Permit �-
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Community Development ELECTRICAL PERMIT APPLICATION
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13125 SW Hall Blvd.
Tigard, OR 97223 Planck/Rec. # 4s a 70 1 S9
Y�, Permit # ECQ 4,r- n a7p
.iP li l Phone (503) 639 -4171 Date Issued 9 - s - 9 s -
s FAX (503) 684 -7297
CITY OF TIGARD TDD No. (503) 684 -2772 Issued by c tiu , l� s. �.� f
Inspection (503) 639 -4175
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development Number of Inspections per permit allowed
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Address Si,.) Tv-rtn Cr 44 3 0 7 Service included: Items Cost(ea) Sum
City /State/Zip 1‘1 O iL q? e.z. 4a. Residential - per unit 4
1000 sq. tt. or less $110.00
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Name (or name of business) bcteftc l S N d e "-- Each ion additional f sq. H. or 1
Y portion thereof $25.00
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Commercial ® Residential ❑ Limited Energy $25.00
Each Maned Home or Modular 2
Dwelling Service or Feeder $68.00
2a. Contractor installation only: 4b. Services or Feeders
1
� Installation, alteration, or relocation 2
Electrical Contractor (A'i l I n M { 'll4 ((P,74 t' / N C� 200 amps or less / $60.00 66 g t- 2
Address Po (Sox azv -1. 's 201 amps to 400 amps $80.00 2
401 amps to 600 amps $120.00 -
Cilty j ( re , r1 0, State Zip cp/ 601 amps to 1000 amps $180.00 2
Phone N . b Zy -3(p / Over 1000 amps or volts $340.00
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Contractor's License No. 34 - vs L Reconnect only $50.00 -
Contractor's Board Reg. No. ?SOS ` 4c. Temporary Services or Feeders
/ Installation, alteration, or relocation 2
Signature of Supr. Elec'n i I , r 200 amps or less $50.00 2
2
License No. /f(.5 -S Phone . • o. 64 -g b� 201 amps to aoo am $75.00 -
/ 401 amps to 600 amps $100.00
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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 tee for branch circuits with
City State Zi purchase of service or feeder lee. 2
City p Each branch circuit $5.00
Phone No. b) The fee for branch circuits withou
The installation is being made on property I own which is purchase of service or feeder lee. 2
First branch circuit $35.00 2
not intended for sale, lease or rent.
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
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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 ins $35.00
Per hour $55.00
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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 $ 6Q oe
5% Surcharge (.05 X total fees) $
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF Sb. 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 $ 13 °
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CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639 -4175 Business Phone: 639 -4171
Footing Rain Drain Cover FINAL:
Foundation Water Line Ceiling - Plumb.
Post/Beam Mech. Shear /Sheath Framing -Mech.
PIbg.Und /FIr /Slab Plbg. Top Out Insulation 47.111
Post/Beam Struct. Mech. Rough -in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr /Sdwlk Reins.
Other: I /C
Date: I t 9 ` c ? A.M. P.M. En ry:
Address: 974/0
Tenant: Ste: MST
BUP:
Con /Own: MEC:
PLM: (1,
ELC: f SCE J 7t
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR•
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d (_
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Inspecto• A Date:
APPROVED _ DISAPPROVED /CALL FOR REINSP. CO
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