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7800 5W 9tiNU STREE'i
07•'26•'95 16!00 TM,0 694 7297 t:ITY (IF TIGARD QUU1 UO2
' Community Development ELECTRICAL PERMIT APPLICATION
I 1195 Sw !1,111 Blvd,
Tigard, OR 97223 Planck/Rec. # �!;-• d?C�;�y _�_
p9ir11it # �-
Phone (50:x) 639 4171 l kp�lte Issued
CITY QF TICAITU FAx (503) fiA4-7297 Issued b —
Tr)r) No, (503) 584 2772 Y .�6ta�l�
Inspection (503) 639.4175
1. Job Address.- 14. Complete Fen Schedule Below � I1I
NElrrlQ of Drvokfp pal I
I ��_�� ��_ _—_ Numhrx of Insp4►eflohe per permit allowed —
AddressqbQa _ v cn incluclPrl linins Cosl(Aa) Suis
City/otate/Zip DR 61,14 4n Residential- p*4 unit ,
1000 sq N o,le" f t t 0()a
nrne or Hama of nrsin n^ Ewd,gddnlnml 1500 sin It or
N '—
( ess lck penton aL,eot =5 on
Commercial A A llrnNal F_nerpr __ p6 n0
Ferh Meaidd!tome or Meduier —�• —
r�..�nr.Q fiBp 00
2a. Contractor installation vrtly: Perviae or feeewr -
4h. 9ervrcaa or Feeders
hr,etlatpn eNerar{nn �, �insauon
Elr!Irir:al (:pn►i aC.ir)r tr— — 200 amps e•14.4 sea nn
AddrPSs-m� �OL"h. Pot Skunp4,o Ono arnr -- "a
Arlt am n le 1100 A-
pr n State Zip a-l� ._ r a _. 9170 no
A�1 601 gmM le icon am pa VPC)00
Phone _ i _ �� �r 1000 nmpe er vatic $14000
Contractor's t..icense No, n-,o^"fwj nroy -- sen 00
Cc+ntrActor's Board Reg. No. 5 ala I S 4r. Temporary Rorvicoi or I . .mare
1 lmh.11011inn,aheMlter, n. nlp•gli^n
Siyrintute of 5upr. Elec'n 2nn Prone nr Los $5000
License No 341-}.a ._ Phone No._a_;a-8(0 ao, amp,to goo empe — !1,
401 4mp4 to Woamp4 f100 no
c>—Hoo Was to toxo Vona -- —�
2b. For owner Ins trills tions: -ge n ekwe
Print (tiwnFi'S Name— 4d. Branch Circvils
--- _--- _ Ne- 4Neretion er ane"119M per panel
AdCtrr��5 —
e)Th-le- b.wneh rfreul,e wvrw
statte Zip __— Irlh'r14M o1 terve:•or AnOw foe
Phone No. -- brh MAnrh N ill c!-oo
_ b)The toe for bran-h�I,prq-4 wfthntn
The Installation is being made c.) property I own, which is P"1 ,"",pr'"k.-er n.eer few'
riot Intended for sale, lease or rent, I riot prsm.h 0narn �_ sins 00 35.Op
Fach addAtoryt branch tonin 00
Owner's 819ifla6W,4
Ie Misealltinpoue
�l ('cervico or lander riot Inoluded)
J. 191? R0Vl0%,--, '$e t lon (i/♦ required ; eann Pump or impallon 61,04 _— W 00
Stich sin or euione itphor- W 1x7
Plop-so chock aypropriata Itntn and onto" to",in section SFl 4'ana'1,1;0le)or•t ttmaed anetgy -- -- "'
panel,4ltoration or etdmnbn S40 OC
4 M mere t"sIdanttaf units In ona attrumuie Miner�ptpla Hai — tion no '
Sorvw*and foodw 225 amps or more
System ovar 800 wits nominA1 41. Finch rdditlonal Ingpoetlon oven
Claoaiffed etas or ninicturp writnining special orrupenty the ollowahto In tiny of thin above
11s dov'ribed In N E C Chpoter 5 n-' tins 00
Pe,t— t45 on
$uhmh 1 sale of plana with ppriicelion whole any of the "hove I-, _ l55no --
apply. Not raquhect for temporary xnatri#ctIvn servi"P, 5, Fees:
N011CF Sa. Fntnr total of abnvp feess . i C,
—
4% Surcharge 1 011 Y total tong)
PFnmiTs BECOME VOID ir WOIIK ON CONSInUCTION subroult
AUTHorTt1ED 19 NOT CC)K4MFNCFD WITHIN 1110 DAYS,On IF 5n• Ent*r 25%of tine A for
CON11TPUCIION on wont, IS SUSPENDED On ABANDONED FOIL Pion novtow It required(Sec.3) s
A PFniou or 180 DAYS AT ANY TIME AFTER WORK IS Subfofal s
COMMENCED [J Trust Account N
s
Balance Due