Permit Community Development ELECTRICAL PERMIT APPLICATION A
r 13125 SW Hall Blvd.
7
Tigard, OR 97223 Planck/Rec. #
'`'` Permit # PLC. g, - f l
� � ;.� �I Phone (503) 639 -4171 Date Issued - 7/;)0/9.5 j , FAX (503) 684 -7297 Issued by 61 k.Q o t�
CITY OF TIGARD ti
TDD No. (503) 684 -2772 �!
Inspection (503) 639 -4175
1. Job Address: 4. Complete Fee Schedule Below:
Name of DevelopmentM,Eft.V�/N'S 11( TR(C.7 Number of Inspections per permit allowed
Ati(dr®��./Abir1(N(�.71=A wp t.(- 1� -ct Service included: Items Cost ( ea ) Sum
City/State/Zip fHZO ( nR-. 4a. Residential - per unit 4
1000 sq. ft. or less $110.00
-
Name (or name of business) fr1 Al \0•15 Each additional soo sq. n. or 1
po thereof $25.00 -
Commercial 171 Residential ❑ Limited Energy $25.00
- Each Manut'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 O Mr.(( C .t. C2CRA ( 200 amps or less $60.00 2
Address P,40. rdA(i. 201 amps to 400 amps $80.00 2
n $Q 401 amps to 600 amps $120.00 2
City I_Ar(4..G C1St,•tCr;,t) State UR Zip 9 ?CS 601 amps to 1000 amps $180.00 2
Phone No. 193S- 4c(' Over 1000 amps or volts $340.00 2
- Contractor's License No. ' Z, - G Reconnect only $50.00
Contractor's Board Reg. No. L4(1 4c. Temporary Services or Feeders
Installation, alteration, or relocation 2
, Signature of Supr. Elec'n 200 amps or less $50.00 2
License No. 23NS -S Phone No. (e35 it56(P 201 amps to 400 amps $75.00 2
401 amps 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
purchase of service or feeder fee. 2
City State Zip Each branch circuit $5.00
Phone No. b) The lee 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 I $35.00 75 ta 2
Each additional branch circuit Zp $5.00 7CCQ00
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
Please check appropriate item and enter fee in section 5B. panel, alteration or extension / $40.00 y a,01:,
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
8 apply. Not required for temporary construction services. 5. Fees:
NOTICE 5a. Enter total of above fees $ 11 61°C)
5% Surcharge (.05 X total fees) $ it.15 ,
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 $ c»7S
rafterniwuMegm app
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec -O- Phone): 639 -4175 Business Phone: 639 -4171
Inspection: ... AA , 0 a _ _ - .0 ` L � i4
I a
Footing Susp. Ceiling Sprin . 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 -Mech.
Underflr. Insul. Shear Wall Gyp. Bd. - Elect.
Date Requested: Wall /
Time: AM PM
Address: c T`� U Le.) , 5 Q k R 0 •
Builder690 cod -D -c g6:, Permit #: e/�5SD(q C)
THE FOLLOWING CORRECTIONS ARE REQUIRED:
af e) 61 e ,1 r - T- e
1 G c_ c 4.7 ...> 7 ,
Inspector: if/(! ( gi...4,1 j;--.
Dater 5 7 5 '
%PPROVED _DISAPPROVED APPROVED SUBJECT TO ABOVE
C all For Reinsp. Tilf m/1;"
s.: — 71 / Le. ty
' CITY OF TIGARD BUILDING INSPECTION NOTIC
Inspection Line (Rec -O- Phone): 639 -4175 ' Business Phone: 639 -4171
( C
Inspection:
Footing Susp. a Sdrink. 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 -Mech.
Underflr. Insul. Shear Wall / Gyp. Bd. - Elect.
Date Requested: l g( 5 '/.c- Time: AM >(PM
Address: 1 /6 6 ( ) a - S . `� Q
Builder 4'Y7 /)/ ; co ZO O S 8( Permit #: F-7. G�U ( 1 a
THE FOLLOWING CORRECTIONS ARE REQUIRED:
Inspector: Date:
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
_Call For Reinsp.
AA j [ J t U
fL /`" CITY OFTIGARD BUILDING INSPECTION'NOTICE
0 Inspection Line (Rec -O- Phone): 639 -4175 Business Phone: 639 -4171
Inspection: , a! _ _) 4._r 11.....-.1._ k li _/ L(., 4 -
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 -Mech.
Underflr. Insul. Shear Wall Gyp. Bd. - Elect.
313156 Date Requested: Time: AM PM
Address: e 7 1 0 0 tt% / (Sa ■ ked s
Builder: L-19---7 _7?-84 Permit #: CZ ,C % ,S —O 1 c f 0
THE FOLLOWING CORRECTIONS ARE REQUIRED:
,_ 4111 _ O a r 40 , 4/ 0 .'
Inspector: ,J/ r /ii e ' `C/ Date: 3��s
. 1\PPROVED _DISAPPROVED _APPROVED SUBJECT TO ABOVE
Call For Reinsp.
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec -O- Phone): 639 -4175 Business Phone: 639 -4171
Inspection: + ?1„.... A.I / •
1
Footing Susp. Ceiling Sp ink. 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 -Mech.
Underflr. Insul. Shear Wall / Gyp. Bd. Sys.
Date Requested: 9 /•- Z l l Time: AM i 'cPM
Addresse�rr,, 1 7 1 7• 1 0t 1 w k , S C c. P 5J •
Builder:( 1,4 , ; Cog0 -- >g2C) Permit #: Z 5 - 01 Rd
THE FOLLOWING CORRECTIONS RE REQ
51, d- r cQ I c ,` cz r
ff ruzc.
Inspector: W / _if Date:
/,PPROVED _DISAPPROVED APPROVED SUBJECT TO ABOVE
_ Call For Reinsp. - ^,4