Permit ;, I/
Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 Planck/Rec. #
Permit # L' Lc 9 5 o I
i1 4 ' *''
� "i Date Issued � 9
1 r .) l I Pho ne (503) 639 -4171 FAX (503) 684 -7297 -14.7111.10
CITY OF TIGARD TDD No. (503) 684 -2772 Issued by
Inspection (503) 639 -4175
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development, 'OLO F C /� 4J' Number of Inspections per permit allowed
Address 24 - 24 1 ��� , /� 'T
ego,9- 'C C Service included: Items Cost(ea) Sum
City /State/Zip - . /-- ee-A. 0:2 c7Z 2-3 4a. Residential - per unit 4
1000 sq ft or less $11000
Name (or name of business) Or Each additional 500 sq ft or
portion thereof $25.00 1
—
Commercial ❑ Residential ritV Limited Energy $25.00
Each Manuf'd Home or Modular 2
Dwelbng 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 - 401 amps to 600 amps $120 00 2
City State Zip 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 am $75 00
401 amps to 600 amps $10000
-
Over 600 amps to 1000 volts
2b. For owner Installations: see 'b' above
� /J Pf_ 4d. Branch Circuits
Print Owner's Name 1 ,e €' O New, alteration or extension per panel
Address /3‘.. 7 V S A..)H7 r (A Cl a) The fee for branch circuits with
City Ci , � � t�Ajei State O2 Zi ` j72 Z3 Purchase of service or feeder fee.
Each branch circuit $5 00 2
Phone No. 3 251-.406 7 b) T he fee for branch crcuis without
The installation is being made o ?roert py I own which is purchase of service or feeder lee• r 2
not intended for sale, or rent. Fast branch circuit I $ 7
Each additional branch circuit $500
Owner's Signature 4e. Miscellaneous
(Service or feeder not included) 2
3. Plan Review section (if required): Each pump or imgation circle $40.00 2 - Each sign or outline lighting $40 00
-
Signal circud(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 ins $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 $ 7 /
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 $ lo
waecanMNN.eprm.rpp 9----
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639 -4175 Business Phone: 639 -4171
Footing Rain Drain Cover /Service FINAL:
Foundation "Water Line Ceiling - Plumb.
Post/Beam Mech. Shear /Sheath Framing -Mech.
PIbg.Und /Flr /Slab Plbg. Top Out Insulation - Elect.
Post/Beam Struct. Mech. Rough -in Gyp. Bd. -Bldg.
San. Sewer Gas Line �Appr /Sdwlk 110110 Other: / K 1 " 'T' /4f
Date: Z A.M. .M. (/ Entry.
Address: / �j ( 7
Tenant: Ste: MST:
� / _ BUP:
Con /CD t. £?M- . 6.2.0-9-.30c) MEC:
PLM:
ELC:
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
r ® ®( c.< ( ae0 o z
Inspector:i 4j,1 -z get Dates' 2- 7 7'/ x "
APPROVED _ DISAPPROVED /CALL FOR REINSP. CO