Permit � � �-������ `
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CI1YOFTI
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COMMUNITY DEVELOPMENT DEPARTMENT ' • . '
' 1mom'Sm Hall Blvd. Tlgarw o,egOn e7223°8199 (503) .
~ ' BUILDIN PER MIT '
• K~l y\ � PERMIT #.......: BUP9570117
. .~-- '~_-~�� ' `�,/_"~
DATE ISSUED: 05/12/9• ,
' ' 639-4171 _ '
'� ' PARCEL: 1S1260C-01107�� .
SITE ADDRESS...: 09627 SW WASHINGTON SQUARE RD .
SUBDIVISION - ZONING: C-G . . ,
BLOCK : LOT... - ' ^ '
.
__ __ ______ .
` REISSUE: , FLOOR AREAS--------�- EXTERIOR WALL CONSTRUCTION:- '
CLASS OF WORK.:ALT FIRSI....: sf Ng N: S: E: `' W: '
TYPE OF USE.,. :COM SECOND... :730 sf PROTECT OPENINGS? .
TYPE OF CONST.:5N • . THIRD ^ sf N: . 8: ��: 'W: '`'
OCCUPANCY GRP. :B2 .F
,IRE : 730 sf ROOF CONST: Es. 'T? : '
OCCUPANCY LOAD:4 BASEMENT,:: sf AREA �P��RAT�D: . .
STOR. :2 HT.: . , 'ft' GARAGE. . . � sf OCCU EP. ED : 1HR �- :
BSMT?: MEZZ? : REQD� SETBACKS-------- REQUIRED
FLOOR LOAD....: psf LEFT: ft RGHT: ft FIR SPKL:Y, SMOK DET..:Y �
. DWELLING UNITS: FRNT: ft REAR: ft FIR HNDICP AC/':Y
, BEDRMS: BATHS: IMP SURFACE: PRO CORRcN .PARKING:
VALUE.$: 150000 � � � ' � ' �`
Remarks: TI for restaurant' �
o �uran� ` � • �
• ' - .-
Owner: - - ' -- FEES --- -
. � `^
WESTERN ROASTERS INC.� type amount ��y date recpt �
. � PRMT $ 558.00 3W 05/12/95 - ' '
. , �
'1680 WILLAMETTE-FALLS DR PLCK $ 36 .70 SW 05/12/95 - • -
WEST LINN l]R 97068 - FIRE $ 223.20 SW 0(12>95 -
Ph�ne #: '. � 5PCT$ 27.90 �W 0 -
�
.
. •
Contractor: ------ ` '.
_ G. WILSON CONSTRUCTION • . ` '
13369 SE KANNE ROAD _ ~' . '� ' . �
' � • ,
. ` �
. . �
PORTLAND OR 97236` ' ---------- - -- ------------
Phone #: 762-0134. $' 1171.80 TOTAL
. �
: Reg #..: 63438 � �' ` . .
' ^.
� ' �' - REQUIRED INSPECTIONS -7-7-- , This perait is issd sob to the regulations �mtai�� in the Framing
m Insp _ '
'.Tiga,d Mumicip,s,I Cada, State uf Ore. Specialty Codes and all otta, Insulation I�sp L_ ----- applicable laws. All work will be in accordance with Gyp Board Insp _�_ � _____.
approved plans. This peroit will expire if work is not . statad Susp Ceilng Insp ___� ' L. _ ' . .
within 180 days of issuance, or if work is suspended for ome ' 'Final 'Inspect ion _,.. � _ '
than 130 day E. , � ' ,, / �
' �l ` ` ' . -- . --- ^ ---_-'
� � • � . ' ' `
� � ___- ___� _____
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. . -__-_-_:__- ._
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�� � ' --___. -_ -___' .�
Permzttee Signature :� •-) _ _ __ _____ ' � ._
; Issued I\y : - ---------' ' ' ' -- -- . `
| . Call for inspeQtion - 63974175 .
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• Commercial Building Permit Application
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223
(503) 639-4171
Jobsite Address: v I k \ Col DA1
.
Tenant:41(A■t 1
Suite # 2- Office Use Only
Valuation: S0,00 :•:Plancic/Rec • • • •
Permit* 7
Owner: l'Ett.r.1 r.. -06 - S - "%life S 5-Kt • Map &• •
Address: LI.Eb .
u - FP - us Op_ ,
'Approvals Required •
LA-44, Oc ci
Planning
Phone: 5S -1 006'(-) Engineering
Other " :
Contractor: ■C•(•-1 T -
OEGO E krea
Address: v, C t 6 I
So4 LLE Cl;- q
Type of const: Lgt/Aek
Phone Ti4?4,
Occupancy class: 77:ir 11/ /
: (OS C
Sprinklereed. No
Contractor's License # c5
(attach copy of current Oregon license) Sq. ft. of project:
Contact name & phone: Dor..\ Story (1st,e'61? etc.)
- 1q0
Proposed use: R,cd-ft,
Architect/Engineer: 50 Ce-ADA
Address:
Previous use: __cargrzy
la7CI C- Sr.
Note: Plumbing & mechanical plans
) GOfi 19 {rOS must be submitted at time of
Phone: 6G - SG-1, building permit application.
JOB DESCRIPTION:
A•plicant Sign:ture & Phone number
Received by: . 4);':. 1 ‘J Date Received:
Permit # Account Description Amount Amt. Pd. Bal. Due
Bldg. Permit (BUILD) J.JOs °
Plumb. Permit (PLUMB)
Mech. Permit (MECH)
State Tax (TAX) 7 7 c70
Bldg:
Plumb:
Mech:
Plan Check (PLANCK) (P
Bldg:
Plumb:
Mech:
Sewer Connection (SWUSA)
Sewer Inspection (SWINSP)
Parks Dev Charge (PKSDC)
Residential TIF (TIF -R)
•
Mass Transit TIF (TIF -MT)
Commercial TIF (TIF -C)
• Industrial TIF (TIF -I)
Institutional TIF (TIF -IS)
Office TIF (TIF -O)
Water Quality (WQUAL)
Water Quantity (WQUANT)
Fire Life Safety (FLS) 22.3 "—
Erosion Cntrl Permit (ERPRMT)
Erosion Planck/USA (ERPLAN)
Erosion Planck/COT (EROSN)
TOTALS: �� .z645
13EPARZMENT OF LAND USE & TRANSPORTATION •
WASHINGTON 55 NORTH FIRST, N DEVELOPMENT
O, OR 97124
COUNTY . INSPECTION REQUESTS: 503/640- 3561/693 -4415
10
OREGON XXXXXXXXX - -> 640 -34'70
'
.Page
. 1 of 1
Date : 05/25/95
Time : 08:05
Permit Type : Commercial Electrical Permit Permit # : 05068124
Permit Status : APPROVED Applied : 05/24/95
Situs Address : 9627 SW WASHINGTON SQUARE RD TI Issued : 05/24/95
Permit Title : OMSI - M2A Completed :
Permit Descr. : JOB 4049 SERVICE /27 CIRCUITS To Expire : 11/20/95
Project Title : OMSI M -2A Project # : P0050280
Project Descr. : JOB 4049 SERVICE /27,CIRCUiTS • * EROSION *
•
Parcel Number : 2S1TI - Land Use District :
Valuation 0
Legal Descr. •
Owner : INSPECTION - TIGARD Construction : OTH
Applicant Name : HENKES ELECTRIC 'Classification : 900
Applicant Addr.: P. 0. BOX 889 • Occupancy
WOODBURN, OR 97071 Validated by : PH
Applicant Phone: 981 -7022 Inspector Area .
Fee description • Units Fee /Unit Ext fee Data
Service /Feeder:200 amps or less 1 60.00 60.00
Each Branch W/ Feeder [Enter #] 27 5.00 135.00
•
Subtotal Electrical Fees: 195.00 •
State Surcharge of 5 %' 9.75
Total Electrical Fees: • 204.75
* ** Fees Required * ** * ** Fees Collected & Credits *: +* •
Method Check # Receipt No. Date Payment
CK 8435 05/24/95 204.75
• : Fees: 204.75
Adjustments: .00 Total Credits: .00
Total Fees: 204.75 Total Payments: 204.75
•
Balance Due: .00
•
•
NOTICE: This permit becomes null and void if the work or construction for which it is Issued is not commenced within 180 days. Once construction has started,
the permit becomes null and void if construction is interrupted for a period of 180 days. I certify that the information presented by the applicant and
his agent or agents in support of this permit Is true and correct to the best of our knowledge. I acknowledge that the Building Department's reliance
upon false and misleading information may invalidate this permit. All provisions of applicable laws and ordinances governing the construction and use
of this building or structure will be complied with whether or not specified on the plans or noted on the plans correction sheets. I acknowledge that
the granting of a permit does not grant authority to access private property or to use easements. I further acknowledge that the use or occupancy of
the structure or building permitted depends upon my calling for inspections at various times during the process of construction and the building
inspection staff verifying compliance with the various codes. Use or occupancy of the building or structure permitted prior to approval by the
Building Department is solely at the risk of the applicant and such use or occupancy is revocable until all inspection requirements are satisfied and
approval is given by the Building Official. I further acknowledge that a lien may be placed on the title of the property upon which the permit is issued
specifying that the use or occupancy of the building or structure is provisional and revocable until the satisfaction of all inspection requirements.
•
APPLICANT'S SIGNATURE
•
l
9- \..
WASHINGTON Department Use Transportation
ELECTRICAL PERMIT
Department of Land Use &Trtation
W Electrical Inspection Section APPLICATION
155 North Fi rst t Avenue, #350 -12
Hillsboro, Oregon 97124
Information: (503) 640 -3470 Fax: (503) 693 -4412 l
PLEASE PRINT Number CV) CI, CI / �/
Date 5-12 ��
Please complete all sections, .1 through 5.
1. Locati / o n n of install tion /� 4. Complete Fee Schedule below
Address 9(or�' 7 .5 LQ� t t 10 3 , . red Number of inspections per permit allowed
/ c
Building (/ Service included: Items Cost(ea.) Sum
City 9,q..e,� Suite te No. J"f -�/�
Tenant Name „,. ,..., . A. Residential - per unit
(if commercial) 1'I2
1000 sq. ft or less $110.00 4
Each additional 500 sq. ft
Map No. Tax Lot or portion thereof $25.00
Book: Page: Section: Each Energy $25.00 1
Thomas Map 9 Each Manuf'd Home or Modular
Directions Dwelling Service or Feeder $68.00 2
B. Services or Feeders
Commercial Residential n Installation, alterations or relocation /
200 amps or less $60.00 6 -0 2
2a. Contractor installation only: 201 amps to 400 amps $80.00 2
401 amps to 600 amps $120.00 2
Electrical Contractor 411!>°s Fw�teir 601 amps to 1000 amps $180.00 2
Address PO r 'ST Over 1000 amps or volts $340.00 2
City 1IIcvxLhr,,eaf State. ZIP '7707/ Reconnect only $50.00 2
Date /.- q,s Job Number 1 1 1 0 1 6 7
Property Owner C. Temporary Services or Feeders
Contractor's License No. a 9- 1 c) ; ' Installation, alteration or relocation
Contractor's Board Reg. No. g9t
200 amps or less $50.00 2
201 amps to 400 amps $75.00 2
Si nature of Sur. Elec'n cu_Q�4. Over 600 amps to 1000 volts see "B" above
License No. .., 401 amps to 600 amps $100.00 2
g p Phone No. ((// ?€ / -7o�� c3,'3 3 / S
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 /3S 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
• Each sign or outline lighting $40.00 . 2
Owner's Signature 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 $ / 9 5. -
above apply. Not required for temporary construction 5% Surcharge (.05 X total fees) $ /:ZS
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 $ o20i1• ?S
681 -3699 or 681 -3698
24 -hour recorder, one working day in advance of need
BL28 • 3/95
DEPARTMENT OF LAND USE & TRANSPORTATION
•"1 WASHINGTON 55 NORTH F RST, HILLSBORO, OR 97 DIVISION 4
1 COUNTY, INSPECTION REQUESTS: 503 /640 - 3561/693 -4415
Illar OREGON
XXXXXXXXX - -> 640 -34
Page : 1 of 1
Date : 05/05/95
Time : 15:44
Permit Type : Commercial Electrical Permit Permit # : 05067351
Permit Status : APPROVED Applied : 05/05/95
Situs Address : 9627 SW WASHINGTON SQUARE RD Ti Issued : 05/05/95
Permit Title : GYROS SERVICE /34 CIRCUITS Completed .
Permit Descr. :.JOB 4043 SPACE FC8 To Expire 11/01/95
Project Title : GYROS - SERV10E/34 CIRCUITS Project # : P0049726
Project.Descr. : JOB 4043 * EROSION *
Parcel Number : 3S1'1'1 - Land Use District :
Valuation U
Legal Descr. • •
Owner : INSPECTION - 'l'IGARD Construction : OTH
Applicant Name : HENKES ELECTRIC Classification : 900
Applicant Addr.: P. O. BOX 889 Occupancy
WOODBURN, OR 97071 Validated by : PH
Applicant Phone: 981 -7022 Inspector Area :
•
Fee description Units Fee/Unit Ext fee Data .
•
Service /Feeder:200 amps or less 1 60.00 60.00
Each Branch W/ Feeder [Enter #] 34 5.00 170.00 •
Subtotal Electrical Fees: 230.00
State Surcharge of 5=,5 11.50
Total Electrical Fees: 241.50
* ** Fees Required * ** * ** Fees Collected & Credits * **
Method Check # Receijt No. Date Payment
CK 8371 05/05/95 241.50
• TOTAL THIS DATE * * * * * * * ** 241.50 .
• Fees: 241.50 •
Adjustments: .00 'Total Credits: .00
Total Fees: 241.50 Total Payments: 241.50
Balance Due: .00
•
•
NOTICE: This permit becomes null and void if the work or construction for which it Is issued Is not commenced within 180 days. Once construction has started,
the permit becomes null and void if construction is interrupted for a period of 180 days. I certify that the Information presented by the applicant and
his agent or agents in support of this permit Is true and correct to the best of our knowledge. I acknowledge that the Building Department's reliance
upon false and misleading information may invalidate this permit. All provisions of applicable laws and ordinances governing the construction and use
of this building or structure will be compiled with whether or not specified on the plans or noted on the plans correction sheets. I acknowledge that
the granting of a permit does not grant authority to access private property or to use easements. I further acknowledge that the use or occupancy of
the structure or building permitted depends upon my calling for inspections at various times during the process of construction and the building
inspection staff verifying compliance with the various codes. Use or occupancy of the building or structure permitted prior to approval by the
Building Department is solely at the risk of the applicant and such use or occupancy Is revocable until all inspection requirements are satisfied and
approval is given by the Building Official. I further acknowledge that a lien may be placed on the title of the property upon which the permit is issued
specifying that the use or occupancy of the building or structure is provisional and revocable until the satisfaction of all inspection requirements.
• APPUCANT'S SIGNATURE
WASHINGTON COUNTY ELECTRICAL PERMIT
Department of Land Use & Transportation
Electrical Inspection Section
UN,
155 North First Avenue #350 -12 APPLICATION
Hillsboro, Oregon 97124
Information: (503) 640 -3470 Fax: (503) 693 -4412
Project/Permit � 7 � r/ Date 5 -5 -9.1
PLEASE PRINT Number
Please complete all sections, '1 through 5. 4. Complete Fee Schedule below
•
1. Location of installation � Number of inspections per permit allowed
Address 96 ,27 S: j v IA) /kit.. ,5 del, Service included: Items Cost(ea.) Sum
Buildin A. Residential - per unit
City - 17 y 4.4 Suite No. /C__ S
1000 sq. ft. or less $110.00 4
Tenant Name , Each additional 500 sq. ft
(if commercial) f _- •11 1 . or portion thereof $25.00
Limited Energy $25.00 1
Tax Lot Map No. Each Manuf'd Home or Modular
Dwelling Service or Feeder $68.00 2
Thomas Map Book: Page: Section:
Directions B. Services or Feeders
Installation, alterations or relocation
200 amps or less I $60.00 loC) 2
Commerciall5C Residential I 201 amps to 400 amps $80.00 2
401 amps to 600 amps $120.00 2
2a. Contractor in tallation only: 601 amps to 1000 amps $180.00 2
Y• Over 1000 amps or volts $340.00 2
Electrical C ntractor , y a' -./ ' - .t '' NC- Reconnect only $50.00 2
Address C . evy i`- -c Wdo,''h ,m.' Cl. 92 07/
Date S - Ai -9 ` Job Number Ai CN.1 C. Temporary Services or Feeders
Property Owner Installation, alteration or relocation
Contractor's License No. .94Y ` 200 amps or less $50.00 2
Contractor's Board Reg. No. Frantic. 201 amps to 400 amps $75.00 2
401 amps to 600 amps $100.00 2
Signature of Supr. Elec'n Over 600 amps to 1000 volts see 'B' above
License No. 333/S Phone No. 0 1 -70A- _ D. Branch Circuits
New, alteration or extension per panel
2b. For owner installations: a) The fee for branch circuits with
purchase of service or feeder fee.
Print Owner's Name Phone No. Each branch circuit .3 1 $5.00 '1 70 -• - 2
b) The fee for branch circuits without
Address purchase of service or feeder fee.
First branch circuit $35.00 2
City State Zip Each add'nl branch circuit $5.00 2
E. Miscellaneous (Service or Feeder not included)
The installation is being made on property 1 own Each pump or irrigation circle $40.00 2
which is not intended for sale, lease or rent. Each sign or outline lighting $40.00 2
Signal circuit(s) or a limited
Owner's Signature energy panel, alteration
or extension $40.00 2
F. Each additional inspection over the allowable
in any of the above
3. Plan Review section (if required) Per inspection $35.00
Please check appropriate item and enter fee in section 5B. Per hour $55.00
In Plant $55.00
4 or more residential units in one structure
Service over 800 amps; feeder 800 amps or more 5. Fees
System over 600 volts nominal A. Enter total of above fees $ A: AO
Classified area or structure containing special 5% Surcharge (.05 X total fees) $ I / . So
occupancy as described in N.E.C. Chapter 5 Subtotal $
B. Enter 25% of line A for
Submit 2 sets of plans with application where any of the Plan Review if required (Section 3) $
above apply. Not required for temporary construction Subtotal $
services. $
Less Bulk Label Fee
Balance Due $ aht to u o
For inspections call This permit becomes null and void H the work authorized by the permit Is not commenced
640 -3561 or 693 -4415 within 180 days from date of Issuance of such permit or H the work authorized is
suspended or abandoned at any time after work is commenced for a period of 180 days.
24 -hour recorder, one working day in advance of need Electrical Permits are non - refundable and non - transferable.
1/94
•
•
•
DEPARTMENT OF LAND USE & TRANSPORTATION
• WASHINGTON 55 NORTH FIRST, DEVELOPMENT DIVISION
HILLSBORO, OR97 24
COUNTY, INSPECTION REQUESTS: 503/640- 3561/693 -4415
OREGON
XXXXXXXXX - -> 640 -34'70
•
Page : 1 of 1
Date : 05/05/95
Time : 15:45
. Permit Type : Commercial Electrical Permit Permit # : 05067350 '
Permit Status : APPROVED Applied : 05/05/95
Situs Address : 9627 SW WASHINGTON SQUARE RD Ti Issued : 05/05/95
Permit Title : RAINIER ROAS'T'ER . Completed :
Permit Descr. : JOB 4044• 4 SERVICES /21 CIRCUITS To Expire : 11/01/95
Project Title : RAINIER ROASTER Project # : P0049725
Project Descr. : JOB 4044 4 SERV10ES /21 CIRCUITS * EROSION *
•
Parcel Number . 2S1'T'1 - Land Use District :
Valuation 0
Legal Descr.
Owner : INSPECTION = TIGARD Construction : OTH
Applicant Name HENKES ELECTRIC Classification : 900
Applicant Addr.: P. O. BOX 889 Occupancy
WOODBURN, OR 97071 Validated by : PH
Applicant Phone: 931- 7022 Inspector Area :
Fee description - Units Fee /Unit Ext fee Data
Service /Feeder:200 amps or less 1 60.00 60.00
Each Branch W/ Feeder [Enter #] 21 5.00 105.00
Subtotal Electrical Fees: 165.00
State Surcharge of 5% 8.25
Total Electrical Fees: 173.25
* ** Fees Required * ** * ** • Fees Collected & Credits * **
• Method Check # Receipt No. Date Payment
CK 8371 05/05/95 173.25
TOTAL THIS DATE * ** * * *x ** .173.25 •
Fees: 173.25
Adjustments: .00 Total Credits: .00
Total Fees: 173.25 Total Payments: 173.25
•
Balance Due: .00
•
•
•
•
•
•
•
NOTICE: This permit becomes null and void If the work or construction for which it is issued is not commenced within 180 days. Once construction has started,
the permit becomes null and void if construction is Interrupted for a period of 180 days. I certify that the information presented by the applicant and
his agent or agents in support of this-permit is true and correct to the best of our knowledge. I acknowledge that the Building Department's reliance
upon false and misleading information may invalidate this permit All provisions of applicable laws and ordinances governing the construction and use
of this building or structure will be complied with whether or not specified the plans or noted on the plans correction sheets. I acknowledge that
the granting of a permit does not grant authority to access private property or to use easements. I further acknowledge that the use or occupancy of
the structure or building permitted depends upon my calling for inspections at various times during the process of construction and the building
inspection staff verifying'compliance with the various codes. Use or occupancy of the building or structure permitted prior to approval by the
•
Building Department Is solely at the risk of the applicant and such use or occupancy is revocable until all inspection requirements are satisfied and
•
approval is given by the Building Official. I further acknowledge that a lien may be placed on the title of the property upon which the permit is issued
•
specifying that the use or occupancy of the building or structure is provisional and revocable until the satisfaction of all inspection requirements.
•
•
•
• APPLICANT'S SIGNATURE
•
WHION TY
Depa NGT of Land Use & Transportation ELECTRICAL PERMIT
V a po ical Inspection Section APPLICATION
X155 155 North First Avenue, #350 -12
Hillsboro, Oregon 97124
Information: (503) 640-3470 Fax: (503) 693 -4412
Permit PLEASE.PRINT _ Number ct73 Date 5--
Please complete all sections, 1` through 5. 4. Complete Fee Schedule below
1. Location of installation Number of Inspections per permit allowed
Address 9 i- S c.0 Vt/,W, S ki Service included: Items Cost(ea.) Sum
Buildin A. Residential - per unit
City •1ii y psi, 0 Suite No. /QC-- 2-
Tenant Name Q 1000 sq. ft. or less $110.00 4
(if commercial) II ;i s .°a,,,, (• 't )A-' eee. Each addi e thereof sq. ft
or portion of $25.00
Limited Energy $25.00 1
Map No. Tax Lot Each Manuf'd Home or Modular
Dwelling Service or Feeder $68.00 2
Thomas Map Book: Page: Section:
Directions B. Services or Feeders
Installation, alterations or relocation
200 amps or less ' $60.00 e' 0 - vt ' 2
Commercial N Residential ❑ 201 amps to 400 amps $80.00 2
401 amps to 600 amps $120.00 2
2a. Contractor installation only: 601 amps to 1000 amps $180.00 2
Y' Over 1000 amps or volts $340.00 2
Electrical Contractor 1.1 p , f,,� j= /. ,JQ Reconnect only $50.00 2
Address K a16, .
• City Lt/d.•,,.i P.t. State n2n ZIP Yx.)7c C. Temporary Services or Feeders
Date -S- 14 - 9S' Job Number I1441 Installation, alteration or relocation
Property Owner 200 amps or less $50.00 2
Contractor's License No. H- JS/G 201 amps to 400 amps $75.00 2
gat, N2 401 amps to 600 amps $100.00 2
Contractor's Board Reg. No. ga
Over 600 amps to 1000 volts see 'B' above
Signature of Supr. Elec'n .n .- t...W..- �, D. Branch Circuits
License No. 333 / .S Phone No. ?co- 7na� New, alteration or extension per panel
a) The fee for branch circuits with
2b. For owner installations: purchase of service or feeder fee.
Each branch circuit .2.I $5.00 f d S 2
Print Owner's Name Phone No. b) The fee for branch circuits without
purchase of service or feeder fee.
Address First branch circuit $35.00 2
Each add'nl branch circuit $5.00 2
City State Zip E. Miscellaneous (Service or Feeder not included)
Each pump or irrigation circle $40.00 2
The installation is being made on property I own Each sign or outline lighting $40.00 2
which is not intended for sale, lease or rent. Signal circuit(s) or a limited
energy panel, alteration
Owner's Signature or extension $40.00 2
F. Each additional inspection over the allowable
in any of the above
3. Plan Review section (if required) Per inspection $35.00
Per hour $55.00
Please check appropriate Item and enter fee In section 56. In Plant $55.00
4 or more residential units in one structure 5. Fees
Service and feeder, 800 amps or more
System over 600 volts nominal A. Enter total of above fees $ / 6S• -
Classified area or structure containing special 5% Surcharge (.05 X total fees) $ R. AS'
occupancy as described in N.E.C. Chapter 5 Subtotal $
B. Enter 25% of line A for
Submit 2 sets of plans with application where any of the Plan Review if required (Section 3) $
above apply. Not required for temporary construction Subtotal $
services. ❑ Trust Account $
Balance Due $ �®
For inspections call This permit becomes null and void If the work authorized by the
640 -3561 or 693 -4415 h permit le n commenced
within 180 days from date of Issuance of such permit or If the work authorized Is
suspended or abandoned at any time after work is commenced for a period of 180 days.
24 -hour recorder, one working day in advance of need Electrical Permits are non - refundable and non- transferable.
8/94
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec- O- Phorie): 639 4175 "Business Phone: 639 -4171
Inspection: RO i 41 d p i� 6-0 ,
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
Plbg. Underfloor Rain Drain Framing - Iumb:
Alarm Water Line Insulation
Underflr. Insul. Shear Wall Gyp. Bd. - Elect.
�/� /� 5 9 /5" Date Requested: , Time: AM PM
Address: (.7 ,� / «) /9 a Q. 7
Builder:, c T 3 Permit #: £ 5- '°1 I
THE FOLLOWING CORRECTIO /R ,,REO HED :int- X , -'-
(eget- /ta-' fr.:44.../
Inspector: Date: -� 3
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
_Call For Reinsp.