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Permit oft WASHINGTON COUNTY RESTRICTED Department of Land Use & Transportation iii. Electrical 55 North First Avenue, #350 -12 ELECTRICAL ENERGY Hillsboro, 97124 APPLICATION Information: (503) 503) 64040 -- 343470 0 Fax: (503) 693-4412 PLEASE PRINT 5 Please complete all sections, 1 through 5, Permit No. 1. of installatio Date 0(p3a X 15 Addr - SW �U r ( h� • city T15 al ci Zip Code 4 17 •2 - 23 4. Type of work: Map No. Tax Lot RESIDENTIAL Restricted Energy Fee $40.00 Thomas Map Book: Page Section (for all systems) Check type of work involved: Directions - Audio and Stereo Systems* Commercial E,1 Residential E ` Burglar Alarm . - T elephone Systems* - Tenant Name aQ A kc Garage Door Opener* (if commercial) 1 n I V l r `"' _ F ire Alarm H eating, Ventilation and Air Conditioning Systems' 2. Contractor application: - Vacuum Systems* Electrical Contractor lA b I" cle.C L _ Other Address 2..449 1vc .1 (advva COMMERCIAL Fee for each system $40.00 Cit p0 (11 0-h State © &'Zip 1 7232 (see OAR 918- 260-260) Date b/ i /0-5 Job Number Check type of work involved: Property Owner Contractor's License No. 3132.- - C.1.- Boiler Controls Contractor's Board Reg. No 6 65 Phone No. 28 Clock Systems ^sg44 Data Telecommunications Installations Fire Alarm Installation 3. Owner application: HVAC Instrumentation Print Owner's Name Phone No. Intercom and Paging System Landscape Irrigation Control' Address Medical Nurse Calls City State Zip Outdoor Landscape Lighting* This permit is issued under OAR 918 -320 -370. The applicant agrees Protective Signalin ■ to make only restricted energy installations (100 volt amps or less) then gac rA051 c under this permit and to do the following: 1. Only use electrical licensed persons to do installations where required. (Certain residential and other transactions are exempt I Number of Systems from licensing. These have asterisks (). All others need licens- ing.) 2. Call for an inspection when all the installations under this permit • No licenses are required. Licenses are required for all other installations. are ready for inspection. 3. Purchase separate permits for all installations that are not ready 5. Fees for inspection when the Inspector is out to inspect under this permit. Enter fees $ 4o .H 4. Assume responsibility for assuming that all corrections required by the inspector are done, and 5. Assume responsibility for calling for a final inspection when all of 5% Surcharge (.05 X total above) $ 2 op ' the corrections are completed. The person signing this permit must be the applicant or a person Trust Account $ authorized to bind the applicant. Signature . iii _/ Total $ 4 2 . PA Authority if other than applicant This permit becomes null and void if the work authorized by the permit is not commenced within 180 days from date of issuance For inspections call of such permit or if the work authorized is suspended or abandoned 640 -3561 or 693 -4415 at any time after work is commenced for a period 01180 days. Electrical Permits are non - refundable and non - transferable. 24 -hour recorder, one working day in advance of need BL24 - 114