Permit Community Development ELECTRICAL PERMIT APPLICATION /
13125 SW Hall Blvd.
Tigard, OR 97223 Planck/Rec. #
Att K , Permit # 6 �.G 75-0117
...Anil, 1 1 1 Phone (503) 639 -4171
.� ,� J " FAX (503) 684 -7297 Date Issued QQ - 7 /n 9.
CITY OF TIGARD TDD No. (503) 684 -2772 Issued by P
Inspection (503) 639 -4175
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development q o Number of Inspections per permit allowed
Address - 1 CO I 51 1 tV\. Service included: Items Cost(ea) Sum
City/State/Zip I , V I_ et 72---23 4a. Residential - per unit I � 4
1000 sq. ft. or less ) $110.00 1 11).00
•1�D
Name (or name of business)--)011, P ta kli Each additional 500 sq. ft. or
QQ portion thereof $25.00 1
Commercial ❑ Residential Limited Energ $25.00 -
Each Manul'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
City State Zip 401 amps to 600 amps $120.00 2
ty p 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 'b' above.
� g .'iD r 4d. Branch Circuits
Print Owner's �J O N New, alteration or extension per panel
Addres / 1 ,S(/ f//1/6 a) The lee for branch circuits with
purchase of service or feeder fee. 2
City
VW 71.,,,e40 State OK Zip 72,L Each branch circuit $5.00
Phone No. 2 V6 - 3 7X3 b) The fee for branch circuits w ithout
The installation is be made on property I own which is pu rchase of service or feeder fee. 2
not intended for s a , le ase r rent. First branch circuit $35.00 2 -
E ac h add branch circuit $5.00
Owner's Signature / n e 4e. Miscellaneous
(Service or feeder not included) 2
circle $40.00 2
3. Plan Review section (if required): Each pump or irrigation circle
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:
NOTICE 5a. Enter total of above fees $ 1)0 g
5% Surcharge (.05 X total fees) $ 5.5"0
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $
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 $ 1 (6-.6V
4 /10 /00 Activities for Case #: ELC95 -00147
5:00:32 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELCA001 APPlication received 7/10/95 BON RECD J`H 11/17/95
ELCA003 Permit created 7/10/95 BON RECD J'H 11/17/95 .
ELCA500 (F) Issue permit • 7/10/95 BON PASS J'H 11/17/95 •
ELCA799 Elect'I Final 12/7/95 MJR PASS • MJR 12/7/95
ELCA800 Case finaled 12/7/95 MJR YES • MJR 12/7/95 •
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CITY OF TIGARD BUILDING INSPECTION NOTI A wt
7 Inspection Line (Rec -O- Phone): 639 -4175 Business Phone 639441C
Inspection:
Footing Susp. Ceiling Sprink. Rough -in Appr /Sdwlk
Foundation Plbg. Underslab Mech. Rough -in Fireplace
Post/Beam Struct. Plbg. Top Out Elec. Rough -in CD
Post/Beam Mech. San. Sewer Gas Line -Bldg.
Plbg. Underfloor Rain Drain Framing - Plumb.
Alarm Water Line Insulation -Mech.
Underflr. Insul. ( Shear / Wall Gyp. Bd. g�
Date Requested: /Z� 7 1 Time: 4AM PM
Address: 70 / `J &/ i it/c
Builder: Permit #: F. 9S: a/ v7
THE FOLLOWING CORRECTIONS ARE REQUIRED:
IIII
--' * e ) c lr'j ccr l % 49
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C F
Inspector: , t or Date:
PPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinsp. P/145