Permit V
Ank WASHINGTON CO ELECTRICAL PERMIT
Department of Land UN Use &i 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 PLC 0 15- 01 Zen Date (Q 13v 1 �5
1. Location of installation q (p 4-15 4. Complete Fee Schedule below
Address SV Hashinaton Square Road Number of inspections per permit allowed
City Ti Suite No. S ;'i220 Service included: Items Cost(ea.) Sum
Tenant Name A. Residential - per unit
(if commercial) G yros -Gyros
1000 sq. ft. or less $110.00 4
Map No. Tax Lot Each additional 500 sq ft
P 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
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 Atlas El ec tri ca T 401 amps to 600 amps $120.00 2
601 amps to 1000 amps $180.00 2
Address 4403 SE Roethe Road Over 1000 amps or volts $340.00 2
City l i Iwaukie State OR ZIP 97267 Reconnect only $50.00 2
Date '5/23/95 Job Number 3286
Property Owner "yros- Cyr9 ; '''innar Pacific i iC C. Temporary Services or Feeders
Contractor's License No. i,.:,2 Installation, alteration or relocation
Contractor's Board Reg. No. ?- 2 -2C 200 amps or less $50.00 2
j 201 amps to 400 amps $75.00 2
Signature of Sup:, Elec'n �e..t�_ 401 amps to 600 amps $1 00.00 2
License No. 1 '+ 00 S Phone No. 6 59 2212 Over 600 amps to 1000 volts see "B " above
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 -1 $35.00 35.60 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
4 or more residential units in one structure in any of the above 9
Per inspection $35.00 Z
Service and feeder, 800 amps or more Per hour $55.00
f
System over 600 volts nominal In Plant $55.00
N .
Classified area or structure containing special
occupancy as described in N.E.C. Chapter 5 5. Fees N
Submit 2 sets of plans with application where any of the A. Enter total of above fees $
X5.00 '
above apply. Not required for temporary construction 5% Surcharge (.05 X total fees) $ 1.75
services. Subtotal $
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 Balance Due $ 36.75
681 -3699 or 681 -3698 Li
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
Date Requested �} AM PM BLD
Location `7 0' ''VIA Suite MEC
Contact Person Ph PLM
Contractor Ph SWR (�
BUILDING Tenant/Owner V I Ync a j j�S ELC
Retaining Wall , J RA 9' - C)(
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 Ai ! . Sie OL Ki . We Iv? Ar, I 'ail?
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 \
T FAIL \I
ELECTRICAL
��rdree -�
Rough In
UG /Slab
Low Volta
Fire arm
Fi
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hail, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk
Date [ ` �f 9 at Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.