Permit • Ti 6A0
WASHINGTON COUNTY ELECTRICAL PERMIT
Department of La se & Transportation
V,
Electrical I ction Section
APPLICATION
155 First Avenue #350 -12
sboro, Oregon 97124
Inform on: (503) 640 -3470 Fax: (503) 693 -4412
PLEASE PRINT Number (� 0 Date Ii qC
Please complete all sections, '1 through 5
1. Location ofinstallatio > 4. Complete Fee Schedule below
Address / / /I.4 '/14•X* c}p,m,e't' / yAz Number of inspections per permit allowed
.�dA- {lama"/// fC /1S BiiiIding��
City r.-6:e .eiyr-/ C ? 0 7 Suite No. • 5>l, '-/ Service included: Items Cost(ea.) Sum,
Tenant Name - j, rr A. Residential - per unit
(if commercial) . �to J41 /0"/
1000 sq. ft. or less $110.00 4
Each additional 500 sq ft
Map No. Tax Lot
or portion thereof $25.00
Book: Page: Section: Limited Energy $25.00 1
Thomas Map 9 Each Manuf'd Home or Modular
5
Directions Dwelling Service or Feeder , $68.00 2
1
B. Services or Feeders .....► 4,140",....;,.4,140",....;,.), Commercial Residential Installation, alterations or relocation 4 � /!�`' % ;a-C)
200 amps or less $60.00 -- 2
2a. Contractor installation only: 201 amps to 400 amps $80.00 2
Electrical Contractor ALL- G!7` ' Er perizic 401 amps to 600 amps
$120.00
601 amps to 1000 amps 2 $180.00 2
Address c-010 Al. W, DA .A9 (E L S 577 7 Over 1000 amps or volts - $340.00 2
City Vc.�rn(OLP e_r' . State o. ZIP cf 9 3 • Reconnect only �-- $50.00 2
Date h//q/45 Job Number
Property Owner W,511INb1tr1 S ,fa al(Ea9 o -F 0 4.4 i) C. Temporary Services or Feeders
Contractor's License No. 3 7 Y C Installation, alteration or relocation
Contractors Board Reg. No. $- 70 I L1- 2 00 amps or less -- $50.00 2
1'•2►1 201 amps to 400 amps _ 100 .00 2
401 Signature of Supr. Elec'n r 501 /#11 O er to 000 volts see "B" abo 1e 0.00 2
License No. 3' 79 S Phone No. (FDSJ - 0510 -
D. Branch Circuits
2b. For owner installations: New, alteration or extension per panel
a) The fee for branch circuits with
Print Owner's Name Phone No. purchase of service or fe er e.
Each branch circuit $5.00 1 2
Address b) The fee for branch circuits wit out
purchase of service or feeder fee.
City State Zip First branch circuit $35.00 2
Each add'nl branch circuit $5.00 -' 2
The installation is being made on property I own E. Miscellaneous (Service or Feeder not inclu e A
which is not intended for sale, lease or rent. Each pump or irrigation circle - $40.00 2
Owner's Signature Each sign or outline lighting $40.00 -W' '- 2
g Signal circuit(s) or a limited
. energy panel, alteration
3. Plan Review section (if required) or extension $40.00 2
Please check appropriate item and enter fee in section 5B. F. Each additional inspection over the allowable
4 or more residential units in one structure in any of the above
Per inspection $35.00
Service and feeder, 800 amps or more Per hour $55.00
System over 600 volts nominal In Plant $55.00
Classified area or structure containing special
occupancy as described in N.E.C. Chapter 5 5. Fees
Submit 2 sets of plans with application where any of the A. Enter total of above fees $ Aqc•
above apply. Not required for temporary construction 5% Surcharge (.05 X total fees) $ I y - 7S -
services. Subtotal $
Thls permit becomes null and void if the work authorized by the permit is B. Enter 25% of line A for _
not commenced within 180 days from date of issuance of such permit or Plan Review if required (Section 3) $
if the work authorized is suspended or abandoned at any time after work Subtotal $
is commenced for a period of 180 days. Electrical Permits are non- 11 $
refundable and non - transferable. / �y Trust Account
or inspections call ---1139 / /15 Balance Du I9,fl. briSI q, $1 D ' .7(
24 -hour recorder, one working dvance of need 66go
�' BL28 • 3/95
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec -O- Phone): 639 -4175 Business Phone: 639 -4171
Inspection:
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.
Date Requested: / 7/ / `1 C Time: AM PM
Address: 2L 5 (� �\ , / '`�
Builder: ( 2 -0 — v /,S ej Permit #: EZc /5 -co $-
THE FOLLOWING CORRECTIONS ARE REQUIRED:
2:7 e.:•,..- i c i ..b.r Are I
In ector: A , 4-4 A (, Date:
t A Date,
/ ARPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
_Call For Reinsp.
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line:, 639 -4175 Business Line: 639 -4171
BUP
n Date Requested AM PM BLD
Location '1 � W
�� Qk Suite MEC
. Contact Person Ph PLM
Contractor Ph SWR
BUILDING Tenant/Owner 6(') 5: con ELC 6 15
— ccsz
Retaining Wall EL( 9 _ 6 / 2 S
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT _
Post & Beam
Ext Sheath /Shear -
Int Sheath /Shear -
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler • _ . [i / !. a Co,► - 1
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
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
- - FAIL
ELECTRICAL
- 'rvice
Rou• - • 1- :m
UG /Slab
Low Voltage
Fire Alarm
PASS PART FAIL
S
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: [ ] to inspect - no access
ADA
Other oach /Sidewalk Date 7 - G �j'
F Inspector c>e_Asi ll Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.