Permit f
WASHINGTON COUNTY ELECTRICAL PERMIT 'v
`t1 "�' fi Department of Land Use & Transportation
Electrical Inspection Section
lip 155 North First Avenue, #350 -12 APPLICATION
Hillsboro, Oregon 97124
Information: (503) 640-3470 Fax: (503) 693 -4412
Permit in
PLEASE PRINT Number �� 5 ' 0 2 - 3 Date Col 3 O 9 l i
Please complete all sections, 1 through 5. 4. Complete Fee Schedule below
Number of inspections per permit allowed
1. Location of installation
Address 9,500 cltii Lrh r Rd Service included: Items Cost(ea.) Sum
Building A. Residential - per unit
City, / -� a ,,, c i Suite No. '
1000 sq. ft. or less $110.00 4
Tenant Name 1 Each additional 500 sq. ft
(if commercial) (e.4_,,,,r." rr, (j ry,, or portion thereof $25.00
Limited Energy $25.00 1
Map No. Tax Lot Each Manuf'd Home or Modular
Dwelling Service or Feeder $68.00 2
Thomas Map Book: Page: Section:
Directions 44 7.44A;,7 / r - , Spa 4 . 41,..ir.
y u B. Services or Feeders
I n -il rr, 0 Jinrtl 4l n1 y Ahone ei Ae' i 4 Installation, alterations or relocation
(Ol 200 amps or less $60.00 2
Commercial g Residential n 201 amps to 400 amps $80.00 2
401 amps to 600 amps $120.00 2
•
601 amps to 1000 amps $180.00 2
2a. Contractor installation only: Over 1000 amps or volts $340.00 2
Electrical Contractor jj 5 ,,4, fG� ) 4 4 ,, *, .> Reconnect only $50.00 2
Address3.202 yE l:S .f , lrr)vfr/If,VA A, /VA 5;',F4,63
Date i -19 -95 Job Number C. Temporary Services or Feeders
Property Owner Installation, alteration or relocation .
Contractor's License No. - 3 /'r3 7 V 200 amps or less $50.00 ' 2
Contractor's Board Reg. No. S/, 5 Y 201 amps to 400 amps $75.00 2
401 amps to 600 amps $100.00 2
Signature of Supr. Elec'n ,11' ,L 4 Over 600 amps to 1000 volts see °13° above
License No. 30,745 Phone No. , /a ' 93-,5700 D. Branch Circuits
New, alteration or extension per panel
2b. For owner installations: a) The fee for branch circuits with
purchase of service or feeder fee.
Print Owner's Name Phone No. Each branch circuit $5.00 2
b) The fee for branch circuits without - .
Address purchase of service or feeder fee.
First branch circuit / $35.00 3 5.00 2
City State Zip Each add'nl branch circuit__ $5.00 /S. 00 2
E. Miscellaneous (Service or Feeder not included)
The installation is being made on property I own Each pump or irrigation circle $40.00 2
which is not intended for sale, lease or rent. Each sign or outline lighting $40.00 2
Signal circuit(s) or a limited
Owner's Signature energy panel, alteration
- or extension $40.00 2
F. Each additional inspection over the allowable
in any of the above
3. Plan Review section (if required) Per inspection $35.00
Please check appropriate item and enter fee in section 5B. Per hour $55.00
In Plant $55.00
4 or more residential units in one structure
Service and feeder, 800 amps or more 5. Fees
System over 600 volts nominal A. Enter total of above fees . $ 50. 00
Classified area or structure containing special 5% Surcharge .(.05 X total fees) $ 02 50
occupancy as described in N.E.C. Chapter 5 Subtotal $ 52,50
B. Enter 25% of line A for
Submit 2 sets of plans with application where any of the Plan Review if required (Section 3) $
above apply. Not required for temporary construction Subtotal $
services. $
Less Bulk Label Fee
Balance Due $ .�.2 SO ,
For inspections call This permit becomes null and void lf the work authorized by the permit Is not commenced
640 - 3561 or 693 -4415 within 180 days from date of issuance of such permit or if the work authorized is
suspended or abandoned at any time after work Is commenced fora period of 180 days.
24 -hour recorder, one working day in advance of need Electrical Permits are non - refundable and non - transferable.
4/94
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
C D l att 1 e - Requested � 1,� AM PM BLD
//��
Location `'i ) LCAJV t . Suite MEC
Contact Person Ph PLM
Contractor Ph SWR .
BUILDING Tenant/Owner ELC ' i • e ( v
Retaining Wall ELF 1 C� • 1
Footing Access:
Foundation FPS
Ftg Drain • SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam &LC 9 7 a7 S
Ext Sheath /Shear
Int Sheath /Shear �
Framing - -�-�(_. 9 Z
Insulation
Drywall Nailing
Firewall nn /
Fire Sprinkler fT I � A- y s it c.ws ec Cn iv 4 / �/
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL 051
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL `C q--)- O? 9l uo Td c J 3� 2s--_ /O G�
' be, p
Post & Beam C✓ / l
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
4 PART FAIL
SITE
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
Approach /Sidewalk 7 2 4 v Date y f (
Other Inspector 4 p� Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.