Permit Community Development ELECTRICAL PERMIT APPLICATION /
Ai) 13125 SW Hall Blvd.
Tigard, OR 97223 Planck/Rec. #
�,� Permit # h —C IC VI %N
.� �l Phone (503) 639 -4171 Date Issued 7 - i i - 1S -
FAX (503) 684 -7297
Issued by -
CITY OF TIGARD TDD No. (503) 684 -2772 13U1/l1n l e N�l/���Q U ►�l.
Inspection (503) 639 -4175
I . 1. Job Address: 4. Complete Fee Schedule Below:
Name of Development F.)(),,q,(Z 0 Number of Inspections per permit allowed
Address gicL -1 1J.. -e-P5S Qca Service included: Items Cost(ea) Sum
City /State/Zip TtgA0_,, 4a. Residential - per unit 4
1000 sq ft or less $110 00
-
Name (or name of business) SQ) fa 1212(7 Each additional 500 sq ft or 1
�--t� portion thereof $25 00
Commercial Ili Residential ❑ 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 2
Electrical Contractor tit. ∎ LAt. 5w CJ 200 amps or less $6000 2
Addrg s ?, 2 S S n1 -> , (.�2c) +41L..�1� 201 amps to 400 amps $80 00 2
Ci Vo an- Statec�✓?sz Z i ) a 1 Z 401 amps to 1000 amps $120 00 2
2
P 601 amps to l000 amps also 00
Phone No. 'Z. SS 130 $ Over 1000 amps or volts $340 00 2
Contractor's License No. 2L -ci o C-J-..5 Reconnect only $5000
Contractor's Board Reg. No. 4ad.} to '1 4c. Temporary Services or Feeders
Installation, alteration, or relocation 2
Signature of Supr. Elec'n N a 200 amps or less $5000 2
License No. 341 201 amps to 400 amps $75 00 2
' S) Ph0 No. 281 ' � R 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 fee for branch circuits withou
The installation is being made on property I own which is purchase of service or feeder fee. 2
not intended for sale, lease or rent. First branch drat $35 00 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 irrigation cirde $a0 00 2
Each sign or outline lighting $40 00
Signal arcun(s) or a limited energy ���7 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 descnbed in N.E.0 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 U
NOTICE 5a. Enter total of above fees $ 14Q
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 $ 42-
woarcortdr MMCpm 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 'i 1P3) L) , 1 ��1 5j • Suite MEC
Contact Person Ph PLM
Contractor Ph SWR
BUILDING Tenant/Owner 5} ELC 9S
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear /
Framing —�G �C S / •
Insulation /
Drywall Nailing ff(( S vS Fop W ,$ - J f G tij
Firewall < <!
Fire Sprinkler
Fire Alarm 7 4 `/ - � _C�- /
Susp'd Ceiling `` '� C
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] 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 /J
Approach /Sidewalk Date L )-G 9 Inspector �. Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.