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Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 Planck/Rec. #,
Permit # t- 95 -
Phone (503) 639-4171 Issued p7-37--�S'
�XP�� ed
CITY OF TIGARD FAX (503) 684-7297 y
TDD N,). (503) 684-2772 —
Inspection (503) 639-41115
1. Job Address: 4. Complete Fee Schedule Below:
I
i
Name of Development N:.mber of Inspections per permit allowed — �
Address 9310 , {r11 SHrvice included Items Cost(ea) Sum
City/State/Zip�f9,C.� D� - 4a. Residential-per unit
1000 aq II or less $11000
Name (or name of'ousiness)__, Each additional 500 sq It or
portion Thereof $2500
Commercial❑ Residential Limited Energy 52500
Each Manul'd Home or Modul.r
CrvalMng Service or Feeder f6E 00
2a. Contractor installation only: 4b. Services or Feeders
Irstallauon,alteration or relocation 2
Electrical Contractor RFD ' ,-, ELECTR IC C Q_ . INC 200 anpe or lose S6000
Address 2002 S - CL i Ni ON 201 amps to 400 amps fP^ 2
401 arrive to 600 amps r
City 0 R T L A N D State U R Zip 9/2uz— 601 amps to 1000 amps u
Phone No. (S[l j ) 2 1 3i'—n l Over 1000 amps or voAs '007, 2
Contractor's License No. 'zb_ Reconnect only
Contractor's Board Rer No. q443
�. 4c. Temporary Services or Feeders
Irwta+folian arteralicn.it relocation 2
Signature of Supr. Elec' -- kit 200 amps or lose $5000 2
Lice'',se No._2n5q �q Phone 201 amps to 400 amps s75 0P 2
401 amps to 600 amps $10000
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 1 rhe tae las,branch cncutls Will
city.---- State Zip purchase or ssryka or Awdsr Aw. 2
�arh branch circuit $500
Phr•ne No hi The fee lot branch circuits W(hout
he install6tiun is being made on property I own which is purchase of tarvics or Awder hs.First branch circuit $35 00 A` 2 2
not intended for sale, lease Or rent. Each adad oral branch circuit 4 t5 00
f 4ne's Signaturh 4e. Miscellaneous
(Service or feeder not included)
3. Plan Review section (I► required): Each pump a,vrreation circle $40 00 2
Each sign or outline lighting $a0 00
�Irsaeer .ruCs'apptop► a,ah5n or eite'nii66"- fan 00 _
4 or more residential units in one structure Minor Labels(101 $10000
r' Service and feeder 225 amps or more —�
un System over 600 volts nominal 4t. Each additional inspection over
Classified area or structure containing special occupancy the allowable in any of the above
t' as described in N E C. Chapter 5 `'r Inope13500
_
cbon is,hn.lr 1;5;00 _
In Planl f55 00 i
Submit 2 sets of plans with application where any of the above --
apply. Not required for temporary construction services. S. Fees:
-� 5a. Enter total of above tees $
NOTICE 5°/,Surcharge(05 X total fees) $
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtorel $ _ ^_
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF 5b. Enter 25N of line A for
CONSTrUCTION OR WORK is SUSPENDED OR ABANDONED POR Plan Review if required!Sec 3, $ _
A P�RIOU OF 180 DAYS AT ANY TIME AF TEFL WORW IS subtotal g
;OMMENCED El crust Account it $
Balance Due $
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