Permit Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 Planck/Rec. #
Permit # F i_e 05-024(
A .I "��il Phone (503) 639 -4171 Date Issued 7- 3l
FAX (503) 684 -7297
CITY OF TIGARD TDD No. (503) 684 -2772 Issued by - M u 4�noa k�-
Inspection (503) 639 -4175
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development c+ Number of Inspections per permit allowed
Address 9 Q-f��;J u� r> n v - � Wc Service included: Items Cost(ea) Sum
i
City/State/Zip i l at.. --- i 0 It, 9 -72.1`1 4a. Residential - per unit 4
H 1000 sq. ft. or less $110.00
-
Name (or name of business) Each additional 500 sq. ft. o 1
portion thereof $25.00
Commercial ❑ Residential izi Limited Energy $25.00
- Each Manuf'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 1 GY1 • Me,�Y?� /`yl''c'. 200 amps or less $60.00 2
Address 0 Q) C) gm) Bays) -14)11.5,10,1.0- 201 amps to 400 amps $80.00 2
401 amps to 600 amps $120.00 2
City aV� State Olt. Zip ct?®oS -
`7 / 75 601 amps to 1000 amps $180.00 2
Phone No. �- 6 -� 0 ! Over l000 amps or volts $340.00
Contractor's License No. 311 --3 g e. Reconnect only $50.00
Contractor's Board Reg. No. AS/ Zi °.1 4c. Temporary Services or Feeders
qq.,, Installation, alteration, or relocation 2
S of Sur. Elec'n .221-7 , 200 amps or less $50.00
-
201 amps to 400 amps $75.00 2
- License No. - 6115 Phone No. b Z .. 781b'/ 401 amps to 600 amps $100.00
Over 600 amps to 1000 volts
2b. For owner installations: see 'b• above.
4d. Branch Circuits
Print 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 fee. 2
Each branch circuit $5.00
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. , 171 2
not intended for sale, lease or rent. First branch circuit ) $35.00 W 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 $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 Min 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:
i
NOTICE 5a. Enter total of above fees $
5% Surcharge (.05 X total fees) $
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 $ .A1.-7
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CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171
Date Requested: `F' (I ([ U A.M. P.M. MST:
Location: 1 l b S 12- 2- 4'Le.k_ 1J BUP:
Tenant: , / Suite: Bldg: MEC: q , ) '— ao c )
& s - ; t a2 '75 / l / g Phone: PLM: I
Owner: ��11 C -_.. n I e Phone: /' ELC: 7 _ C I l
Je.e if , d C cO ` r 61 1 % ,� `� ELR:
SIT:
BUILDING BLDG (con't) PLUMBING MECHANICAL ELECTRICAL SITE
Site Post/Beam Post/Beam Post/Beam Cover /Service Sewer /Storm
Footing Roof UndFl/Slab Rough -In Ceiling Water Line
Slab Framing Top Out Gas Line Rough -In UG Sprinkler
Foundation Insulation Sewer Hood/Duct Reconnect Vault
Bsmt Damp Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain Drain A/C UG Slab
Shear /Sheath Fire Spklr /Alm Crawl/Found Dr Heat Pump Low Volt
Approved Approved Approved Approved Approved
Appr /Sdwlk Not Approved Not Approved Not Approved Not Approved Not Approved
FINAL FINAL FINAL FINAL FINAL
/ 6 4PJ )°''ILD .
(1/ /161°
O Call for reinspectV/ O Reinspection fee of $ r uired before next inspection O Unable to inspect
Inspector: 41. - Dat -lr, r Page of
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