Permit ,
`_ J. Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 Planck/Rec. # 9S- D6 246.
Permit # f/C qS- O nl
4 " l' � l . ' I '' Phone (503) 639 -4171 Date Issued g- 7- 9s
_ma- �"" FAX (503) 684 -7297
CITY OF TIGARD TDD No. (503) 684 -2772 Issued by CV-par/p ScLr� 4
Inspection (503) 639 -4175
1 1. Job Address: 4. Complete Fee Schedule Below:
Name of Development Number of Inspections per permit allowed
Address 12835 SW WA T K I Ns Service included: Items Cost(ea) Sum
City /State/Zip T i GA R D. OR 97223 4a. Residential - per unit 4
1000 sq It or less $110 00
-
Name (or name of business) Each additional 500 sq ft or 1
L EI portion thereof $25.00
Commercial El Residential LEI Limited Energy $2500
- Each Maned Home or Modular 2
Dwelling Service or Feeder $68.00
—
2a. Contractor installation only:
4b. Services or Feeders •
Installation, alteration, or relocation / Bo 2
Electrical Contractor RED'S E L F C T R I C Co _ , I N C. 200 amps or less / $60 00 (p
201 amps to 400 amps - $80 00 2
Address 2002 S CLINTON 401 amps to 600 amps $120 00 2 - City PORTLAND nn State OR ZIg 7 2 0 2 601 amps to 1000 amps $180 00 2
A -
Phone No. ( ) l J 3) 233-6467 Over 1000 amps or volts $340 00 2
Contractor's License No. a - Reconnect only $5000
- Contractor's Board Reg. No. i t i t III 4c. Temporary Services or Feeders
'' IT/ Installation, alteration, or relocation 2
Signature of Supr. Elec' _ , - - ., , .y/ iii' 200 amps or less $50 00 2
License No. 2059 S ' _ Phon s o. ,_ , 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 Name New, alteration or extension per panel
Address a) The fee for branch circuits with
City State Zip purchase of service or feeder tee. 2
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
First branch circuit $35 00 2
not intended for sale, lease or rent. Each additional branch circuit $5 00
Owner's Signature 4e. Miscellaneous
(Service or feeder not included) 2
Each pump or trngation circle $40 00 2
3. Plan Review section (if required): Each sign or outline lighting $40.00
Signal circurt(s) or a limited energy 2
Please check appropriate item and enter fee in section 5B. panel, aheration 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 inspectio $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: o a
NOTICE 5a. Enter total of above fees $
. ::
5% Surcharge (.05 X total fees) $
• 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 $
rmdlmmdaA.I.. m app
CITY.OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested �,� , AM PM BLD
Location 127;5 (OCO ✓�. �S Suite MEC
Contact Person Ph PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC C IS - 0?()
Retaining Wall ELR •
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Note �/
Slab 'fib �t - Ger . SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation ill Drywall Nailing /1 �S 4..>9 S C.L Mpg re Y1 i`yy / Lf ,5 G /e cJ
Firewall /
Fire Sprinkler - Se Y vice_ w4 S' Cr i 17 P C.
Fire Alarm
Susp'd Ceiling
Roof
Misc: -
Final
0
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab C l S (2. —
Top Out
Water Service _
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
• - - • - T FAIL
ELECTRICA
UG /Slab
Low Voltage
Fire Alarm
Final '
PASS PART FAIL C .
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ I Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk Date Inspector Ext
Other p
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.