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- 791:011)-1 TtelL I rji Oftr d f ; . fr Community Development ELECTRICAL PERMIT A P LICATION 41� ,
...
SW Hall Blvd. TTigard, OR 97223 Permit # 4 1 3 125
� Date Issued
_ 627.4ifce97....7._
eel it Phone (503) 639 -4171
' FAX (503) 684 -7297
CITY OF TIGARD TDD No. (503) 684 -2772 D
Inspection (503) 639 -4175 4 (e 6 / 6(1) ' 4j )
1. Job Address: � egeitA/ 4. Complete Fee Schedule Below:
Name of Development _ Number of Inspections per permit allowed
Address /5 701 <■,() ?h&, FIG //P UY Service included. Items Cost(ea) Sum
City /State /Zip'7Tei- Al) O l2 571--Z-3 4a. Residential - per unit
1000 sq. ft. or less $110 00 4
Name (or name of business) Each additional 500 sq. ft. or
portion thereof $25.00
-
Commercial 13 Residential III Limited Energy $25.00 1 -
Each Manurd Home or Modular
Dwelling Service or Feeder $68 00 2
2a. Contractor installation only:
4b. Services or Feeders
Installation, alteration, or relocation
Electrical Contractor e' er. 200 amps or less $60.00 2
Address.2 / Se- 73eP 201 amps to 400 amps $8000 2
- / 1i.I 4.SAM State DA___ Zip q 401 amps to 600 amps $120.00 2
City �_ P / �� � $180.00 2
601 amps to 1000 amps
Phone No. .57/.. cyc,79 Over 1000 amps or volts $340.00 2
Job NO. (Ai (r(7,g Reconnect only $so 00 2
contractor's license NO. _ .4'1 r-y3 %r 4c. Temporary Services or Feeders
Contractor's Board Reg. NO. Installation, alteration, or relocation
Signature of Supr. Elec'n 200 amps or less 2
-
License No. g-/I i- `I S Phone . SOS - J130 , 201 amps to 400 amps $50.00 2
401 amps to 600 amps $75.00
Over 600 amps to 1000 volts $100.00
2b. For owner installations: see "b" above
4d. Branch Circuits
Print Owner's Name New, alteration or extension per pane
Address a) The fee for branch circuits with
purchase of service or feeder fee. 2
City State Zip 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
Ea
a additionaal l br b anch circuit
not intended for sale, lease or rent. First t ddch nr 1 $ 00 0 •
� ,
�'�5
Owner's Signature 4e. Miscellaneous I �l //1 $ $5 .00 1 - TJl
v
(Service or feeder .t included) 2
3. Plan Review section (if required): Each pump or imgation circle $40.00 2
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, 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 inspection $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:
5a. Enter total of above fees $
NOTICE 5% Surcharge (.05 X total fees)
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $ a . aS
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. werdvcomdevlekc- ❑ Trust Account #
$
prm,epp
Balance Due $
ft t
1 v#
, CITY OF TIGARD BUILDING INSPECTION DIVISION
1 24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171
Date Requested: - 7 - 25 --c? / A.M. P.M. MST:
Location: / 3 D i it_ _ � �_ .� BUP:
✓�{
Tenant: 4M() 1
- ' /LW () Suite: Bldg: MEC:
Contractor: ,4 /, A . / 4 il` / 2 Phone: el jD - 7 7/ 7 PLM:
Owner: Phone: ELC: 9 7 -aq n7
ELR:
��SIT:
BUILDING BLDG - (con't) PLUMBING MECHANICAL ELECTRICAL SITE
Site Post/Beam Post/Beam Post/Beam Cover/Service Sewer /Stone
Footing Roof UndFl/Slab Rough -In Ceiling Water Line
Slab Framing Top Out Gas Line Rough -In UG Sprinkler
Foundation Insulation Sewer Hood/Duct Reconnect Vault
Bsmt Damp Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain Drain A/C UG Slab
Shear /Sheath Fire Spklr /Alm Crawl/Found Dr Heat Pump Low Volt
Approved Approved Approved A SIB s Approved
Appr /Sdwlk Not Approved Not Approved Not Approved .
puma: eved Not Approved
FINAL FINAL FINAL FINAL
3D , c 13 i N ,194 IVE L -
l'?! -X S /zE Cii cu /7 -- 3 '. 5 A, N!- MFP'J9-TE .
c .
O Call for reinspectio 0 Reinspection fee of $ required before C next inspection O Unable to inspect
Inspector: Date: l - / . Page of
1
CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171
Date Requested: &/ /q 7 A.M. P.M. MST:
Location: (370! 3u) Pct. 4-CL AJ-ext7, BUP:
Tenant: r 7O() / /A ' f /,5S /0A/ Suite: Bldg: MEC:
Contractor: nn� /� 2 Phone: 6,35- PLM:
Owner: , i1 ' C e h � .h Phone: 3 4L n eD— ELC: g7-0/5
�,
q
: ! l—dcl:. -;G7
BUILDING BLDG (con't) PLUMBING MECHANICAL LF L
,SIT:
)
Site Post/Beam Post/Beam Post/Beam Cover/Service Sewer/Storm
Footing Roof UndFl/Slab Rough -In Ceiling Water Line
Slab Framing Top Out Gas Line Rough -In UG Sprinkler
Foundation Insulation Sewer Hood/Duct Reconnect Vault
Bsmt Damp Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain Drain A/C UG Slab
Shear /Sheath Fire Spklr /Alm Crawl/Found Dr Heat Pump .
Approved Approved Approved - iprovar Approved
Appr /Sdwlk Not Approved Not Approved Not Approved - 1 • • roved Not Approved
FINAL FINAL FINAL FINAL FINAL
.1'' ..i ii - < , AO ha ■ 1
CAMOIPM. = eve A/ .• -
C- -ter- s/c 7 7 --‹!;15 - 6 C
O Call for reinspection 0 Reinspection fee of required before next inspection 0 Unable to inspect
C
Inspector: 1/� r e . Q ( Pi, d - Date: giro ' -..c. C. ? 7 Page / of (