Permit WASHINGTON COUNTY ELECTRICAL PERMIT Department of Land Use & Transportation
gip 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 ' L.q,5- Q')5 Date 621 K0,5
5
1. Location of installation / / 6 Sq, 4. Complete Fee Schedule below
Address `tom K/CJss4 . 2 � Number of inspections per permit allowed
Building
City 7;fe".4.4,l Suite No. / V-
Z Service included: Items Cost(ea.) Sum
Tenant Name / A. Residential - per unit
(if commercial) L
1000 sq. ft. or less $110.00 4
Ma No. Tax Lot Each additional 500 sq. ft
P or portion thereof $25.00 -°
Book: Page: Section: Limited Energy _1 $25.00 i 1
Thomas Map 9 Each Manuf'd Home or Modular
Directions Dwelling Service or Feeder $68.00 2
Commercial ❑ Residential El Installation, 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 Cie,- 401 amps to 600 amps $120.00 2
601 amps to 1000 amps $180.00 2
Address --at Over 1000 amps or volts $340.00 2
City re AMMO, 1 6 Stat- ./ ZIP I • Reconnect only $50.00 2
Date - /Z.- Job Number
Property Owner C. Temporary Services or Feeders
Contractor's License No. Jc -le, Installation, alteration or relocation
Contractor's Board Reg. No. 2i! 7
200 amps or less $50.00 2
G 201 amps to 400 amps $75.00, 2
401 am to Signature of Supr. Eldn .. Over 600 amp to 1000 volts see "B" above00.00 2
e k.4 ��/-'��
License No. y3i/ - -S P one No. -V2_- 7olJ
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
Per inspection $35.00
Service and feeder, 800 amps or more Per hour / $55.00 ,55
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 Da
Submit 2 sets of plans with application where any of the A. Enter total of above fees $ / t5 5 • -9
above apply. Not required for temporary construction 5% Surcharge (.05 X total fees) $ 5. 25
services. Subtotal $ ) 55. 25
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 . I / O --
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 q (0S"1 (J &S i, � t S4 • Suite MEC
Contact Person Ph PLM
Contractor Ph SWR ,. /�
BUILDING Tenant/Owner (e)onG� ELC 9S _0 , c g
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 /�
Fire Sprinkler QiC C'j
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
1--
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
/f a
PASS PAR AIL
ECTRICA
Service
•
Rough In
UG /Slab
Low Voltage
Fire Alarm
r P
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 i
Approach /Sidewalk
Other Date Inspector I 0_ A: tit /. Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.