Permit (7) .v, 10 a., 1.1.: 40 y0YJ 504 I1 (:11Y L I F T 1(iAM.? Ij002 /002
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Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 PlanckiRec. # 9S- a 7 ao . 3
,. Permit # ,EGc its R G
— o��
.1 I' Phone (503) 6394171
Date Issued /Q - FAX (503) 684.7297 a y- 9s //
CITY OF TIGARD TDD No. (503) 684 -2772 Issued by ChO� r /P �'chir,. /7"
Inspection (503) 639 -4175
1. Job Address: / - 4. Complete Fee Schedule Below:
Name of Development M e i n e t^ ` p M i- t- Ie ( Number of b immetiene per permit .Flawed
Address es 2 n_ S - �p �i C San�ce incluc hd: ' lama Cows) Sum
. City/State/Zip 1 0 R- � 7 7 2 1 4a. Reeidendd • per unit • •
J moo riot aims $110.00
-
Name (or name of business) Eats ewe boo eve K or
pain Owned 225.00
Comrrterci3l Residential ❑ tailesel r 1
Ea Mrrfd Horne Modular 2
Rah
WON 6ervies er Roar ta.00 �—,
2a. Contractor Installation only:
Santee or Feeders
Electrtical Contractor?( t friers Elecfri 1nt; . hotelman. o r kw °" �0C•001 �.00 2
Address 2 " L. r II + INC( 201 ergs to 400 ehnpa 1$50.00 2
City • State Ole % • WA soy
Zir wet a m *attunes alzom 2
Phone No 7 =�; -- 6 •tom or emu 1000 1000 amps 5150.00 2
Contracto — . cense No. a — Reconnect o rt w ` 2
Contractors B o a r d Reg. No. • 4 7 i 4a Temporary Services or Feeders
S' nature of Supr. Elec'n _ . ,_
g 0 I NaMrion. deratien. a relocation 2
.lam t _ ■ vi 200 woos or Iws i60.00 2
License No.) 91 70 - , i one N • N. lL *. - C'2 ' 4 2 : " :4""P" :+ o 2
Oar 600 Maps ee 1000 .e1s
2b. For owner installations: . V Wan.
Print Owners Name 40. Branch Circuits
Address New admen or ononeon per pool
y The he ter beach awoke with
City S .�` ti rnahae• at service or *MN be. 2
Phone No. Ears+ b ang% caul WOO
to The tae ter breach onVils arlAorR
The installation is being made on property I own which is punomm ar ee.•ttap a Msertr lira 2
not intended for sale, lease or rent. ti" bore" circuit I 2iS 00 �2_ 2
Eaell ia.ame brands anal ME 5600 r
Owners Signature 4e. Miscslfaneow
(Service or feeder not included) 2
3. Plan Review section (if required): Esdl camp or Wigwag dale 10.00 2
Each pi5n or aaMe *thy SAO 00
SOW ooailIe► or • Smiled snow 2
Please check eppropriede item and enter fee in section 511. panel. aheretion or aaesnden 210.00
4 or Mo residendal unite in one MOWS Mir labor (10) $100.00
re
Service and leader 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 •swctien sts.00
Per hour ti66.00
Submit 2 seta of plane with application where any of the above t " X11 t(55.00
spPIT• Now required for temporary coIeV UCtlet services. 5. Fees: bee
-�/ S OV ,. l
NUNOTICE Se. Enter coral of above ee $ '7
5 Surcharge (.05 X total lees) $ • 7 S
Subtotal
PERMITS BECOME VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 160 DAYS, OR IF 5b. Enter 259$, of line A for
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Plan Review if required (Seo.3) $
A PERIOD OF tau DAYS AT ANY TIME AFTER WORK IS Subtotal $
COMMENCED. ❑ Trust Account I 5
Balance cue - $ R :45
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested /2- /oo AM PM BLD
Location /a,( Suite MEC
Contact Person Ph PLM
Contractor Ph SW -
BUILDING Tenant/Owner 95-00q
Retaining Wall ELR
Footing Access: ,, /J
Foundation F i1 �.a D 101 FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post h Beam no-k- ' - fi i M
Ext Sheath /Shear lTl
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall �J
Fire Sprinkler /T�[ Sy P 11/ S AL/4"•‹? Y ✓ .,[ 'O COJYI/ !Y 14,)/1/j
Fire Alarm yy ,,��
Susp'd Ceiling )//J / U f 1/] Ceo CY e Y re MA 1/1, LS'
Roof
Misc:
Final F /_
PASS PART FAIL
PLUMBING
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
�C€CTRICA�
Service
Rough In
UG /Slab
Low Voltage
Fire _larm
" CO RT FAIL
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA / Oth /Sidewalk Dat Inspector 4/1 g&e./1 Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.