Permit WASHINGTON COUNTY ELECTRICAL PERMIT
Department of Land Use & Transportation
Iiiiif Electrical Inspection Section APPLICATION
155 North Fi rst t Avenue, #350 -12
Hillsboro, Oregon 97124
Information: (503) 640 -3470 Fax: (503) 693 -4412
PLEASE PRINT Permit
Please complete all sections, 1 throu 5. Number LC_ i 0 I --- Date ` i �
1. Location of installation 4. Complete Fee Schedule below
Address 9637 S!! ' is S h i r gton Square Rd . Number of inspections per permit allowed
Building
City Tigard garr; Suite te No. 223 S included: Items Cost( ea.) Sum
Tenant Name A. Residential - per unit
(if commercial) SBARRO
1000 sq. ft. or less $110 00 4
Map 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 ❑ 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
Electrical Contractor Atlas Electrical 401 amps to 600 amps $120.00 2
r 3 SE Roethe Ro ad 1 601 amps to 1000 amps $180.00 2
Address f Over 1000 amps or volts $340.00 2
City i': i i waukie State OR ZIP 572b7 Reconnect only $50.00 2
Date 7/10/05 Job Number 3465
Property Owner ':i rma r Pacific C. Temporary Services or Feeders
Contractor's License No. 3 - 2C Installation, alteration or relocation
Contractors Board Reg. No
200 amps or less $50 00 2
201 amps to 400 amps $75 00 2
Signature of Su r. Elec'n 401 amps to 600 amps $100 00 2
g P Over 600 amps to 1000 volts see "B" above
License No. 14865 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 's. no 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
Per inspection $35 00
Service and feeder, 800 amps or more 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
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) $
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 $ 36.75
681 -3699 or 681 -3698
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 9Co'ri I)2 Sk SI . Suite MEC
Contact Person Ph PLM .
Contractor Ph SWR
BUILDING Tenant/Owner Q rct, ELC 15 1 S S
Retaining Wall ELR
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 Ai 6;15 ptr iv( S GtpOPdt r Co 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
FAIL
•
Rough In
UG /Slab
Low Voltage ;,4.
Fire Alarm
F'
PASS 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 7 C
Approach /Sidewalk t
I
Date ` 7 Inspector Other D
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
1