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Community Development ELECTRICAL KIRMIT APPLICATION
13125 SW Hall Blvd
Tigard, OR 97223 Planck/Rec. #-95-,1 c yy-
Permit # f/l
Phone (503) 639-4171 Date Issued
FAX (503) 684-7297 Issued b Cdo,•l�5 Sc -
CITY OF TIGARD TDD No (503) 684-2772 Y A'�d r
Inspection (50�) 639-4175
—,. Job Address 4. Complete Fee Schedule oelow:
Name of Development 1 3 5 t h AVENUE WELL _ Number of Inspections per permit allowed
Address_ Service included, Items Cost(ea) Sum
City/State/Zip TIGARD ., O R-G O N 9 7 2 2 3 4a. Residential-per unit 4
000 sq II or lose $11000
Name (or name of business) TIGARD WATER DEPT . Each additional 500 eq It or
podtoi,thereof $2500 1
Commercial El Residential Limited Er ]y $2500
Each
w o H 55074 ch Manurd Home or Modular 2
Dwelling Service or Feeder $66 00 _
28. Contractor installation Only: 4b.Services or Feeders
n.
Electrical Contractor_ F 10\11 L L R ELECTRIC In200ilallalwp alteration,or relncah°" 2
200 amps or gess $60 00 2
Address 1 1 8 6 0 SW GRELNBURG R O A U 201 amps to 400 amps $8000 2
Citi' T 1 G A R D State r1 L) Zip , 401 amps to 600 amps $120 o0 2
1 — �1J1— �1�L.1— 601 amps to 1000 nmpa $18000 2
Phone No. 6 3 9-4 6-2 7 _ Over 1000 amps a volts $34000 2
Contractor's License No._ 3 4- 1 3 C laeconned only $5000
Contractor's Board Reg, No. 3 7 4 10 4c. Temporary Services or Feeders
Installation alteration,or�olocalton 2
Signature of Supr. Elec'n ✓dw,-,YL,�x— 200 amps or leas $5000
License No. L 81 6 8 Phone No. 6 3 9-4 6 7 201 amps to 400 amps $75 oc
401 amps to 600 amps $10000
Over 600 amps to 1000 volts —--
2b. For owner installations: ss.-•b'above
4d. Branch Circuits
Print Owner's Name `_ New,alteration or extension per panel
Address a)The lea for brarch circuits with
City_ State Zip pwchsse of service or feeder fee. 2
— Each br unci,^ir bit $!100
Phone No. h)The fee for branch circuits without
The installation is being made on property I own which is purchase of service or feeder Me. 2
not intended for sale, lease or rent. First branch circuit __ $3r,00 2
Each nddsional branch circuit $500
Owner's Sig-ature 4e. Miscellaneous
(Service or feeder not included) 2
3. Plan Review section (if required): Each pump or irrigation circle $4000 4 0 . O 0 2
Each sign or outline lighting __ $40 00
Signal cimuu(s)m s limited energy 2
Please check appropriate item and enter fee in section 5B. panel,aneration or extension $4000
4 or more residential units in one structure Minor Labsis(10) $10000
Service and feeder 225 amps or more
Sy,,tem over 600 volts nominal 4f. Each additional inspection rover
_Classifis-1 area or structure containing special occupancy the allowable in any of the above
as described in N E C Chapter 5 Per inspection $3500
i� Par hour $55 00
~i Submit 7 +els of ni-na with application where any of the k.r r,ve n Plant $55 00
Lr)
r apply. Not requirod for temporary construction services. S. Fees:
f–
..t NOT' E
5a. Enter total of above fees $ 40 . 0 0
5%Surcharge(05 X total fees) $ 2 _ H 0
2 I Subtotal $
4 PERMITS BECOME VOID IF WORK OR CONSTRUCTION
w AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF Sb. Enter 25/,of line A for
CONSTRUCTION OR WORK IS SUPPENDED OR ABANDONED FOR Plan Review if required(Sec 3) $
A PERIOD OF 180 DAYS AT AN'( TIME AFTER WORK IS ^ Trust Account N $
Subtotal
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COMMENCED RUR14ORIGINAL _
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A►PPLICAMN Valance Due $ l ;' . I)I)_ I
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CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec-O-Phone): 639-4175, Busihess Phone: 639-4171
Inspection: t. �l.
Footing Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
Foundation Plbg. Underslab Mech, Rough-in Fireplaze
Post/Beam Struct. Plbg. Top Out Elec. Rough-in FINAL: i
Post/Beam Mech. San. Sewer Gas Line -Bldg.
Plbg. Underfloor Rain Drain Framing -Plumb.
Aiarm Water Line Insulation -Mech.
Underflr. Insul. Shear Wall Gyp. 9d. -Elect.
Date Requested: 3Gr �' L_ ,'rime: AM PM
Address: v
_ j Ut !�? I u rs pf ,r4
Builder: ��ls Permit #:15
1HE FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspector c L , Date:_
APPROVED DISH?PROVED APPROVED SUBJECT TO ABOVE
_Call For Reinsp. 7-; Q
CITY OF TIGARD -- RFCE:ip"r OF PAYMENT RECEIP1 NO. e S5--P6f.%831
CHECK AM(lUNT s 4 :'. 00
NAME t FWAHLEN ELECTRIC COMPANY CAF3H AMOUNT 0. 1210
ADDRrSS s lt860 S. W. (-.,Rr..ENSERG ROAD PAYMENT DATF t 0A10P195p
TIGARD, 0R. sumvisinN
9W.23-
PURPOSE OF PAYMENT AMOUNT PAID PURPOSE* OF PAYMENT AMOUNT PAID
..........
�_a E T i ii E A L- E- -f 40. 00 ST. BUILD PER 2. 01A
135)"H AVENUE WELL
TOTAL AMOUNT PAID 42. M0
08%30.'95 16:13 FRAHLER ELECTRIC 4 INSPECT TIG_,ARD N0.472 P001
FRAHLER ELECTRIC COMPANY --
11860 S.W. CREENBURG ROAD, TICARD, ORECON 97223 '
PHONE (533) 639-4627
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t FAX INF PECTION REQUEST
j FAX *(503)639-4. 673
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DATE: REGEIVING_ F'AX NUMBER:
RECEIVING LOCATION : -c- .0 -
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SENDER _ C / //
NUMBER OF PAGES : 0 � ( INCLUDING TRANSMITTAL)
PERMIT NiJMBT.R: �--� C/' �-/fC/ 41
ADDRESS:
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