Permit !or l ✓
AN WASHINGTON COUNTY ELECTRICAL PERMIT
Department of Land Use & Transportation
W Electrical Inspection Section APPLICATION
155 North First Avenue, #350 -12
Hillsboro, Oregon 97124
Information: (503) 640 -3470 Fax: (503) 6934412
PLEASE PRINT Permit
Please complete all sections, 1 through 5. Number EL 55 - 0/0 9 Date 6/2 6 /9.5
1. Location of installation n 4. Complete Fee Schedule below
Address 96 21 Sw. 6 5Q. RD Number of Inspections per permit allowed
Building No. S ervice included: Items Cost ea. Sum
City r1Gl� Suite F - Z Cost( ea.)
Tenant Name n- n A. Residential - per unit
(if commercial) N se fG.D _ / 1� r
1000 sq. ft or less $110.00 4
Map No. Tax Lot Each additional 500 sq. ft
or portion thereof $25.00
Limited Energy $25.00 1
Thomas Map Book: Page: Section: 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 /I KES i .-GC . 401 amps to 600 amps $120.00 2
601 amps to 1000 amps $180.00 2
Address Over 1000 amps or volts $340.00 2 •
City State ZIP Reconnect only $50.00 2
Date , Number 'Cl -95 -O /1
Property Owner / k U►N MR-R C. Temporary Services or Feeders
Contractor's License No. Installation, alteration or relocation
Contractor's Board Reg. No. Mir 200 amps or less $50.00 2
j 201 amps to 400 amps $75.00 2
Signature of Supr. Elec'n 401 amps to 600 amps $100.00 2
'yam Over 600 amps to 1000 volts see "B" above
License No.5$5 3 /6- one No. 201-3 7-19/9
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'nI 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 I $40.00 l(/Q� 2
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 O v
Submit 2 sets of plans with application where any of the A. Enter total of above fees $ O,
above apply. Not required for temporary construction 5% Surcharge (.05 X total fees) $ 2.
services. Subtotal $ 41Z.�
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 $ 1 . -
elefigngemplitIONINI
24-hour recorder, one working day in advance of need BL26 • • 3/95
639 -%/
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec -O- Phone): 639 -4175 Business Phone: 639-1171
ilI ..
Inspection: fa a. =JA ZA + �' -.0 ' ` _AIWA
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. �'
Date Requested: c 4 q s Time:�AM PM
Address: CG 0 (,U ' � 62 • 1— 0
Builder: Permit #: ' 9 5 (cY(
THE FOLLOWING CORRECTIONS ARE REQUIRED:
.
vi it j /7 .�` if"f te) .0l
y
4 4 4..s°'
Inspector: Date• 7' - 27 ^ 95
A PROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
_Call For Reinsp.
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested AM PM BLD
Location 1 (p Z) Lt ln acy n S r • Suite MEC
Contact Person Ph PLM
Contractor Ph SWR
BUILDING Tenant/Owner 2 0-4 s -eA, ELC 9S -'6) 7:
Retaining Wall ELIE q s— Cc 0 9
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 14/ / / 1 l S�/ S' _<- t El 1/ a ( C 9
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
Fi
/ PASS P FAIL
ELECTRICAL \
Rough In
UG /Slab )0
L
9
ow Voltage
Fir- • • : •
'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 — C Other D Insp ec t or Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.