Permit 16
WASHINGTON COUNTY
Department of Land Use & Transportation ELECTRICAL PERMIT
W 155 North 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 throu
Number M.LCa - 00 3 7 Date ea( 12195
1. Location of installation ^ 4. Complete Fee Schedule below
Address
___5(_
Address „� ` ft 0 Number of inspections per permit allowed
1 uildiry�
City ` r p-7 Suite No. 3 Service included: Items Cost(ea.) Sum
Tenant ime { `' A. Residential - per unit
(if commercial) J-V �.L)
{ 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: Limited Energy $25.00 1
p� g Each Manuf'd Home or Modular
Di ect' ns c� • • - ) _ Dwelling Service or Feeder $68.00 2
t ie
B. Services or Feeders
Commercial Residential n
� Installation, alterations or relocation
/ 200 amps or less 2 1
2a. Contractor 7l only: , 201 amps to 400 amps $80.00 2
Electrical Contractor 401 amps to 600 amps $120.00 2
'r- b rt 601 amps to 1000 amps $180.00 2
Address 2 s 3 } ? W 1 ' nv,- S Over 1000 amps or volts $340 00 2
City e. , State WA' ZIP 2_ Reconnect only $50 00 2
Date j,x,4 -a-- IZ SS Job Number U •- 7
Property Owner C. Temporary Services or Feeders
Contractor's License No. 3? - ,18.6" G Installation, alteration or relocation
Contractor's Board Reg. No. Ii; 200 amps or less $50 00 2
1 201 amps to 400 amps $75.00 2 to 60 mps 401 Signature of Supr. Elec'n I i Ovea6 O oa 00 volts see "B" above
2
License No. - 3'7- (or No. S3 lG l (
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 LI4 $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 $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
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 $ 3 L C.
above apply. Not required for temporary construction 5% Surcharge (.05 X total fees) $ / 7,
services. Subtotal $ .'57. --
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 $ 357. '
681 -3699 or 681 -3698
24 -hour recorder, one working day in advance of need
BL28 • 3/95
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec -O- Phone): 639 -4175 Business Phone: 639 -4171
Inspection: 4 r re9
Footing 54: Susp. Ceiling Sprink. Rough -in Appr /Sdwlk
Foundation Plbg. Underslab Mech. Rough -in Fireplace
Post/Beam Struct. Plbg. Top Out Elec. Rough -in Alp
Post/Beam Mech. San. Sewer Gas Line -; dg.
9
Plbg. Underfloor Rain Drain Framing - Plumb.
Alarm Water Line Insulation -Mech.
Underflr. Insul. Shear Wall Gyp. Bd.
Date Requested: Time: AM PM
Address: 7 7 4'- c. $ .
Builder: Permit #: /J ' ()Q j 7
THE FOLLOWING CORRECTIONS ARE REQUIRED:
r � ?( co ( gi-r-rt:(7
iise ,7-Neic___d ,
i
Inspector: 4 _ / / - -_- Date: ��"
/� APPROVED _DISAPPROVED _APPROVED SUBJECT TO ABOVE
/� _Call For Reinsp.
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested c� AM PM BLD
Location 6 1(0 - ;) (ArAS 1,� 1 Suite MEC
Contact Person Ph PLM
Contractor ,/� � Ph n L SWR � amr,2
BUILDING Tenant/Owner S r>({/IZ/Z r[ S ELC 1 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 5 - _
Fire Sprinkler J` P V/ €-1
Fire Alarm •
Susp'd Ceiling L
Roof
Misc: 6 ' � / 4 / 5 ki P _ r� n 7-/ d -FV b� f
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
PASS PART FAIL
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
PASS PART FAIL
SITE
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 Inspector Ins Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.