Permit 7-1 G/370
7"I Department of Land Use & Transportation ELECTRICAL PERMIT
Electrical Inspection Section
O p 1 i5 N o th F egonv Avenue, #350-12 APPLICATION
Information: (503) 640-3470 Fax: (503) 6934412
Permit
PLEASE PRINT Number ELL 95- O / /t/ Date 61 7 I'.5
Please complete all sections, 1 through 5.
wi Rjw omplete Fee Schedule below
1. Location of installation Number of Inspections per permit allowed
Address to 7 3 S to TI T/il'U L IV . Service included: Items Cost(ea.) Sum
Building A. Residential - per unit
City T l ( l4-27) Suite No.
1000 sq. ft. or less $110.00 4
Tenant Name Each additional 500 sq. ft
(if commercial) or portion thereof $25.00
Limited Energy $25.00 1
Map No. Tax Lot Each Manufd Home or Modular
Dwelling Service or Feeder $68.00 2
Thomas Map Book: Page: 6 8 S Section: .- D
Directions B. Services or Feeders
Installation, alterations or relocation
200 amps or less $60.00 2
Commercial n Residential [ k 201 amps to 400 amps $80.00 2
401 amps to 600 amps $120.00 2
2a. Contractor installation onl : 601 amps to 1000 amps $180.00 2
Y Over 1000 amps or volts $340.00 2
Electrical Contractor R Ec_ k �L EC7-k I C 14C • Reconnect only $50.00 2
Address 931 g" 5 c MA i2 c y cu, c.�C e 2
Date Job Number M. / C 97 C. Temporary Services or Feeders
Property Owner Ro - 1"S/t'l m r11 Installation, alteration or relocation
Contractor's License No. 3, - S C_ 200 amps or less $50.00 2
Contractor's Board Reg. No. 2- C. 9 201 amps to 400 amps $75.00 2
401 amps to 600 amps $100.00 2
Signature of Supr. Elec'n L .L,% A,�' Over 600 amps to 1000 volts see •B• above
License No. / ;\.2 6...3 Phone Cc - 739'6 D. Branch Circuits
New, alteration or extension per panel
2b. For owner installations: a) The fee for branch circuits with
purchase of service or feeder fee.
Print Owners Name Phone No. Each branch circuit $5.00 2
b) The fee for branch circuits without
Address purchase of service or feeder fee. o b
First branch circuit / $35.00 3 S 2
City State Zip Each add'nl branch circuit $5.00 2
E. Miscellaneous (Service or Feeder not included)
The installation is being made on property I own Each pump or irrigation circle $40.00 2
which is not intended for sale, lease or rent. Each sign or outline lighting $40.00 2
Signal circuit(s) or a limited
Owner's Signature energy panel, alteration
or extension $40.00 2
F. Each additional inspection over the allowable
in any of the above
3. Plan Review section (if required) Per inspection $35.00
Please check appropriate hem and enter fee in section 5B. Per hour
In Plant $55.00
4 or more residential units in one structure
Service and feeder, 800 amps or more 5. Fees g
System over 600 volts nominal A. Enter total of above fees $ 3 s
Classified area or structure containing special 5% Surcharge (.05 X total fees) $ / 1$
occupancy as described in N.E.C. Chapter 5 Subtotal $ 31,,
B. Enter 25% of line A for
Submit 2 sets of plans with application where any of the Plan Review if required (Section 3) $
above apply. Not required for temporary construction Subtotal $ 34
services. $
Less Bulk Label Fee
Balance Due $ 3 t.. 2
For inspections call This permit becomes null and void if the work authorized by the permit le not commenced
640 - 3561 or 693 -4415 within 180 days from date of Issuance of such permit or If the work authorized Is
suspended or abandoned at any time after work Is commenced for a period of 180 days.
24 -hour recorder, one working day in advance of need Electrical Permits are non-refundable and non- transferable.
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