Permit V
Community Development ' ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 Planck/Rec. # 9,; - 2 7/ ,Q75-
Permit # A7C9.c- O 6'x-9'
�,r ' ,t 11 Phone (503) 639 -4171 Date Issued /0- /9- Qs
FAX (503) 684 -7297
CITY OF TIGARD TDD No. (503) 684 -2772 Issued by Ch a r /�s Sr�irr� /cif
Inspection (503) 639 -4175
1. Job Address: 4. Complete Fee Schedule Below:
Name of DevelOp eiit Number of Inspections per permit allowed
Address V 4 Service included: Items Cost(ea) Sum
City /State/Zip y
icircvrct, + Ors 4a. Residential • per unit 4
1000 sq ft or less $110 00
Name (or name o business) Each additional 500 sq ft or 1
portion thereof $25 00
Commercial Residential ❑ Limited Energy
- $25 00
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 Contractor it _. ,e 200 amps or less $60.00 2
Addr s 11 ' — ` q114,11%1 201 amps to 400 amps $80 00 2
' 401 a to 600 amps $120 00
- City Si sal
St Zip 1" 601 amps to 1000 amps $180 00 2
Phone No. Z„ 1 Over 1000 amps or volts $340 00
- Contractor's License No. �. ® Reconnect only $50 00
- Contractor's Board Reg. No. g ...WTI 4c. Temporary Services or Feeders
Installation, alteration, or relocation 2
Signature of Supr. Elec'n 4 2 00 amps or less $50 00 2 -
License No. �t `IS hone Noel CV 401 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 tee for branch circuits with
Ci State Zi purchase of service or feeder fee. 2
•7 p 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
not intended for sale, lease or rent. First branch circuit ! $35 00 ' 36.00 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 $5500
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 $ 13 •
5% Surcharge (.05 X total fees) $ 111..
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 $
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CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639 -4175 Business Phone: 639 -4171
Footing Rain Drain Cover /Service FINAL:
Foundation Water Line Ceiling - Plumb.
Post/Beam Mech. Shear /Sheath Framing -Mech.
PIbg.Und /Flr /Slab Plbg. Top Out Insulation
Post/Beam Struct. Mech. Rough -in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr /Sdwlk 4 Reins.
Other: ( J
Date: I � � 9 A. P.M.) 1 Entry.
Address:
Tenant: Ste: MST:
�y�
Con /Own: 0/ 1 BUP: �/ MEC:
PLM:
THE FOLLOWING CORREC IONS ARE REQUIRED: ELR:
P- ( r? cqv/cqr
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Inspector: 61 �/ rC %.02 `e )_f Date: / 7
)(APPROVED _ DISAPPROVED/CALL FOR REINSP. 40 CO