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Permit AR" WASHINGTON COUNTY ELECTRICAL PERMIT Department of Land Use & Transportation W n Electrical Inspection Section APPLICATION 155 North First 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 EC 9 5 - O 12 Date C4 1. Location of installation 6 1(12Z - 7 l va.s k . 4. Complete Fee Schedule below Address laas hi gn ton Square M a l l , , ■Kct . Number of inspections per permit allowed Building S ervice included: Items Cost ea. Sum City Ti gard Suite No. Space FC2 Cost( es.) Tenant Name A. Residential - per unit (if commercial) Rainier Roaster 1000 sq. ft. or less $110.00 4 Ma No. Tax Lot Each additional 500 sq ft p 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 ® Residential n 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 600 amps $120.00 2 Electrical Contractor Atlas Electrical 601 amps to 1000 amps $180.00 2 Address 4403 Se Roethe Road Over 1000 amps or volts $340.00 2 City Ni l wau k i e State OR ZIP 97267 Reconnect only $50.00 2 Date 6 /L 6 / 95 Jo Number 3428 Property Owner W i nma r � ac i f i c C. Temporary Services or Feeders Contractor's License No. 3 - 2C Installation, alteration or relocation Contractor's Board Reg. No. 1532 _ 200 amps or less $50.00 2 201 amps to 400 amps $75.00 2 Signature of Su r. Elec'n LI� l e 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 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 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 ('n 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 r. Classified area or structure containing special , 3 occupancy as described in N.E.C. Chapter 5 5. Fees l 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) $ 51 if the work authorized is suspended or abandoned at any time after work Subtotal $ , I 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 iS 681 -3699 or 681 -3698 0' 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 Date Requested AM PM BLD Location I ( 2J) lit 1n ,1.c n l r S . Suite MEC Contact Person Ph PLM Contractor Ph SWR BUILDING Tenant/Owner f 62/ yL'� Q S4-Q/�, ELC 9S--6) 7r) Retaining Wall EL( q S — ©C® / 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 CO gi Fi re Sprinkler G ! / S > ,S' 414.1 .c eT r 92 e , Y C7 C 114 /� Fire Alarm (/ / y 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 ( tip al j PASS P FAIL • ELECTRICAL S' ica Rough In UG /Slab 50 L 9 ow Voltage Fir PASS ART 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 2-At Other Date Inspector Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.