Permit WASHINGTON COUNTY
01111" Department of Land Use & Transportation ELECTRICAL PERMIT
1 1• Electrical Inspection Section APPLICATION
155 North First Avenue, #350 -12
Hillsboro, Oregon 97124
Information: 503 640 -3470 Fax: 503 693 -4412
Project/Permit
PLEASE PRINT Number Ei-C.1 g Date ( ,$ - 1C
Please complete all sections, 1 through 5.
1. Location of installgtion/ 4. Complete Fee Schedule below
Address '''62 / !/ �v ` f ' " ' ' , Number of inspections per permit allowed
Building Service included: Items Cost(ea.) Sum
City ! Suite No.
Tenant Name A. Residential - per unit
(d commercial) 6 y `e- cc, ay ipar 1000 sq. ft. or less $110.00 4
/ ! 1 Each additional 500 sq. ft
Tax Lot � ( � �
Map No. or portion thereof $25.00
Limited Energy $25.00 1
Thomas Map Book: Page: Section: Each Manufd 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 2
201 amps to 400 amps $80.00 2
2a. Contractor ins . allatian oply: - 401 amps to 600 amps $120.00 2
Electrical Contr- or // / .4 - , 601 amps to 1000 amps $180.00 2
Address ,-> f! - G4.- - .._ Over 1000 amps or volts $340.00 2
Date to - 7- - ' Job Number Reconnect only $50.00 2
Property Owner GJ'• 6' TQti NW: Rr_.
Contractor's License No. C. Temporary Services or Feeders
Contractor's Board Reg. No. iM �� In stallation, alteration or relocation
200 amps or less $50.00 2
201 amps to 400 amps $75.00 2
Signature of Supr. Elec'n r 401 amps to 600 amps $100.00 2
License No. .. '/ J Phone No. _23. ' / 5-3 Over 600 amps to 1000 volts see'B' above
2b. For owner installations: D. Branch Circuits
New, alteration or extension per panel
Print Owner's Name Phone No. a) The fee for branch circuits with
purchase of service or feeder fee.
Address Each branch circuit $5.00 2
b) The fee for branch circuits without
City State Zip purchase of service or feeder fee.
First branch circuit $35.00 2
The installation is being made on property I own Each add'nl branch circuit $5.00 2
which is not intended for sale, lease or rent. E. Miscellaneous (Service or Feeder not included)
Each pump or irrigation circle $40.00 n . 2
-2- O wner's Signature Each sign or outline lighting _ $40.00 .f
Signal circuit(s) or a limited
3. Plan Review section (if required) energy panel, alteration
Please check appropriate Item and enter fee in section 5B. or extension $40.00 2
1 & 2 family dwellings over 320 amps sic meter F. Each additional inspection over the allowable
-
4 or more residential units in one structure in any of the above
Per inspection $35.00
Service over 225 amps; feeder 400 amps or more Per hour $55.00
System over 600 volts nominal In Plant $55.00
Building over 3 stories in height
Building over 10,000 sq. ft. 5. Fees ef---
Occupant load over 99 persons A. Enter total of above fees $
Manufactured Structures Park or Recreational 5% Surcharge (.05 X total fees) $
Vehicle Park; new, addition or alteration Subtotal $
Classified area or structure containing special B. Enter 25% of line A for
-
occupancy as described in N.E.C. Chapter 5 Plan Review if required (Section 3) $
Subtotal $
Submit 2 sets of plans with application where any of the Less Bulk Label Fee $
above apply. Not required for temporary construction
services. Balance Due $.
For inspections call Thls permit becomes null and void If the work authorized by the permit b not commenced
640 -3561 or 693 -4415 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.
5/93
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date
Requested "� AM PM BLD
`7
Location V1`I7 KJ1/4 Suite MEC
Contact Person Ph PLM
Contractor // �� Ph SWR U
BUILDING Tenant/Owner VL1Yt)C auY S o ELC -/ °(')I g'
Retaining Wall JJ E1 , g , 9c — 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 n
Fire Sprinkler /, _i ! S le 1 1? s WI' q r 1 V7 CID Ai 1011 C
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
ELECTRICA
5'�rai
Rough In
UG /Slab
L
Fi S
PASS " PART FAIL
S E
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 72 7 ! t Et — Ins ec or x h Date Inspector
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.