Permit ■
J/
. --i - Community Development ELECTRICAL PERMIT APPLICATION
A ,�,� 13125 SW Hall Blvd.
Tigard, OR 97223 Planck/Rec. #
x , U Permit # E LC 95 - a•3/
,',. � 1 Phone (503) 639 -4171
� ��' I " FAX (503) 684 -7297 Date Issued ��ii`r
CITY OF TIGARD TDD No. (503) 684 -2772 Issued by
Inspection (503) 639 -4175
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development Washington So . Food C t. Number of Inspections per permit allowed
Address 9651 SW Washington Sq. Rd. Service included: Items Cost(ea) Sum •
City/State/Zip Tigard OR 9 7 2 2 3 4a. Residential - per unit 4
1000 sq. ft. or less $110.00
Name (or name of business)Macheezmo MOuse Each additional 500 sq. ft. or 1 ,
portion thereof $25.00
Commercial ® Residential ❑ Limited Energy $25.00 - Each Manuf'd Home or Modular 2
Dwelling Service or Feeder $68.00
2a. Contractor installation only:
4b. Services or Feeders
Installation. alteration, or relocation 2 .
Electrical ContractorH e a t h Signs 200 amps or less $60.00 2
Address 4 6 4 4 SE 17th Ave 201 amps to 400 amps $80.00 2
City Portland StateOR Zip 97202 401 amps to 600 amps $120.00 2
-
ty P 601 amps to 1000 amps $180.00 2 -
Phone No. 232 -2620 Over 1000 amps or volts $340.00 2
Contractor's License No. 37 -45 C Reconnedonly $50.00 1
Contractor's Board Re• No. 6426 , 4c. Temporary Services or Feeders
� // Installation, alteration, or relocation 2 •
- Signature of Supr. Elec'n G,. _ _ � 200 amps or less $50.00 2
License No. 515 s i g Phone N • r rr, 201 amps to 400 amps $75.00 2
- 0r 2 - 2 6 /A 401 amps to 600 amps $100.00
Over 600 amps to 1000 volts
2b. For owner Installations: see 'b' above.
Print 4d. Branch Circuits
rint Owner's Name
New, alteration or extension per panel
Address a) The fee for branch circuits with
City State Zip purchase of service or feeder fee. 2
Each branch circuit $5.00
Phone No. b) The fee for branch circuits withou
The installation is being made on property I own which is purchase of service or feeder fee. . 2
First branch circuit $35.00 2
not intended for sale, lease or rent. Each additional branch circuit $5.00
Owner's Signature 4e. Miscellaneous
' (Service or feeder not included) • 2
3. Plan Review section (if required): Each pump or irrigation circle Ill $40.00 2
Each sign or outline lighting \ 1 / $40.00 AO nn
Signal circuit(s) or a limited energy 2
Please check appropriate item and enter tee in section 5B. panel, alteration or extension $40.00
4 or more residential units in one structure M inor Labels (10) $100.00
Service and feeder 225 amps or more
System over 600 volts nominal 4f. Each additional inspection over
Classified area or structure containing special occupancy the allowable in any of the above
as described in N.E.C. Chapter 5 Per inspection $35.00
Per hour $55.00 1
In Plant $55.00
Submit 2 sets of plans with application where any of the above
apply. Not required for temporary construction services.
5. Fees:
NOTICE 5a. Enter total of above fees $ 40.00
5% Surcharge (.05 X total fees) $ 2.00
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5b. Enter 25% of line A for
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Plan Review if required (Sec.3) $
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal $
COMMENCED. ❑ Trust Account # $
Balance Due $ 42.00
woniNcandnAigeoprmagp c? ' ec t '
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested AM PM BLD
Location 9 (pc\ Ls. Suite MEC
Contact Person Ph PLM
Contractor Ph SWR ��,l�
BUILDING Tenant/Owner (\ 1 l,Q�? ), 0 n/101.(,( ELC QS °dC;C�7
Retaining Wall ELIr q 5-d l2
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
at Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing /7 4 t Sy(S" 199 cylkag r f n cc) 41,49n
Fi rewall /
Fire Sprinkler
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
ELECTRICAL
'e
Rough In
UG /Slab •
ow Voltage
ir- arm
P i l ia4 PART FAIL
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 7 - 7— � �j
Other D a t e In ctr
l speo /!Yl QJ�� Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.