Permit Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 Planck/Rec. # 1-6z So
, �^ I ,, : � Permit # 1 /_r9.S -D
Ali Phone (503) 639 -4171 Date Issued e-1-95
� FAX (503) 684 -7297
CITY OF TIGARD TDD No. (503) 684 -2772 Issued by L Diu r /er SC�+ m,c��
Inspection (503) 639 -4175
i 1. Job Address: 4. Complete Fee Schedule Below:
Name of Development Pe n ri r 14 . d d,tv Number of Inspections per permit allowed
Address 9Son S w ii .)a (1)/6 1 S Rd Service included: Items Cost(ea) Sum
City /State/Zip 1- Pn r +I ant) / 12, 5'7 2 2- 3 4a. Residential - per unit 4
1000 sq. ft or less $110.00
-
Name (or name of business) „fn , s't42 E addt sq ft or 1
-
portion thereof $ts 00
Commercial Residential El 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 , SJ < r ` / r2Q J 1 'L j411., J 200 amps or less $60.00 2
Address _32n 9 ,ll� 5 . Li' 201 amps to 400 amps $80.00 2
' / 401 amps to 600 amps $120 00 2
City V rt eseonfi v r StateLe n- Zip ?Ls 3 601 amps to 1000 amps $180 00 2
Phone No. .R4,0 -- X93 -inn Over 1000 amps or volts
- $340 00 2
Contractor's License No. ..":?7—,3 50C, Reconned only $5000
Contractor's Board Reg. No. • '/ 3/3 S 4c. Temporary Services or Feeders
' Installation, alteration, or relocation 2
Signature of Supr. Elec'n ,, � 200 amps or less $6000 2
License No. 302v_S Phone , b. ,, • - .. — a •
201 amps to 400 amps $�5 o0
40 1 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 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 / $3500 35.00 2
Each additional branch circuit // $500 r, S . 00
Owner's Signature 4e. Miscellaneous
' (Service or feeder not included) 2
3. Plan Review section (if required): Each pump or imgation circle $40 00 2 - Each sign or outline lighting $40.00
Signal cucuit(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.0 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 $ 90, 00
5% Surcharge (05 X total fees) $ 9,50
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $ 9u1 50
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 $ 961,60
wodoomd.NWCpm app
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.
Plbg.Und/FIr/Slab Plbg. Top Out Insulation 41311,
Post/Beam Struct. Mech. Rough -in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr /Sdwlk Reins.
Other:
Date: 5'/! / (�� A.M. P.M. Ent :
Address: S -
Tenant: Ste: MST:
BUP:.
Con /Own: , - - MEd:
3 62 0 — Ca. 3'5/ O U ELC: ILCIMEOP_D
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
Inspector: [` l'G Date:
y �� ?
APPROVED _ DISAPPROVED /CALL FOR REINSP. 4 41150 CO