Permit (/
Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 Planck/Rec. #
411A, Permit # � LG 9�- G
,' .� �I Phone (503) 639 -4171 Date Issued c,"1":—...
FAX (503) 684 -7297
CITY OF TIGARD TDD No. (503) 684 -2772 Issued by ��
Inspection (503) 639 -4175
I 1. Job Address: 4. Complete Fee Schedule Below:
Name of DevelopmentWa s h i n g t o n Sq. (food court) Number of Inspections per permit allowed
Address 9633 S W Washington Sq. Rd. Service included: Items Cost(ea) Sum
City/State/Zip Tigard OR 9 7 2 2 3 4a. Residential - per unit 4
1000 sq ft or less $110 00
Name (or name of business) Cool Temptations Each additional 500sq ft or 1 ,
portion thereof $25.00
Commercial n Residential ❑ Limited Energy $2500
Each Manufd 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 Heath Signs 200 amps or less $60.00 2
—
Address 4644 S E 17th Ave . 201 amps to 400 amps $80.00 2
City Portland State OR ZiP972n7
401 amps to 1 00 amp $18000 2
`7 601 amps to 1000 amps $180 00 2
Phone No. 232 -2620 Over 1000 amps or volts $34000 2
Contractor's License No. 37 -45 C Reconned only $5000 -
Contractor's Board Reg. No. 64263 ' , 4c. Temporary Services or Feeders
D
/ Installation, alteration, or relocation 2
Signature of Supr. Elec'n , �, _ 200 amps or less $5000 2
License No. 51 5 SI Phone No. — • y 201 amps to 400 amps $7500 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 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 of service or feeder fee. 2
First branch circuit $35 00 2
not intended for sale, lease or rent. Each additional branch circuit $500
Owner's Signature 4e. Miscellaneous
(Service or feeder not included) • 2
3. Plan Review section (if required): Each pump or imgation arde / �-� � $40 00 2
Each sign or outline lighting \ 1 / $40 00 4u. 00
Signal arcuit(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) $10000
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:
NOTICE 5a. Enter total of above fees $ 40.00
5% Surcharge (.05 X total fees) $ 7 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 # $ 42.00
Balance Due $
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CITY OF TIGARD BUIL' DIfTG INSPECTION NOTICE
Inspection Line (Rec -O- Phone): 639 -4175 Business Phone: 639 -4171
Inspection: : : r-(-, IL i/ mirra........elLJ
Footing Susp. Ceiling Sprink. Rough -in Appr /Sdwlk
Foundation Plbg. Underslab Mech. Rough -in Fireplace
Post/Beam Struct. Plbg. Top Out Elec. Rough -in FINAL:
Post/Beam Mech. San. Sewer Gas Line -Bldg.
Plbg. Underfloor Rain Drain Framing - Plumb.
Alarm Water Line Insulation -Mech.
Underflr. Insul. Shear Wall Gyp. Bd. -EI
Date Requested: - 7 j1 g' I �.' Time: A PM
Address: . 5 33 i - 3 C- . ( ,
Builder: a--'j F 6 9 F6 (fl , Permit #:
THE FOLLOWING CORRECTIONS ARE REQUIRED: fz�', mil„/ Se (V /; ~z
'C ‘ir c,) r
Inspector: � j G, 0 A , • 4I Date:7_ — 7)
PROVED _DISAPPROVED APPROVED SUBJECT TO ABOVE
— \ _Call For Reinsp.