Permit •
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F WASHINGTON COUNTY ELECTRICAL PERMIT
Department of Land Use & Transportation
Electrical Inspection Section APPLICATION
155 North First Avenue, #350 -12
Hillsboro, Oregon 97124
Information: (503) 640 -3470 Fax: (503) 693 -4412
PLEASE PRINT Permit
Please complete all sections, 1' through 5. Number E (...0 q,5- 01 17 Date 651 Z52I9 S
1. Location of ins tgllation , r _sQ 4. Complete Fee Schedule below
Address 4 702.c s , U/, I/451 f, , 54 t l p . , Number of inspections per permit allowed
Building Service included: Items Cost(ea.) Sum
City Suite No.
Tenant Name A. Residential - per unit
'
if commercial)
r-
V 1 * J r V
( )O 1000 sq . ft or less $110.00 4
Each additional 500 sq. ft
Map No. Tax Lot or portion thereof $25.00
Thomas Map Book: Page: Section: Each Energy $25.00 1
P 9 Each h Manuf'd Home or Modular
Directions , Dwelling Service or Feeder $68.00 2
B. Services or Feeders
Commercial Residential ❑
Installation, alterations or relocation
200 amps or less $60.00 2
2a. Contractor installation only: 201 amps to 400 amps $80.00 2
nh 1 401 amps to 600 amps $120.00 2
Electrical Contractor Gt / N(11 V-- /r C� 601 amps to 1000 amps $180.00 2
PA
Address r aoy 3.5)s r'- Over 1000 amps or volts $340.00 2
City C! !l State ZI P �/� Reconnect only $50.00 2
Date ( - 2q.- �l ( obNumber��=(r15 /
Property Owner C. Temporary Services or Feeders
Contractor's License No. • - d a «0;. Installation, alteration or relocation
Contractor's Board Reg. No. I►l�t�
200 amps or less $50.00 2
• / 201 amps to 400 amps $75.00 2
Signature of Su r. Elec'n 7 nelOPPII � R 401 a mps to 600 amps $1 00.00 2
g , ' Over 600 amps to 1000 volts see "B" above
License No. Pho 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 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 included)
which is not intended for sale, lease or rent. Each pump or irrigation circle $4 2
Owner's Signature Each sign or outline lighting $40.00 2
9 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
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
occupancy as described in N.E.C. Chapter 5 5. Fees J
Submit 2 sets of plans with application where any of the A. Enter total of above fees $ q0.
above apply. Not required for temporary construction 5% Surcharge (.05 X total fees) $ Z.o"v
services. Subtotal $ '17.
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) $
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- $
❑
refundable and non - transferable. Trust Account •
For inspections call Bala Due $ 1 / Z Ov n - }lp.:,,z, iam ttiroi1 1voj.%rp
24 -hour recorder, one working day in advance of need
BL28 • 3/95
(03?-905
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested ,, I,� AM PM BLD
Location q lU 25 iA 'AJV ' S7 • Suite MEC
Contact Person Ph PLM
Contractor C Ph SWR �1
BUILDING Tenant/Owner • lJ16t,(7 5-4,194y) ELC 9S'01 J l
Retaining Wall ELR
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 [ / � 5;1,5'4 lin cW /-�
r d c 6 n p
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
)3AS S—B611. FAIL
ELECTRICA
S ervice
Rough In
UG /Slab
Low Voltage
Fire Alarm
CD 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: [ ] Unable to inspect - no access
ADA 7-'7, / C�
Approach /Sidewalk D a t e b ^ [ I nspec t or Ext
Other -
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.