Permit 1
. AN WASHINGTON COUNTY ELECTRICAL PERMIT
Department of Land Use & Transportation
Electrical Inspection Fi Section APPLICATION
155 North First t Avenue, #350 -12
Hillsboro, Oregon 97124
Information: (503) 640 -3470 Fax: (503) 6934412 .
PLEASE PRINT . ' Permit
Please complete all sections,-1 through 5: Number e LC- 9, - 01 2 -5 Date (o 1 30 I 9,-5'
1. Location of installation 9 ( Z 5 4. Complete Fee Schedule below
Address SW !!as hi ng ton Square Rd. Number of inspections per permit allowed
City
Tigard B • S pace I 2 1 2 Service included: Items Cost(ea.) Sum
• Tenant Name EDO JAPAN A. Residential - per unit
(if commercial)
1000 sq. ft. or less $110.00 4
Map No. Tax Lot Each additional 500 sq. ft
or portion thereof $25.00
Book: Page: Section:
Limited Each Ma n f'd $25.00 1
Thomas Map 9 Each Manuf'd Home or Modular
Directions Dwelling Service or Feeder $68.00 2
Commercial Residential n B. Services or Feeders
Installation, alterations or relocation
200 amps or less $60.00 2
2a. Contractor installation only: 201 amps to 400 amps $80.00 2
Electrical Contractor Atl as Electrical
401 amps to 1000 amps $120.00 2
4403 l� }toethe Road 601 amps to 1000 amps $180.00 2
Address Over 1000 amps or volts $340.00 2
City ;•;i iwaukie State UR ZIP L 12b/ • Reconnect only $50.00 2
Date 6/23 Job Number 3420
Property Owner :Ji nr:lar Pacific C. Temporary Services or Feeders
Contractor's License No. 1532 Installation, alteration or relocation
Contractor's Board Reg. No. ` 200 a mps or less $50 00 2
201 amps to 400 amps 1 00 2
) � / // /� 401 amps to 600 amps $100 00 00 2
Signature of Su�rcElec'n ,�`X Over 600 amps to 1000 volts see "B" above
License No. 148ES Phone No.
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 feeder fee.
Each branch circuit $5.00 2
Address b) The fee for branch circuits without
purchase of service or feed! fee.
City State Zip P First branch circuit $35.00 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 included)
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 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 •r4
4 or more residential units in one structure in any of the above 9
amps or more Per inspection $35.00 �-
Service and feeder, 800 am
P Per hour $55.00
System over 600 volts nominal In Plant $55.00
Classified area or structure containing special N
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 $ 35.00 i
above apply. Not required for temporary construction 5% Surcharge (.05 X total fees) $ 1.75 kIP
services. Subtotal $ CI
This 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) $ 9./
if the work authorized is suspended or abandoned at any time after work Subtotal $ GI
is commenced for a period of 180 days. Electrical Permits are non- ❑ $
refundable and non - transferable. Trust Account
For Inspections call Balance Due $ 36.75
�
681 -3699 or 681 -3698
24 -hour recorder, one working day in advance of need
BL28 • 3/95
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line:. 639 -4175 • Business Line: 639 -4171
BUP
n Date Requested I ,� AM PM BLD
Location '1 �2 W
S QSk 9 . Suite MEC
. Contact Person Ph PLM
Contractor Ph SWR
G
BUILDING Tenant/Owner LCt('D OTa-eCtAl ELC q5 -oosz
Retaining Wall EL( q - i 12 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 L s -6 c V ✓ a C o �J 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 • -
UG /Slab
Low Voltage
Fire Alarm
PART 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
Approach /Sidewalk
Other Date L b Inspector .it p Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.