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i:\records\microfilm\targets\building.doc
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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 A,-,pr/Sdwlk
Foundation Plbg. Undersiab Mech. Rough-in Fireplace
Post/Beam Struct. Plbg. Top Out Elec. Rough-in FINAL:
Post/Beane Mech. San. Sewer Gas Line -Bldg.
Plbg. Uodeif;oor Rain Drain Framing -Plumb.
Alarm Water 1-ine Insulation -Meeh.
UrJerflr. Insul. Sheai Wall Gyp. Bd. -Elect.
Date Requested: r r Time: AM PM
Address:
Builder: Permit
THE FOLLOWIN%, CORRECTIONS ARE REQUIRED:
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01
6-1
Inspector:0s"i c7
Date: a
PPROVED _DISAPPROVED _APPROVED SUBJECT TO ABOVE
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—Call For Reinsp.
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Community Developmert ELECTRICAL PERMIT APPLICATION
13125 SW Hill Blvd. -4' ;;a r" - )t-, 7
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Tigard, OR 97223 Planck/Pec. #-1x it u -)
Permit # _ L_cU� 1_5 D
Phone (503) 635-4171 Date Issued I__ 10 -11-j, �
FAX (503) 684-7297 Issued by'-I Vitt Wky t.---
GIrr OF TIGARD rDD No. (503) 684-2172
Inspection (5031639-4175
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development Number of Incpections pea permit allowed
4.,T(y-\,Eg--ST, Service Included Items Cost(ea) Sum
Address �S � 5� -
City/State/Zi p -� t C, -C� :�' (I -7Z 2 3 4s. Residential-per unit 4
1000sq ft or leer. $110 00
E"0 P .F M���1�._J F_ach ndde+onsl FrJO aq 11 or
Name (or name of business) f , f`T portion thereof $2600
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Commercial❑ Residential[� Each Each ito Energy $2500
Manul'd Honor or Modular 2
Dwelling Ssrviot or Feeder see 00
29. Contractor Installation only: 4b.Services or Feeders
Installatinn,alteration,or relocation 2
Electrical Contractor 200 amps or leas —_- sm D0 2
r 201 amps to 400 amps $8000 2
i Addrens -- 401 amps 10 800 amps $120002
2
CityState Zip_, 601 amps to 1000 amps $18000 1 I
Phone No. Over 1000 amp@ or volt, $34000 2
Contractor's License No. Reconnect only sw oo _
Contractor's Board Reg. N0. 4c.Temporary Services or Feeders
Installation,alteration,or relocation 2
Signature of Supr. Elec n 200 amps or leas $5000 _r^ 2
201 rmps to 400 amps $75^7 2
License No. Phone No._ ___ 401 amps to e0o amps s10000
Over 600 am" .n 1000 volts
2b. For owner Installations: eee'b'abov@
��t tlr J 4d.1Aranch Circuits
Print Owner's Name HCl�C�-- 4-1 aUereuon or extens+on per panel
Address12-2,-So -S—j- l li n hr^CMZ 1 a)Thep fee for branch err file w/fh
City `t t C-)+R State_ —.Cy Zip ; purona"of wvt;... (do 2
I - Each branch arced A
Phone No. �t ( b)The Ian for branch circuits Mr..
.LL e _ -( � c purchaso of sarvke or Atwdor Ase. -''• 2
The installation is being made on props .7 which i, F+rat branch circuit oo�) _0(: 2
not intended for sale, lease or rent. Q �`.
Each additional brand circuit �^2
Owner's Signature_ �f" �* Sam..---- _ 4e.Mise. r»us
4 (Son•k; feertor of included) 2
3. Plan Re vie sects n (j� ,Ire'I). Each pump orirngatior `- $4000 2
Each sign of outline lighting _ $40.00
Sit,�nei circutt(s)or a limited energy 2
Please choLk appropriate it rcl,er lot ion SR. panel,alteration or extension S4000
1 _4 or more residential"'r '.•nf dtNc loeiq Minor Labels(10) $10000
Service and feeder 22: r$a
system over 600 vett ,rim Jt Each dlditional inspection over
Classified area or struct , .rntmirling spit. the allowable in any of the above
as describe,)in N.E C:. -nt"r S Per inepncuon $3500
PRI noir $55 00
In Pleat $5500
Submit 2 sets of plans with appit t the above
apply. Not required for tomporrq canstr• .ten services. 5. Fees:
NOTICE Ss. Enter total of above fees $ 3Sr�V
5%Surcharge(.05 X total fees) $
PERMITS BECOME VOID IF'NORK OR CONSTf..JCTION Subtotal $
At1THORIZED IS NOT COMMENCED WITHIN 180 DAYS,OR It- 5b "iter 25%of line A for
CONSTRUCTION OR WORM:IS SUSPENDED OR ABANDONED ,:)R lan Review if required(Sec 3) !'
A PERIOD OF 180 DAYS A'"ANY TIME AFTER WOF ; Subtotal
COMMENCED ❑ Trust Account# $
Balance Due s 6 `7
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