Permit r
'i' Community Development ELECTRICAL PERMIT APPLICATION
./
13125 SW Hall Blvd.
Tigard, OR 97223 Planck/Rec. # 4 5- AC 9 as-6- Permit # €' /e 45'- 07,a,y
'u� 1 Phone (503) 639 -4171 Date Issued -/I -9s
�'�'` FAX (503) 684 -7297
•
CITY OF TIGARD TDD No. (503) 684 -2772 Issued by CAo/ lr-s ScArn • d>
Inspection (503) 639 -4175
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development WASHINGTON SQUARE Number of Inspections per permit allowed
Address 9469 S . W . W A S H I N G T O N S Q. ROAD Service included: Items Cost(ea) Sum
City/State/Zip TIGARD, O R E G O N 97223 4a. Residential - per unit 4
1000 sq ft or less $110 00
-
Name (or name of business) HEALTH H A U S Each additional soo sq ft or 1
portion thereof $25 00
—
Commercial ® Residential ❑ Limited Energy $2500
Each Manuf'd Home or Modular 2
W 0# 55065 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 ELECTRIC CO. _ 200 amps or less $60 00 2
Address 1 1 8 h 0 S W C R F F N R I I R (, R f1 A 1) 201 amps to 400 amps $60 00 2
- S tate 0 R Zip 9 7 2 2 3 401 a "'PS to 600 amps $120 00 2 -
City TIGARD p 601 amps to 1000 amps $160 00 2
Phone No. 639-4627 Over 1000 amps or volts $340 00 2
Contractor's License No. 34-13C Reconnect only $50.00
- Contractor's Board Reg. No. . 74 1 0 4c. Temporary Services or Feeders
44, � Installation, alteration, or relocation 2
14.--- Signature of Supr. Elec'n g/ �?.o4✓ 200 amps or less $50 00 2
201 amps to 400 amps $75 00 2
License No. 1 81 6 Phone No. 639-4627 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 fee for branch circuits with
purchase of service or feeder fee. 2
City State Zip 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 1 $3500 3 5 . 0 0 2
Each additional branch circuit – 8 — $5 00 4 U . U 0
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 circwt(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 M inor 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 $ 75.00
5% Surcharge (.05 X total fees) $ 3.75
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. RE'rURN ORIGINAL ❑ Trust Account # $
APPLICATION Balance Due $ 78.75
radeee nd.v\N.c.pm app
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec -O- Phone): 639 -4175 Business Phone: 639 -4171
Inspection: / e-a-i : ,C'_4----'
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: / gl �°/< Time: AM PM
Address: q '7 Cwt/ / --<5 CL
Builder.✓ L 't �OJ�
4i - 1 a 7 Permit #: :: (21
-GcS
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspector) die e / K cf Date: 7--0- 75
APPROVED . DISAPPROVED APPROVED SUBJECT TO ABOVE
_Call For Reinsp. & t---A,
r
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec -O- Phone): 639 -4175 Business Phone: 639 -4171
Inspection: / T
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: ) 0 [''r' /93 Time: AM PM
Address: '1'71(2 / f ,) / q" S a Rd
Builder: Permit #: G 3 zjt
THE FOLLOWING CORRECTIONS ARE REQUIRED: C 9.5 D- -7 3
t p f ■ u
Inspector: /H Lp „e A Date: f ,"-'
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
_ Call For Reinsp.
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