Permit Community Development ELECTRICAL PERMIT APPLICATION 1/
"ti 13125 SW Hall Blvd.
Tigard, OR 97223 Planck/Rec. #
, ii � ria Permit # ec_c. -- 7s - -0 - s --- s
.j �/ Phone (503) 639 -4171 Date Issued 6 5-- °�'"'� FAX (503) 684 -7297 Issued by /-/
CITY OF TIGARD TDD No. (503) 684 -2772 Y
Inspection (503) 639 -4175
1. Job Address: 4. Complete Fee Schedule Below:
•
Name of Development LEfina R € s i b E WC..F Number of Inspections per permit allowed
Address 93Cb Su,) '1 H-►N Ati Service included: Items Cost(ea) Sum
City /State/Zip 71 t t;p ( '€ , q )223 4a. Residential - per unit I/ �� 4
t 1000 sq. ft. or less I $110.00 or
Name (or name of business) Each additional 500 sq. ft. or
portion thereof $25.00 1
Commercial ❑ Residential lEr Limited Energy $25.00
Each Manuf'd Home or Modular 2
Dwelling Service or Feeder $68.00
2a. Contractor installation only:
4b. Services or Feeders
Installation, alteration, or relocation 2
Electrical Contractor 200 amps or less $60.00 2
Address 201 amps to 400 amps $80.00 2
401 amps to 600 amps $120.00 2
City State Zip 601 amps to 1000 amps $180.00 2
Phone No. Over 1000 amps or volts $340.00 2
Contractor's License No. Reconnect only $50.00 -
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
License No. Phone No. 201 amps to 400 amp $75.00 2
401 amps to 600 amps $100.00
Over 600 amps to 1000 volts
2b. For owner installations: see If above.
4d. Branch Circuits
Print Owner's Name i F 1 T}1 1 R ETa New, alteration or extension per panel
Address ot ne .s1.0 ?j,TU l4u t. a) The tee for branch circuits with
City 1 G tr4C N State es Zip 972 purchase of service or feeder fee. 2
T Each branch circuit $5.00
Phone No. 2QR -cOT) b) The fee for branch circuits without
The installation is being made on property I own which is purchase of service or feeder fee. 2
First additional circuit brt $$5.00 2
not intended for sale, lease or rent.
Each addltional branch circuit $5.00
Owner's Signature ('N 4e. Miscellaneous
l (Service or feeder not included) 2
3. Plan Review section (if required): Each pump or irrigation circle $40.00 2
Each sign or outline lighting $40.00
Signal circuit(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 ins $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: (/0,6)°
NOTICE 5a. Enter total of above fees $
5% Surcharge (.05 X total fees) $ (
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $ 1 I S, d
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. ❑ Trust Account # $
Balance-Due $ 11 67-6
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CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171
l art_i r &A.L_ 9': /5" 0
Date Requested: cc�� �j A.M. fq . MST: •
Location: J / v BUP:
Tenant: _ /�
Tenant: -- Suite: Bldg: MEC:
Contractor: k. / • f i Phone: � " 0 077 PLM:
Owner: Phone: ELC: 75-0333
• ail Q , ELR:
P SIT:
BUILDING BLDG (con't) PLUMBING MECHANICAL EC SITE
Site Post/Beam Post/Beam Post/Beam over /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 Low Volt
Approved Approved Approved • pproved Approved
Appr /Sdwlk Not Approved Not Approved Not Approved . - . s • ved Not Approved
FINAL FINAL FINAL L. ,,&-- FINAL
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O Call for reinspe ' i / O Reinspecti • fee of $ require before ext inspection O Unable to inspect
Inspector: AI Date: L 2,5 V Page of