Permit A. /
v
411,1 WASHINGTON COUNTY
Elect
al Ins f action Sec& Transportation ELECTRICAL PERMIT
IP 155 North First Avenue, #350 -12 APPLICATION
Hillsboro, Oregon 97124
Information: (503) 640 -3470 Fax: (503) 693 -4412
Project/Permit
PLEASE PRINT , .. . Number ELC 45 -06)5 Date 6)22 f C 1 5
Please complete all sections,,1 through 5. 4, Complete Fee Schedule below
1. Location of installation ,13.66 Number of Inspections per permit allowed
Address 21% l Service included: Items Cost(ea.) Sum
Building A. Residential - per unit
City -- C-i+,t2.0 Suite No.
1000 sq. ft. or less I $11 0.00 1 ' 4
Tenant Name Each additional 500 sq. ft C P
(if commercial) or portion thereof 3 $25.00 7
Tax Lot �-� 16 Limited Energy " $25.00 1
Map No. Each Manuf'd Home or Modular
Dwelling Service or Feeder $68.00 2
Thomas Map Book: Page: Section:
Directions B. Services or Feeders
Installation, alterations or relocation
200 amps or less $60.00 2
Commercial
n R esidential )c 201 amps to 400 amps $80.00 2
401 amps to 600 amps $120.00 2
2a. Contractor installation only: 601 amps to 1000 amps $180.00 2
Y• Over 1000 amps or volts $340.00 2
Electrical Contractor .CAV\-1-K;eQ,`d Reconnect only $50•00 2
Address '‘\■," tics, ‘fe pa a�(o��et; \of
Date C\7�\ Job Number C. Temporary Services or Feeders
Property Owner ROth L e9#4 Q Et), CO Installation, alteration or relocation
Contractor's License No. ' \o vt, 200 amps or less $50.00 2
Contractor's Board Reg. No. Qi, 1sv7� 201 amps to 400 amps $75.00 2
5 401 amps to 600 amps $100.00 2
Signature of Supr. Elec'n c4C5 u Over 600 amps to 1000 volts see °B' above
License No. ‘7\c-\--‘ Phone No. 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 2
City State Zip Each add'nl branch circuit $5.00 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 over 800 amps; feeder 800 amps or more 5. Fees
System over 600 volts nominal s pv
Classified area or structure containing s ecial A. 5% total r of ge (.05 e (.05 fees $
g p 5% Surchar X total fees) $ . Z 5
occupancy as described in N.E.C. Chapter 5 Subtotal $ 15Y-/. 2' 5
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 $ I ci 4, 25
For inspections call This permit becomes null and void If 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 for a period of 180 days.
24 -hour recorder, one working day in advance of need Electrical Permits are non - refundable and non- transferable.
1/94
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec -O- Phone): 639 -4175 Business Phone: 639 -4171
Inspection:
Footing Susp. Ceiling Sprink. 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. eat.
Date Requested: /l erl 9S Time: AM PM
Address: D 9 2/ (..J �.- C.J -P� c,
``
Builder: C0 e� - 7 iris 9 Paz: < S a I ,s
THE FOLLOWING CORRECTIONS ARE REQUIRED: - ?5"1 �c 7�
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<7 ecf / / ( frrc1)ed
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In pector: " - • ,d /, Date: 7"/ ^�'�
PPROVED _DISAPPROVED APPROVED SUBJECT TO ABOVE
_Call For Reinsp. EFA