Permit 1,..,/ /
AIN WASHINGTON COUNTY ELECTRICAL PERMIT
Department of Land Use & Transportation
liiiiW Electrical Inspection Section APPLICATION
155 North Fi rst t 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 � LC - Jam- Cif ag Date - 1 /
1. Location of installation 9 & 33 4. Complete Fee Schedule below
Address WASHINGTON SQUARE HALL (�,�q5h � q Pcl , Number of inspections per permit allowed
TIGARD
Building
City Suite No.
Service included: Items Cost(ea.) Sum
Tenant Name COOL TEMPTATIONS 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
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 n Residential ❑ 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 ELECTRICAL 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 � , ;1Li!MUlC1L State UR ZIP 9 / 26 / Reconnect only $5000 2
Date 7 -19 -95 Job Number 3487
Property Owner it I NI1AR PACIFIC C. Temporary Services or Feeders
Contractor's License No. 3- Installation, alteration or relocation
Contractor's Board Reg. No. _ 32 . It 200 amps or less $50.00 2
r 201 amps to 400 amps $75.00 2
Signature of Su r. Elec'n I � I . 401 amps to 600 amps $100.00 2
g Over 600 amps to 1000 volts see "B" above
License No. 1486s Phone No. 659 - 2212
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 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 $4o 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 $ 35.00
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
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
pD /at " /l'
Date Requested ,� AM PM BLD
Location I Co3 � k Sin 1.( Suite MEC
Contact Person Ph PLM
Contractor Ph SWR
BUILDING Tenant/Owner
root --ro ) . on J ELC �1 (]
c-co g 2
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 S — i. i if � 1 - . /
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING cd / 4 s'S
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
T FAIL
eRICA
Rough In
Low V b
Low Voltage
Fire Alarm
F'
PASS 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 7 -� 6 ^ ��
Other Date Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.