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Permit 4 Al l ik" WASHINGTON COUNTY ELECTRICAL PERMIT Department of Land Use & Transportation Electrical Inspection Fi Section APPLICATION 155 North First t Avenue, #350 -12 Hillsboro, Oregon 97124 Information: (503) 640 -3470 Fax: (503) 693 -4412 PLEASE PRINT Permit Number 65 Date (P - I _� C Please complete all sections, 1 •through 5. 1. Location of installation 4. Complete Fee Schedule below Address /419505 SW Washington Square Road Number of Inspections per permit allowed Tigard Building City 9 Suite te No. Space #222 Service included: Items Cost(ea.) Sum Tenant Name llacheezmo Mouse 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 ;•!ashingtnn Square :Fall Dwelling Service or Feeder $68.00 2 Commercial © 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 2 401 amps to 1000 am ps $120.00 2 Electrical Contractor Atlas Electrical 601 amps to 1000 amps $180.00 2 Address 4403 SE Rne t he Road Over 1000 amps or volts $340.00 2 City 11i l wau ki e . State OR ZIP • Reconnect only $50.00 2 Date 5/25/95 Job Number 3339 Property Owner 1:i nma r Pacific C. Temporary Services or Feeders Contractor's License No. 3 -2C Installation, alteration or relocation Contractor's Board Reg. No. 153 200 amps or less $50.00 2 201 amps to 400 amps $75.00 2 Si nature of Su r. Elec'n 401 amps to 600 amps $100 2 g P 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 1 $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 Signal sign or outline lighting $40.00 2 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 amps or more Per inspection $35.00 Service and feeder, 800 am P 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 $ 36.75 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 atter 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 i CITY OF TIGARD BUILDING INSPECTION NOTICE Inspection Line (Rec -O- Phone): 639 -4175 Business Phone: 639 -4171 Inspection: : &r. p Q 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. 4431. Date Requested: (cD- l / Q ,s Time: AM PM Address: )J 6 S Builder: CO . 2-11 L _ Permit #: ECG .75 THE FOLLOWING CORRECTIONS ARE REQUIRED: 6 2/p - Inspector: 17/43-7 Dater Y 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 AM PM BLD C� Location 1 CpS\ WC4SIA Suite MEC Contact Person Ph PLM Contractor �n Ph c' SWR � BUILDING Tenant/Owner �i( ej uu 2I (7 alt j , ELC QS' ObO7 Retaining Wall ELC a 5 — d I2 Footing Access: Foundation FPS Ftg Drain Crawl Drain Inspection Notes: SGN Slab SIT Post & Beam Ext Sheath /Shear Int Sheath /Shear Framing Insulation //�� / //c, Drywall Nailing IT I ( Sys a 199 .S GZ e p g r I n c n Firewall / T 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 o w Voltage ) ir- arm C CO* 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 Date ? ?- [ �J ector nS I l� Ext Other p Ian Q Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.