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Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd _
Tigard, OR 97223 Permit #
Date Issued
A0, L Phone (503) 639-4171 —
Ciltlf OVTIZ3ARD FAX (503) 684-7297
TDD No (503) 684-2772
Inspection (503) 639-4175
1. Job Address: 1 4.—Coni'plete Fee', Schedule Below:
Name of Developmen+��.C��1Cn✓v� �e _ PJ:::,rt>er if irspPctions per permit mowed
Address_ I Gi 7 W A' ! Service inrludad items Cost(ea) Surn
City/State/Zip GV"Li ;h r` _ 4a. Residential " per unit
1000 sq it or less t t o uu
Name (or name of business)__ ci
Each additional 500 s h or
- portion thereof $2500
Commercial ❑ Reslderltial� Limited Energy _ $25 00
Each Manufd Home or Modular
Dwelling Service or Feeder Wil 2
2a. Contractor Installation only: �—
L +, 4b. Services or Feeders
Electrical C ntractor �1i ") 1 L� V tY[��� installalalteration,or relocation
200 ampalteration,
or Irsa $6000 2
Addres ��—— �7t 201 amps to 400 amps $8000 2
City V,) State V! Zip ?n]�! 401 amps to 600 amps _ $120 00 2
,1 601 amps to 1000 snips $18000 2
Phone No. t[�Cb -L} � Over 1000 amps or volts -- $34000 2
Job NO. Reconnect only $50 00 _ 2
contractor's license NO. 2 4c. Temporary Services or Feeders
Contractor's Board Reg. ;No. 4>� iY Installation alteiation,or relocation
Signature of Supr. Elec'n 200 amps or less 2
`—' 201 amps to 400 ams $5000
I License No �7, Phone No."-- 401 amps ro roc amps _ $7500 ---- 2
Over 600 amps to 1000 volts $10000 --
2b. For owner installations: see"b"above
4d. Branch Circuits
Print owner's Name New,alteration or extension per pane
Address a)the leo for branch circuits with
City State_ Zip purr.hase or service cr feeder fee.
— -- Each branch circuit $500
Phone No. b)The fee for branch circuits wlthovt
The installation is being made on property I own which is purchase of service or feeder fee.
_�
not intended for sale, lease Or rent. First branch circuit S350f)
additional branch circurr $500
Owner's Siqnnture _ __ 4e. Miscellaneous
(Service or feeder not included) 2
atlon circle $40 00 2
3. Plan Review Sect/On (If required): Each pump or Irri7Esch sign or outline lighting —_ $4000
Signal circull(s)or a limited energy
Please check appropriate Item and enter tee In section 6B. panel,shera6on or extension 3"100
4 or more residential units in one structure Minor Labels(10) _ $10000
Service and feeder 225 amps or more
S rstem over 600 volts nominal 4f Fach additional Inspection ever
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 hourIn Plant 35e DO
__ 355 00
Submit 2 sets of plans with application where any of the above i— --
apply. Not required for temporary construction services. 5. Fees: n<7
fj
NOTICE 6a. Enter total of above fees $
5%Surcharge (05 X total fees) $
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal 6bEnter c5%of line A for $
AUTHORIZED IS NOT COMMENCED WITt;IN 180 DAYS,OR IF . Plan Review if required (Sec 3) $ '
CnNSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Subtotal
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS $
COMMENCED. Trust Account A
nim am S -
Balance Due S _=
CITY OF TIGARD BUILDING INSPECTI('^
Inspection Line: 639-4175 Businp
CE
ess PhonE. ,xTICE
Footing Rain Dain
-4171
Foundation Cover/Service FINAL:
Water Line Calling Post/Beam Mach. Shear/S -Plumb
heath Framing
Plbg.Und/Fir/Slab —�`
Plbg• Top Out Insulation
POst/Beam Struct. Mach. Rough-in G -Elect.
San. Sewer GypBd. -Bldg
Gas Line
Appr/Sdwlk �
Other:
rn.
Date:
_ A.M. P.M.
Address.. Entry:
Tenant:
---- Ste:
n Ow _ -_ MS
—7 Bl1P: ---.`__--- -
(G MEC:
THE FOLLOWING CQFIRECTELC:
IONS ARE REQUIRED: ELR
707
Inspector- ~------ __•�_ #
—_AAPPROVED — Date:
_DISAPPROVED/CALL FOR REINSP
CF CO
City of hard M-CHANICAL PERMIT Planck/Rec. #
13125 SW Nall Blvd. APPLICATION Permit # [I t�-CN��
T,Qa -.23
(503) 639- 1171
Descrip
Table 3A Mechanical Code QTY PRICE` AMT
Joy1 II SW "
I S - Q 1) Permit Feu
Address .,. �� ,P _ �- -O_ 10.00
t� 2) Supplemental Permit 3.00
umace l0 100,000
M1) incl. duds&vents 600
Z"M
(1 "" Furnace 100,000 + — --
Owner 0-0J ` 2) incl. duds&vents 7.50
` - ZIP- Floor Furnanog
3) incl. vent 6.00
— Suspended eater,wall he—ater —
4) or floor mounted heater 6.00
Occupant
° w Vent not mc.in
.r 5) applicneu permit 3.00
Repair of heating,re ng.
�__... 6) cooling,absorption unit 6.00
Boiler or comp,heat pump,air cond.
7) to 3 HP abscrp unit to 100K RTU 6.00
Boiler or comp,heat pump,air cond.
Contractor J c t 8) 3-15 HP absorp unit to SOOK BTU 11.00
�14CKry��r /� rBoiler or comp,heat pump,air con .
V 9) 15.30 HP absorp unit.5.1 mil MjBTU 15,00
�7 Boiler or comp,heat pump,air conY—
c l_ es ft10) 30.50 HP dbsorp unit 1-1.75 mil BTU 22.50
hereby acluvi—ow-Tecigo that I have road this application,that the I Boiler or comp,heat pump75—Ir—C-07—
information given is correct,that I am the owner or authorized agent 11) >50 HP absorp unit 1.75 mil BTU 31.50
of the owner,that plans submitted are in compliance with State Air handling unit to
laws, that I am registered with the Construction Contractor's Board, 12) 10,000 CFM 4.50
that the number given is correct. (11 exempt from State registration, it an ing unit
please give reason below.) _ 13) 10,000 CTM+ 7.50
Non portable
14) evaporate cooler 4.50
Vent an connected
— _ 15) to a single duct 3.00
anti ration system not
16) included in appliance permit 4.50
'" oo saryy
C) —, 17) mechanical exhaust 4.50
escn we a rtio alteration repair Commercia or in ustnaT`
to be a residential or non-residential Q 18) type incinerator 30.00
Existing use o Mer i.e.,woodstovo,water
building nr property 19) heater, solar,clothes dryers,etc. 4 50
Proposed use of 20) Gas piping one to four outlets 200
building or property_ _
Type of fuel •oil Q natural gas 0 LPC;(D electric O 21) More than 4-per outlet
— NOTTC.�
Minimum Fee$25.00 SUBTOTAL CX
PERMITS BECOME VOID IF WORK OR CONSTRUCTION —
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS,OR 5%SURCHARGE , f
IF CONSTRUCTION OR WORK IS SUSPENDED OR
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME PLAN REVIEW 25%OF SUBTOTAL
AFTER WORK IS COMMENCED.
pedal Conditions
— Dale issued ,by�_ __