Permit •
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WASHINGTON COUNTY ELECTRICAL PERIVIIT
Department of Land Use & Transportation
Electrical Inspection Section APPLICATION
4‘. 155 North Fi rst t Avenue, #350 -12
Hillsboro, Oregon 97124
Information: (503) 640 -3470 Fax: (503) 693 -4412
PLEASE PRINT , ' -' - . . ' Permit z_ C �' s 0 4.?--. C)C,: 1 5
' Please complete all section 1 through'5. Number Date
1. Location of installation 4. Complete Fee Schedule below
Address ,./ ,./4:413",>" ,..3 e i g y / A , Number of inspections per permit allowed
Building Service included: Items Cost(ea.) Sum
Cityra-2 Suite No.
Tenant Name A. Residential - per unit
(if commercial) 1000 sq. ft. or less / $110.00 f l' 0-0 4
Map No. 1 (l rte" Tax Lot C-P054 Each additional 500 sq. ft 5 zip
or portion thereof $25.00
Thomas Map B.ok: Page: Section: Each nuf'd Home or Modular
$25.00 1
p 9 � Each Manuf'd
Directions .,- !•i -,, - ' . ?_ "... Dwelling Service or Feeder $68.00 2
Commercial n Residential �( B. Services or Feeders
Installation, alterations or relocation
200 amps or less $60.00 2
2a. Contractor i stallation only: 201 amps to 400 amps $80.00 2
401 amps to 600 amps $120.00 2
Electrical Contractor Xx �;, - e?.X;- pc.- 601 amps to 1000 amps $180.00 2
Address L5 _-' _5'W -) 1s Over 1000 amps or volts $340.00 2
City cs v 7"jr7- .- -c-k -- State c ZIP 22,./ ,/ Reconnect only $50.00 2
Date G -rte -- Job Number G.0
I ' Property Owner Rck_s - e_-3cr C.6 rte- y i_ C. Temporary Services or Feeders
Contractor's License No. fir. • ' z.3 - Installation, alteration or relocation
200 amps or less
Contractor's Board Reg. No �i ..?, 201 amps to 400 amps $50.00
$75.00 2
2
� 401 amps to 600 amps $100.00 2
Signature of Supr. Elec'n erlie64‘
Ove r 600 amps to 1000 volts see "B" above
License No. ,3 st^, r•; „S' Phone No. v.1",hr�`f
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 $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
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 $
above apply. Not required for temporary construction 5% Surcharge (.05 X total fees) $ " )
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 $ /
681 -3699 or 681 -3698
24 -hour recorder, one working day in advance of need
BL28 • 3/95
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CITY OF TIGARD BUILDING INSPECTION NOTICE il
Inspection Line: 639 -4175 Business Phone: 639 -4171
Footing Rain Drain Cover /Service FINAL:
Foundation Water Line Ceiling -Plumb. Post/Beam Mech. Shear /Sheath Framing - ech. PIbg.Und /Flr /Slab Plbg. Top Out Insulation -Elect Post/Beam Struct. Mech. Rough -in Gyp. Bd. -; d• O
San. Sewer Gas Line Appr /Sdwlk Reins.
Other:
Date: 3 // c /9( A.M. P.M. Entry:
Address: ∎ ∎ Ii..
Tenant: Ste: MST: 9_j D 1 7f
(H C
BUP:
co -1 ! _ cl
Con /Own: � EC :
PLM:
ELC:g5 = pnC7
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
,09e m6--c d rT / ti 0/C%Ai / r>
4409- re,t_ /TmG
/').
Inspector: �� Date: If/ 515 C
APPROVED DISAPPROVED /CALL FOR REINSP. CF CO
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CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec-O-Phone): 639 -4175 Business Phone: 639 -4171
Inspection:
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. - Elect.
Date Requested: -- 7// 4 /95 -- Time: AM PM
Address: 1 T j F .
Builder: a Li`T -7 7,5 Permit #: eC._C_ -9 S- OQ `f 7
THE FOLLOWING CORRECTIONS ARE REQUIRED:
Inspector / �j r/4 - / R c“ Date: 7' /P
PROVED _DISAPPROVED APPROVED SUBJECT TO ABOVE
_,AX
Call For Reinsp. 55
-P