Permit 1
1
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Community Development ELECTRICAL PERMIT APPLICATION
. A
13125 SW Hall Blvd. I /� Tigard, OR 97223 Permit # Date Issued 12I j/-1oqs
.I II Phone (503) 639 -4171
FAX (503) 684 -7297
CITY OF TIGARD TDD No. (503) 684 -2772
Inspection (503) 639 -4175
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development `g q -)c S I0 U C...U.SV Number of Inspections per permit allowed
Address 1 . Service included: Items Cost(ea) Sum
City/State /Zip -i le A 4a. Residential - per unit
` j 1000 sq. ft. or less $110.00 4
Name (or name of business) Each additional 500 sq. ft. or
portion thereof $25.00
Commercial El Residential X1 Limited Energy $25.00 1
Each Manufd Home or Modular
Parkin Electric, Inc. 20250 S Molalla Ave. Dwelling Service or Feeder $68.00 2
Oregon City, OR 97045 503 -657 -4958 fax: 557 -1059
4b. Services or Feeders
Contractors License #: 34-4C exp. 10 -01 -98 Installation, alteration, or relocation 2
Supervisor. 4241 -S exp. 10-01-98 200 amps or less $60.00 2
Contractors Board Reg #: 35151 exp. 10-12-98 201 amps to 400 amps $80.00 401 amps to 600 amps $120.00 2
Metro # 2416 exp. 11 -01 -98 601 amps to 1000 amps $180.00 2
e Over 1000 amps or volts $340.00 2
Owner: / ,/ � ^ e Reconnect only $50.00 2
mil/ Cx�-�
w' - -. - ___. -- .- 4c. Temporary Services or Feeders
Contractor's Board Reg. No. Installation, alteration, or relocation 2
Signature of Supr. Elec'n ae - 200 amps or less 2
License No. Phone No. 201 amps to 400 am $50.00 2
401 amps to 600 amps $75.00
Over 600 amps to 1000 volts $100.00
2b. For owner installations: see "b" above.
4d. Branch Circuits
Print Owner's Name New, alteration or extension per pane
Address a) The fee for branch circuits with
purchase of service or feeder fee. 2
City State Zip Each branch circuit $5.00
Phone No. b) The fee for branch circuits $5.00
without
The installation is being made on property I own which is purchase of service or feeder fee.`
ac
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not intended for sale, lease or rent. First branch circuit $
Each addilionaNQ circle $5.00
Owner's Signature 4e. Miscellaneous a tR'1/4AYA
(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 inspection $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:
5a. Enter total of above fees $
NOTICE 5% Surcharge (.05 X total fees) $
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal
5b. Enter 25% of line A for $ �
�
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF Plan Review if required (Sec.3)
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR $
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal $
COMMENCED. worTcomdeNde - ❑ Trust Account # $
vrm ava 2 r
Balance Due $ c J