10720 SW FONNER STREET s
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10720 SW FONNER
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (RecAD-Phone): 639-4175 Business Phone: 639-4171
Inspection:
Footing Susp. Ceiling I prink. Rough-in Appr/Sdwlk
Foundation Plbg. Underslab Mech. Rough-in Fireplace
Post/Roam Struct. Plbg. Top Out Elec. Rough-in FINAL:
Post/Beam Mech. S-an. Sevver Gas Line -Bldg.
Plbg. Urderiloor Rain Dain Framing -Plumb.
Alarm Water Line Insulation -Mech.
Undertlr. Insul, Shear Wall Gyp. Bd. I
Date Requested: �( � Time:—,-AM PM
Address: --,�—`)7 L-CC
THE FOCLOWING CORRECTIONS ARE REOUINED:
APPROVED _-1SPr-'PROVED APPROW-n SUBJECT TO ABOVE
`Call For Reinsp. A ,� ►l C;I-f'
Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd. _ -
F'IanCk�ReC. # y5`� A ���6
Tigard, OR 97223
Permit # E t Qg1 —.------
"'� Phone (503) 639-4171 Date Issued
FAX (503) 684-7297 Issued by
CITY OF TIGARD TDD No. (503) 684-2772
Inspection (503) 639-4175 _�_-----------
I
1. Job Address: r 4. Complete l=ee Schedule Below,
_ =� Number of Inspections per permit allowed —
Name A Develos pment �
Service Included Items Cost(ea) Sum
Address_ a
lia. Residentiai• per unit $11000
City/State/Zip- —�--- loon tt or 11,0
�, �• Each additional boo sU !t or j5 00 I
Name (or name of business) �— I portwn!hereof
[,coded Ene-gy $215100 2
Commercial❑ Residential❑ Fach Manul'd Home or Modular 00 —
pwelkng Service or Feeder
! 2a. Contractor if-istallation only: 4b.Services or Feedels
I,1111,U(n.altrndior, or relocation 2
200 am or 1066 $.90 00
Electrical Contractor t A r rrwr��r i Gf-fir---- 20, ami to coo amp6 $8000
2
z
Address I+)5 —c -) W�' r�� 401 amps to 600 amps $1 2000 r `
City-0 _ t 1.,r __ State Zips__ 001 amps to 1000 amps z
1_` over 1000 amps or volts $14000
Phone No.y q ta—G G f -- Reconnect only $5000
Contractor's License No. o2 is-I y y G
Contractor's Board Reg. Nn._ 4c,Temporary Services or Feeders r
Installation,6lterat, u,relocation 7
200 amps or'ass $5000
Signature ul Supr. Elec'n I=-- I— 201 amps I 1 aoo amps $7500
License No.. Phone 401 amo6 a aoo amps s10o 00
ee•b'above
Over 600 lungs to 1000 volts
e
2b. For owner installation§:
4d. Branch Circuits
Print Ownet's Name_________ New.The
or ranchextenircon perpenal
a)Tho fee Im branch circuits Wfh 7
Addres- purchses of service or Miler hs
City— —
Stat@ Zip—.. Fath Lrnnch circuit $5 GO
Phone N0. b)The leo for branch arcrets 04fhoul ,
purchase of service at Mder Ms.t 5
Te
installation is being made on property I own which is First st branch crcull �__
not intended for sale. lease or rent.
Carh adddrorwl branch arcuil $600
4e. Miscellansou• 2
Owner's Signature. (Service or feeder not included)
$40 0: 2
Each pump or rrnyahon aids _—
3. Plan Review section (if required): Each sign or oulk $4$4000rm lighting _ 2
Signal cimcn(0)or a limded energy $4000
Please check appropriate item and enter fee In section 53. Mnor panel Rhorbels lt0n or extension $tots 00
4 or more residential units in nne structure
- Service and feeder 225 amps or more 4f. FAch additional inspection over
—r System over 600 volts nominal the allowable in any of tho above
Classified area or structure containing special occupancy P- spirclion -- $
as described in N.E C Chapter 5 Per hour $555 00
500
_
In Plant $i500 —
Submit 2 sets of plane with application where any of the above
apply. Not required for temporary construction services. 5. Fees: c,o
5a. Enter total of above fees
NOTICE 5%Surcharge(05 X total fees) $
Subtotal $ -
PERMITS BECOME VOID IF WORK OR CONSTRUCTION 5b. Enter 25%of line A for
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF plan Review it required(Sec.' $
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Subtotal $ --
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS 0 Trust Account# $ _
COMMENCED.
Balance Due $ ,.-0
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