 r
5 % Surcharge (.05 X total fees) $ 5- 2.b
` 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 $ I l°115-
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