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CITY OF TIGAf1D Bll1L N 1ECT ON NOTICE
Inspection Line (Rec-O-Pf,onc): 639-4175 Business Phone: 639-4171
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Inspection:
Footing Susp. Ceiling Sprink. ough in Appr/Sdwlk
Foundation Plbg, Underslab Mech. Rough-in Fireplace
PostBearn Struct. Plbg. Top Out Elec. Rough-in FINAL:
Post/Beam Mech. San. Sewer Gas Line Bldg.
Plbg. Underfloor Rain Drain F ,ming -Plumb.
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Alarm Water Line Insulation -Mech.
Underflr. Insul. Shear Wall Gyp. Bd. -Elect.
Date Requested: Time: AM PM
Address: CJ .G
,¢ Bui, Permit
THE FOLLoO�W CORRECTIONS ARE EQIIIRED:
lnspector:_ _�_ Date:
A PROVED _DISAPPROVED APPROVED SUBJECT TO ABOVE
_Call For Rainsp.
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Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 Planck/Rec. # 9S- a 71 4-1"Y �
Permit # oypv —
Phone (503) 639-4171 Date Issued a 3 Y,S" _
FAX (503) 684.7297Issued by [hQ,^/�.� _SLI�,Zy/ _
CITY OF TIGA,RD TDD No. (503) 684-2772
Inspection (503) 639-4175 —_
f. Job Address: 4. Complete Fee Schedule Below:
Name of Development C H L u E tij H 0;IF�pw��P Number of Inspections per permit allowed —
Addr9sS �d_T5' lt) �"1=API C� Servicd included Items _Cost(ea) Sum
City/State/Z_ip�jiCT19R� 4. Residential-par unit 4
/� 1000 s9 If or laws $11000
Name 'or name of bu3inese)A}L r r PP-0 PL.IL 1 11 ES—- Each additiorul 500 rq It or f25 00 1
portion thereof _M
Commerc al❑ Residential E] Ea;
En fes oo
Each Manuf'd'd Home or Modular 2
Dwelling Service or Feeder f89 00
2a. Contractor installation only: 4b.Services or Feeders
Installation,alleratlon.or relocation 2
Electrical Contractor _ 200 amps or less $6000 2
Address 201 amps to 400 amps $80.00 2
401 amps to 800 amps $12000 2
City State _ Zip-_ 601 amps to 1000 amps $18000 _ 2
Phone No. cNer 1000 arrive or volts $34000 2
Contractor's License N0. Reconnect only Z $5000
Contractor's Board Reg. No. 4c.Temporary Services or Feeders
Installation,Alteration,or relocation 2 �
Signature of Supr. Elec'n _
200 amps or less $50 00 2
I-icense No. Phone No. 201 amps to 400 amps 10000 2
—. 401 snpe l0 800 amps $10000
U0 00
Over 800 amps to 1000 volts
2b. For owner Installations: see•b•above
� 4d. Branch Circuits
Print Owner's Name A-k h_C7 fri V--L N� alteration or extension per panel
Address_fo Go)( 23 c 1G2- n)The fee for branch circuits with 2
City TIrIgo State OR, Zip Q 7 Z 8! Purchase,of Nrvke or Hoole,W. _
Each branch chcult E5 00
Phone No. a t{kZ y b)The toe for branch nrruits knthouf
The installation is being made on property I own which is purchess of servke or Moder W.First it
not intended fir sale, lea or rent. Each aanchnal branch
$$500 >:
Each addA�onal branch arced $500
Owner's SignaturetL/ � _ 4e. Miscellaneous
yl (Service or feeder not included) 2
3. Plan Review section (if required): Each pump or Irrigation circle $4000 --- 2
Each sign or outline lighting $4000 —
Signal cir*wt(s)or A limited energy 2
Please check appropriate item end enter fee in section 50. panel,aheralion or extension foo or,
4 or more residential units in one structure Minnr l.a,els(10) ^_ $10000
Service and leader 225 amps or more
System over 600 volts riomina; 41. Each additional inspection over
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Classified area or structure containing special occupancy the allowable in any of the above
as described in N E C Chapter 5 Per inepr-1 on __ $3',Do
Per hour __ f55 Oil
In Plant $55 00 _
Submit 2 sets of plans with application where any of the above
apply. f of required for temporary construction services. 5. Fees:
NOTICE 59. Enter total of above fees $
5%Surcharge(.05 X total Ines) $ L'
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $ __
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF 5b. Entor 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 WORT( IS Subtotal $
COMMENCED ❑ Trust Accountill $
Balance Due $
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