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Permit FOR OFFICE USE ONLY tectgried Penn Ad • '1= nation '- . Reeeived J Electrical 'q n j 1 IF , g Date/By: / /7 6/e 7- Permit No.: tr/X..-2606"10533 33 Planning Approval Sign City o Tigard Datefav: Permit No.: _ , _ 13125 SW Hall Blvd. JAN 1 7 200 Plan Review • Other Tigard, Oregon 97223 i Date/By: Permit No.: 86p Post Land Use Phone: 503 Fax: S 21F 60' c i>; � , , :a l ;� i} r� Date/8 : case Internet: www.ci.tigard.or. grg �.�, ` z ° ° i . i i Contact 1 El Page 2 for 24 -hour Inspection Request 5O3z6 41' 5 r '" • ' - ° Name/Method; , Supplemental information. .f la ,,, ri: i`. :�' g r rr + „'.::' -' :':; rd':;i:fl,, ',I'LAN:T.EVIEW... - . lei e check` all.jhata .. if.�::.� �. . r `:f'ly. ,h.�W�'r1'���' �P7.7�t1`n. ?`:':� 't'.�'� New construction n Demolition ■ Service over 225 amps- il Health -care facility ,., commercial 1] Hazardous location ri Addition/alteration/replacement n Other: ❑ Service over 320 amps- rating of • ❑ Building over 10,000 square feet, `..'"”` 'i'%, ";'- ik„CAT.)~GAOtY EE .NS' RUCTION'' r <tsll �i :i. 7 18t 2 family dwellings four or more residential units in 1 & 2- Family dwelling ommercia]/Industrial ❑ System over 600 volts nominal one structure 0 Building over three stories ❑ Feeders, 400 amps or more n Accessory Building Multi - Family , 0 Occupant load over 99 persons ❑ Manufactured structures or RV park I Master Builder • Other: ❑ Egress/lighting plan ❑ Other: . _ • . e i Submit sets of plans with any of the above. 'i 1NH +1Prta,�+'ii 01XS?ITE. Ii;QI '�4ki • . A'11dt ' . 6 GA `I0 : : r a ;. ; . k '' ''' .3.j 'i "' -' G ' '-" � The above are not a 13cable to temporar� service. • Job site address: V C /��l ';..n:AU.!.k, ! ',,. '`t:s;'.. ... .., ;1 0k` t. S.p.lik ` .4. ,.fk':t;�:��''F .. i 7 w ` ^A , a ` . `.'p'1' : Suite #: Bldg /Apt. #: Number of ins' ections ' er ' ermit allowed Project Name: , Description Qty Fee (ea.) . Total Cross street/Directions to job site: New residential-single or multi- family per 1 dwelling unit. Includes attached garage. • Service included; • 1000 Sq. ft. or less 145.15 Each additional 500 ft. or •.rtion thereof 33.40 Limited eneri , residential MN 75.00 Q Subdivision: f re-- Lot #: Limited energy, non residential II 75.00 T ax ma / arcel #: Each manufactured home or modular dwelling vr , c:T ' 17vt�;: . , i , .41 1 >!uH i 0;, .,.h'y4' �'' �IflO tQ ';:.:i?',r Hilloa:',i,.. a' �U ;:iG.y;.' 'si:! service and/or feeder 90.90 = ` :.: � _,_ _ Services or feeders - Installation, r/ll1J g- yjG' alteration or relocation: I MI,1 200 am.s or less 81130 / / ' ' r 20I am .s to 400 ernes M 106.85 IMMO sr ' • 401 am. to 600 am •s Mill 160 - 60 MI 7 ' SANTii� W; ,�r�_ltl» , .i` .,,a 6 01 a ni.: to 1000 am.: _© d:. >• t'l!4!,1�';1.. ,,.£ C;t;: :<H,.. 240.60 Over 1000 amps Or volts 454 .65 Name: Reconnect only 66.85 Address: Temporary services or feeders - installation, alteration, or relocation: City /State /Zip_ 200 amps or less 66.85 Phone: Fax: 201 amps to 400 amps 100.30 _ 01 to 600 am.: 133.75 AP: I rows'' k" ..:!i .: it #S ; i . ,'ttONTACT; ERSQN '' :::.''i..r Branch ci rcu i ts -new, alteration, or Name: extension per panel: A. Fee for branch circuits with purchase of Address: _ se rv ice or feeder fee each branc circuit 6,65 City/State/Zip: M_ 8. Fee for branch circuits without purchase of service or feeder fee first branch circuit 46.85 III Phone: I Fax: Each additional branch circuit 6.65 2 ' — E -mail: • Misc.(Service o r feeder not included): }. s0.JXr � ' "T4I3 �.''. . i ,�' r ` '. pis :: ! a:,:.:, ; Each pump or irrigation circle 53,40 2 4: :; d . '" .',,,, i:i! r3f a t ', r,i ?ui, ?.i..:. {2bi;k.:.,..:.':'` '. ..L Each s or outline li:htin 53.40 2 Job No: Signal circuit(s) or a limited energy panel, Business N NorthStar Electrical Contractors alteration or extension . Pa:e 2 III 19450 SW Clpole Rd. #107 tescription: Address: Tualatin, OR 97062 (503) 612 -0840 FaX (503) 612 -0891 Each additional ins . action over the allowable in an of the above: Clt /State /i 1,j0 {134 - 359C CC$ #90454 Metro #1911 Per ins. ction .'r hour min. 1 hour OM 62.50 Phone: Investigation fee: _ CCB I Lie # : Other: Lie. #: 'f , .'.., . . r';r ?'.; &trlent eriiilt' 'eW.. :;';ftf: ry ki6;: Sl ^. Supervising electrician 4 , Subtotal sit attire r • hired: - _ Plan Review 25% of Permit Fee ��� 1V - State Surchar • e 8% of Permit Fee r Print N a m - . 4 jr r ' _ , .y;i; Lit;_ #: _ . _. ': TOTAL. PERMIT PEE ��i MII Authorized Notice: This permit application expires If a permit is not al/ ed - hi Signature: bate: 180 days after it has been accepted as complete. *Fee methodology set by Tri- County Building Industry Service Board. (Please print name) is \Osts\Permit Forms \ElcPcrmitApp.doc 01/03 • E0 /T0 39Vd at11SHI ON TE80ZT9E0Z TT:ST 9002 /9T /10