Permit v. "' ° "C• il
v :.: -n .f La , i-ei: qa .A i• ELECTRICAL PERMIT
�� - , a I ;i : � t , ., r 2 APPLICATION ,
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Information: (503) 640 -3470 Fax: (503) 693 -4412
PLEASE PRINT Permit
Please complete all sections, 1 through 5. Number G 9 Jam- OI T Z Date 1 191 9.5 .
1. Location of installation 711 4. Complete Fee Schedule below
Address i 7 6m '� s v -� t�F Number of Inspections per permit allowed
� //�� Building Service Included: Items Cost(ea.) Sum
City 1/ /IiDC.. Suite No. l
Tenant Name A. Residential - per uni
(if commercial) , %P !:!r,' 9i % %
1000 sq. ft. or less $110.00 1 Jo 4
Map No. 7 5 l O L( i3 l) Tax Lot (ZIA D I I Each additional 500 sq. ft 7 g
or portion thereof $25.00
Book: Page: Section:
Limited Energy $25.00 1
Thomas Map 9 Each ManuYd 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 ins allation onl • 201 amps to 400 amps $80.00 2
• Electrical Contractor c1- E. /-n , 401 amps to 600 amps $120.00 2
601 amps to 1000 amps $180.00 2
Address a 3 N E 't A in,/ 6.71 Over 1000 amps or volts $340.00 2
City )4 i ((5 6 a /to State 0-Qt.■ ZIP 3 ) /02 9 Reconnect only $50.00 2
Date ..lpb Number
Property Owner f t !n-(/l C. Temporary Services or Feeders
Contractor's License No. :1 1 - // $ G Installation, alteration or relocation
Contractor's Board Reg. No. 6 31,7 8' • 200 amps or less $50.00 2
Si
201 amps to 400 amps $75.00 2
Signature of Su r. Elec'n 401 amps to 600 amps $1 00.00 2
9 P Over 600 amps to 1000 volts see "B" above
License No. Phone No. as-3 -/s---
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
g Signal circuit(s) or a limited
energy panel, alteration I J
3. Plan Review section (if required) or extension $40.00 2
Please check appropriate item and enter fee In section 5B. F. Each additional inspection over the allowable f)o
4 or more residential units in one structure in any of the above N.
Service and feeder, 800 amps or more Per inspection $35.00
P Per hour $55.00
System over 600 volts nominal In Plant $55.00 j
Classified area or structure containing special
occupancy as described in N.E.C. Chapter 5 5. Fees -1:g
Submit 2 sets of plans with application where any of the A. Enter total of above fees $ J S
above apply. Not required for temporary construction 5% Surcharge (.05 X total fees) $
services. Subtotal $ / �J
This permit becomes null and void if the work authorized by the permit Is B. Enter 25% of line A for
U
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
�r S
For Inspections call Balance Due $ " 1Y a
24-hour recorder, one working day in advance of need B�zs • 3rss
(03 9- y1 7,5
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. - Elect.
Date Requested: gla/ls Time: AM PM
Address:
BuilderTN- E . (a it 6SS Permit #: pzr,95_ D 18v
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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(= V/ f`e-1
/37 R — , ..
Inspector: // „ � _ Date: iAQ f 7
4 APPROVED _ DISAPPROVED APPROVED SUBJECT TO ABOVE
_ Call For Reinsp.