Permit • I
t/
t Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 Planck/Rec. #
Permit # 6__._= 9s --06;/ s7
M11'' 11 Phone (503) 639 -4171 Issued //-0/
FAX (503) 684 -7297 Issued by 7
CITY OF TIGARD TDD No. (503) 684 -2772
Inspection (503) 639 -4175
1. Job Address: 4. Complete Fee Schedule Below:
Name of DevelopmentWashington Sq. Mall Number of Inspections per permit allowed
Addres0724 Wash. Sq. Rd. #F - 5 Service included. Items Cost(ea) Sum
City /State/Zip Ti gard . OR in 4. : 97771 4a. Residential - per unit 4
1000 sq ft or less $110 00
Name (or name of busines The Gap Each additional 500 sq ft or
portion thereof $25 00 1
-
Corn mercial I Res e - Limited Energy $25 00 2 - Each Manutd Home or Modular
Dwelling Service or Feeder $68 00
2a. Contractor installation only:
4b. Services or Feeders
Installation, alteration, or relocation 2
Electrical Contrac eath Signs 200 amps or less $60.00 2
Address4644 S . th Ave. 201 amps to 400 amps $80 00 2 - 401 amps to 600 amps $120 00 2 - CityPortland State OR Zip 97202 601 amps to 1000 amps $180 00 2
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Over 1000 amps or volts $340 00 2
Phone NO.712-7690 $5000
- Contractor's License No.37 -45 C Reconnect only
Contractor's Board Reg. No.64263 4c. Temporary Services or Feeders
Y / I alteration, or relocation 2
Signature of Supr. Elec'n I A. _ _ 200 amps or less $50 00 2
$75 00 2
License No. 515sig Phon • t 201 amps to 400 amps
- o. 232— 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 lee for branch arcuits with
City State Zip purchase of service or feeder fee. 2
Each branch circuit $5 00
Phone No. b) The lee for branch circuits withou
The installation is being made on property I own which is purchase o1 service or feeder fee. 2
not intended for sale, lease or rent. First branch circuit $3s o0 2
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 irngation crcle 7 � $40 00 2
2
Each sign or outline lighting 3 - $40 00
Signal crrcurt(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 ins $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 $ 80.00
5% Surcharge (.05 X total fees) $ 4.00
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 $ 84.00 9 cc 0 .- ?-z. g
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