Permit Z /
,t, Community Development ELECTRICAL PERMIT APPLICATION A 13125 SW Hall Blvd.
Tigard, OR 97223 Planck/Rec. #
.� �,.a l Permit # g Lc, 95- 0/ 7 q
Phone (503) 639 -4171 Date Issued - 7 I S1q
i -, FAX (503) 684 -7297 /
CITY OF TIGARD TDD No. (503) 684 -2772 .../a Issued by
Inspection (503) 639 -4175 ii-
1. Job Address: �� ' 4. Complete Fee Schedule Below:
NI Name of Development I11 A2.A I A tit ?ar d:It • Number of Inspections per permit allowed
Address I I to 1 "1 S W + A C I 1 r X1.2 Service included: Items Cost(ea) Sum
Ti Cit T 14 D Q - 1 1 7 i 4a. Residential - per unit 4
I 1 000 sq. ft. or less $110.00
Name (or name of business) M P: I k N ES l k t Each additional 500 sq. n. or 1
portion thereof $25.00 -
Commercial Residential ❑ Limited Energy $25.00
Each Manurd Home or Modular 2
Dwelling Service or Feeder $68.00
2a. Contractor installation only:
t 4b. Services or Feeders
Installation, alteration, or relocation 2
Electrical Contractor E i I /...A. C O I m G O si DNS 2 IC 200 amps or less $60.00 2
-
Addrq s P� , e)Cl 1 214-4, 201 amps to 400 amps $80.00 2
t-bP (IAab State Zip g 7 2i z 401 amps to 600 amps $120.00 2
City P 601 amps to 1000 amps $180.00 2 -
Phone No. 292 2 SS Over 1000 amps or volts $340.00 2
Contractor's License No. .t-lt420 ■ (1 (4 _ Reconnect only $50.00 -
'Contractor's Board Reg. No. r r 4c. Temporary Services or Feeders
.� '' / I alteration, or relocation 2
Signature of Su r. E ec'n . L a r a f d �/ 200 amps or less $50.00 2 - License No. Z( S ' hone No2 A2-72_,c, 201 amps to 400 amps 401 amps to 600 amps $75.00 2
$100.00
Over 600 amps to 1000 volts
2b. For owner installations: see 'b' above.
Print 4d. Branch Circuits
rint Owner's Name
New, alteration or extension per panel
Address a) The fee for branch circuits with
City State Zip Each urchase of d or feeder fee. $5.00 2
Phone No. b) The lee 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 bit l $35.00 2 z?z not intended for sale, lease or rent.
Each add'Aional branch circuit 2 z $5.00
Owner's Signature 4e. Miscellaneous
(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 41. 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: d�
NOTICE 5a. Enter total of above fees $ __' /'�
5% Surcharge (.05 X total fees) $ (j
Subtotal $ i
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 if required (Sec.3) $
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Subtotal $
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS
COMMENCED. ❑ Trust Account # $
Balance Due $ /AT i 25-
weee 111wm.PRT.49
6/16/99 Activities for Case #: ELC95 -00174
2:05:49 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELCC500 (F)Issue permit 7/18/95 SUE PASS J'H 11/16/95
ELCC001 Application received 11/16/95 11/16/95 J *H 11/16/95
ELCC003 Permit created 11/16/95 11/16/95 J *H 11/16/95
ELCC700 Ceiling Cover 11/16/95 11/16/95 J'H 11/16/95
ELCC720 Wall Cover 11/16/95 11/16/95 J'H 11/16/95
ELCC730 Elect'I Service 11/16/95 11/16/95 J'H 11/16/95
ELCC799 Elect'I Final 11/16/95 9/26/95 MJR APPR JDA 11/30/95 see BUP for this case. All
electrical inspections added on
that permit. by MJR. Final
approved.
ELCC800 Case Finaled 11/30/95 JDA PASS JDA 11/30/95
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