The URL can be used to link to this page

Permit V. R ECEIVED � /,,2. . Electrical Permit Application roll: orr,c I: t'sr. t1,11_, City of Tigard Receiver) I -' • 13125 SW Hill Blvd., Tigard, OR 97223 I 3 I Z O1Z Dure/BV. t 1 ( 47//0 -- S+-- Permit Nog z.c. ?Do. .. c., .344' Plan Review Phone: 303.718.2439 Fax; 503.598,1960 i 1�,.1.L) inspection Lino: 503.639.417 Date/By. Other Par,nj �1,� _ t��S'b Date le /Macho loot: Internet: wow a a -Dt• CITY OF TIGARD I c Page 2 for a ri } 11411 r i , ' 1 F, rd. w.. ,,, Su t,„ ��. Information , :. i. r , '. , �• 1 r ° ' �d'�fL.�.yJ i i d. •ill. i ;; ti� r :.. � tvotificd � r� c�•tr '+� 2 { �r � '� p� i�'"7"�Ak Supplemental fu MxttA � i v ... ,� � ti � p 1 wit ru u t � r �' V�1up b w) El Ncw construction ' •! Addition/alteration/replacement Please check all that apply (submit eels of g plans w/itcros cheated below). *ss -. Service or (coder 400 amps a ewer ❑ iSuildinll over three stories ❑ Dcmo11ti9n ❑ Other: 4 ru� , whore the available fault current ❑ Mamas and boutyard5. f :3.. k _ 'ta � u '•� tv ,',: , {. U u I li • v , ( " i .. exceeds 10,000 ;imps or 150 volts or ❑ Floating buildings [] I and 2-family dwelling less to ground, or exceeds 14.000 ❑ Commercial—use a icultu,al g'Commercial /industrial ❑ A ccessory building amps for all other 'intuit:glom buildings, ❑ ;Multifamily Q Master builder I ❑ Other: O Fire pu mp. ❑ TEutallruiou of 75 KVA or ir iyr fl ,Lli.� , .e 4 .l 0A67 1, y r i i ' 1 t'', " d v r r ^ 1 , u w l u enc system, larger separately derived x x v I ; �y,, r�,- �1 O E,nu t1t Y Y Iar P Y stem. Y ❑ Addition of new motor load of ❑ "A" "B" ] 2" ! 3" Job no.; Job site address: % +� 1 i ii 100HP or more occupancy, I l y 1 j -1 t -7 01 4, - D Six or more roe exmiiatip it� © Rocrontioma vehicle parks \ _ a k I 9.1-tarn l ucahoms. facilities. �) I 1:1 di Supply voltage for more m, �` '. azardous 600 volts nominal. Suite/bldg. /apt no.. Project name: S ' ' • Service or feeder 600 amps or more J : v; ,,�,'glwa•n0' .. "; M7Mt ! "1V5 T ' C ` 1 ross strcet/direclions to job site: i. - 1 _ .. �' ~ �' % 0 ' b ul ' F. w ,: • j Deteripdm, Q11 the. Total • v New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision, Lot no.: 1,000 sq. ft. or less MI 168.54 4 Tax map /parcel no_ La add'I 500 sq. ft. or portion 33.92 r i7 rr, map/ parcel r r i gryr+ 4Y. I y� y L energy, residential R ,if.i t�l� fl WPll' It)�4 , p it �V �. .. tat ...ni 0,7 (� : �-t��1.'I, P �' +i#', ,.'• "^:.''.re'NS'I•i ' o.,v.37t: (with above sr]_ R.1 75.00 Limited energy, multifamily 8 75,00 — s residential with above ...11. ©i 1y S ervices ur feeders installation, alteration. and/or relocation tt,,.M CL ' a. • ' - ,1 n ..a Ytl y nr il(p ll 200 amps or less 10D 70 2 tia.r r. +'a: ,,+�t;rl!�,, 6 1i• dEmi is .. l,r',03�, t 201 amps to 400 amps � MI 133.56 I Name. fY4 401 amps tp 600 amps (i\, d' 601 amps to 1,000 amps MI 301. 1E1 Address' -ti- ' Over 1,000 amps or volts 552,26 City/State/Z • ; f * Temporary services or feeders installation, alteration, and/or - relocation Phone' ( ) Fax ( ) , 200 amps or less 59.36 1 i Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125 08 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps 599 amps 168x4 2 . 1 Branch circuits - new• alteration, or extension, per panel Owner signature Date A. Fee for branch circuits with v_lni�mi.y :" r rl�ltY :f'� r, ,t'°,rl anrtwm�7 � of ^r �r' jt+i�•S ,. E'll above service ortcederfee ,,:." ..__. .. .�,�,.E. � :.1 Lriy. 1yV'_pW ..� w' '► 7.42 2 each branch circuit Business name `� ` - _� y / B. Fea for branch circuits without Service or feeder fee, first branch circuit 56.18 2 Each add branch circuit 7.42 11 Address' 41t� I ' 2 1 >t .. - ./._ Miscellaneous (service or feeder not included) _ City/State/ZIP: - i. i ♦ Each manufactured or modular . , _ i. dvecninl y service and/or feeder 67.84 2 Phone: (...E. .. 4c7—''S Fax: ; ( ) + Reconnect only t 67 84 2 11 ® ' Pump or irrigation circle 67.84 2 i gi �i9 i ' •"i r r C' i{. r • .. `` t Sign or outline lighting 67,84 2 � P.t i .,Ct.;e b 7 v a � 4 L Signal circuits) or limitedx e...,. ncrgy g Business name: 3 panel, alteration. oroxaanslon. Pa c2 2 Each additional inspection over allowable in any of the abov Address: 2 1 C-t.) 0 ` s , Additional inspection (I hr min) 66.25/ hr City /State /ZIP. , . - �v+.) * w - ` _ Investigation (l hr min) 66,25! hr industrial plant (1 hr min) 78.18/ hr Phone: (' ,) 7 5 cf Fax: ( ) , 1 I'�' 0 I t 0 inspections for which no fee is - 90.00/ hr 1 • 1 r� s. citicall listed ' hr min CC13 Lic.: t - t ectrical Lic. "I Sup v. 1 ,'7 !In'', , n7ywya .j*T*4„ % ' II ..1 ;741 4 y ,ux r Suprv. Electrician signature, required: _ EA� Subtotal: C. 3 '' Plan review (25% of permit fee): _ i 5 , go Print name' x .� IMMEI State surcharge (12% of permit tie): 7 , e Authorized signature: TOTAL PERMiT , a 'flay permit application expires if a permit iv out obtai within 180 duya after It hay beau accepted as complete. lf/ a Date: 1 • Number of inspections allowed per permit. f{ Q 7 • ( ',� I: lliuitdinia ctinu\BLC•ParmilApp.dvc 07101/10 440.46151(11 os, /WEB a TO /TO 39tld 33N L6Z£ZBZEOS 812:9T ZTOZ /t£ /0t