Permit w 061' Community Development "' 'ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223
Phone (503) 639 -4171 Planck/Rec. #
,��, Y, i .a Permit # C, 15 - o �, 4S
I' *` ' l
.1,1 ' -• I Date Issued $ D -I1 -15- -15- CITY OF TIGARD FAX (503) 684 -7297 Issued by M,u-Q,ka." i.,- TDD No. (503) 684 -2772
Inspection (503) 639 -4175
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development El Y IN / f CAE/Aeon, Number of Inspections per permit allowed
Address 13? 70 SW PAC 1 - Cl C Hu V Service included: Items Cost(ea) Sum
City /State/Zip t ..¢-2 d 1 D 2 4a. Residential - per unit 4
1000 sq. ft. or less $110.00 -
Name (or name of business) r / i'/ /V G ° ® 1 I E additional 500 sq. ft. or
I portion thereof $25.00
Commercial Residential ❑ Limited Energy $25.00
Each Manufd 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 Al. (A) . hi rail) 200 amps or less $60.00 / ZD - 2
Address 280o /111.42 '-/ ��df 201 amps to 400 amps $80.00 2
City -4Afd State OR-- Zip 9 72,1 , 401 amps to 600 amps $120.00 2
(B
601 amps to 1000 amps $180.00 2
Phone No. Z7 - 7 - 7 867 Over 1000 amps or volts $340.00 2
Contractor's License No. 2 fo - 95'2- r Reconnect only $50.00
-
Contractor's Board Reg. No. 6 c/ 5 c.7 4c. Temporary Services or Feeders
Installation, alteration, or relocation 2
Signature of Supr. Elec'n `1%f..4- (° -i e 200 amps or less $50.00 2 - 201 amps to 400 amps $75.00 2 -
License No. 3/5'5 s Phone No. L z - 7 64 7 401 to 600 amps $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 purchase of service or feeder lee. • / 2
Each branch circuit 2 5 $5.00 CS
Phone No. 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
not intended for sale, lease or rent. First branch circuit $35.00 2
Each additional branch circuit $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 f $40.00 4 /0
Signal circuit(s) or a limited energy 2
Please check appropriate item and enter fee in section 5B. panel, alteration or extension / $40.00 qo
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 inspectio $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:
NOTICE 5a. Enter total of above fees $ 325 '
5% Surcharge (.05 X total fees) $ /1, 2 S
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $ y /_ Z 5
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) $ Si.. ZS
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal $ 42 s p
COMMENCED. ❑ Trust Account # $
worecandiMeloc-prntagp c( Balance Due $ Lu SD
9 c; - __ 0( //7__(
•
03/30/2000 Activities for Case #: ELC95 -00345
10:10:51 AM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELCC001 Application received 10/19/1995 BON RECD TMP 12/07/1995
ELCC003 Permit created 10/19/1995 BON PEND TMP 12/07/1995
ELCC799 Elect'I Final 10/19/1995 11/01/1995 MJR PASS JF 05/15/1996
ELCC500 (F)Issue permit 10/19/1995 BON PASS TMP 12/07/1995 •
ELCC800 Case Finaled 05/15/1996 JF 05/15/1996
ELCC720 Wall Cover 02/29/2000 02/29/2000 09/12/1995 MJR PASS No Hold HAP 02/29/2000 Entered from review of records
BUP95 -00247
ELCC730 Elect'I Service 02/29/2000 02/29/2000 09/19/1995 MJR PASS No Hold HAP 02/29/2000 Entered from review of records
BUP95 -00247
ELCC799 Elect'I Final 02/29/2000 02/29/2000 11/03/1995 MJR PASS No Hold HAP 02/29/2000 Entered from review of records
BUP95 -00247
•
•
9
1
Page 1 of 1
CITY OF TIGARD BUILDING INSPECTION NOTICE -
Inspection Line (R c -O- Phone): 639 -4175 Business Phone: 639 -4171
Inspection: C p (1' re
Footing Susp. Ceiling Sprink. Rough -in Appr /Sdwlk
Foundation Plbg. Underslab Mech. Rough -in Fireplace
Post/Beam Struct. Plbg. Top Out Elec. Rough -in FINAL:
Post/Beam Mech. San. Sewer Gas Line -Bldg.
Plbg. Underfloor Rain Drain Framing - Plumb.
Alarm Water Line Insulation
Underflr. Insul. Shear Wall Gyp. Bd. Z.)
Date Requested: 1/ – — //9� / Time: AM PM
.3
Address: /39 7 V Axe , 14-- Y
Builder: /f J. G() p / Permit #: 6d. 95 "Q? '�
THE FOLLOWING CORRECTIONS A RE REQUIRED:
f ri al is e---
f
Inspector: de, _ ___,„ . / Date)/ / _-_ / C� aN
� SQPPROVED _DISAPPROVED APPROVED SUBJECT TO ABOVE
_Call For Reinsp. �?
VV