Permit JOB# -S/ C v
.- - Community Development ELECTRICAL PERMIT APPLICATION A • 13125 SW Hall Blvd.
Tigard, OR 97223 Planck/Rec. #`1S- . 6P,Is 7
. yl .� +,.� Permit # F)CQS -f-3t1 01.30
iI Phone (503) 639 -4171 Date Issued 9-3-9,c
� � "" FAX (503) 684 -7297
CITY OF TIGARD TDD No. (503) 684 -2772 Issued by Char les Schm.�
Inspection (503) 639 -4175
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development / p , - (� Number of Inspections per permit allowed
S� I
Address / &AS .0 - I t'LS Service included Items Cost(ea) Sum
City/State/Zip T a4 ') (/,C ,0-1 4a. Residential - per unit 4
V 1000 sq ft or less $110 00
Name (or name of business) Each additional 500 sq ft or 1
portion thereof $25 00
-
Commercial ❑ Residential -0' Limited Energy $2500 - Each Manuf'd Home or Modular 2
Dwelling Service or Feeder $68 00
2a. Contractor installation only: 4b. Services or Feeders ( .( G
I-( 4-0 l
Installation, alteration, or relocation 2
Electrical Contractor D . A . J E R O M E ELECTRIC 200 amps or less $60 00 60 (X) 2
Address PO BOX 7 51 201 amps to 400 amps $80 00 2
City HILLSBORO State OR Zip 97123 1
401 amps to00amps $18000 2
City p 601 amps to 1000 amps $180 00 2
Phone No. 6 4 8 -5 1 4 4 Over 1000 amps or volts $340.00 2
Contractor's License No. 3 4 -1 19 r Reconnect only $50 00
Contractor's Board Reg. No. 3 6 0 5 1 4c. Temporary Services'or Feeders
Installation, alteration, or relocation 2
Signature of Supr. Elec'n 200 amps or less $5000 2
License No. X77 S Phone No. . 201 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
New, alteration or extension per panel
Address a) The fee for branch branch anch circuits cuits 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 installati. • s being made on prope I own which is purchase of service or feeder fee. 2
First branch circuit $35 00 2
not i to . -d for sale, lease or rent.
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: r�
NOTICE 5a. Enter total of above fees $ (O_ CE)
5% Surcharge (.05 X total fees) $ 3
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $ 63 vU
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 $ l� �(,
COMMENCED. ❑ Trust Account # $
Balance Due $
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