Permit 4.4
4111% WASHINGTON COUNTY /
Department of Land Use & Transportation E L ECT R I CA L P E R M I T
le
E
U Inspection
First Electrical I sion Section
APPLICATION
le North Fi Avenue, #350 -12
Hillsboro, Oregon 97124 Y
Information: (503) 640 -3470 Fax: (503) 693-44 �F, PI RE D
PLEASE PRINT Per
complete all sections, 1 through 5. Number f.i..C, C I 5 - . Date (01 -3195
1. Locarigirls ' = N §c 4. Complete Fee Schedule below 6 47
Address ll tt77, ► O a Number of inspections per permit allowed
Building Service included: Items Cost(ea.) Sum
City � Suite No. "-
• Tenant Name A. Residential - per unit
(if commercial) 1 "�
1000 sq. ft or less $110.00 4
Map No. Tax Lot Each additional 500 sq. ft
P o. or portion thereof $25.00
Thomas Map Book: Page: Section: Each Energy $25 00 1
P 9 Each h Manuf'd Home or Modular
Directions Dwelling Service or Feeder $68.00 2
Commercial Residential n B. Services or Feeders
Installation, alterations or relocation
200 amps or less $60.00 2
2a. Contractor install . ly : 201 amps to 400 amps $80.00 2
, - 401 amps to 600 amps $120.00 2
Electrical Contractor . 2 :0111 '''••••• - )� - 601 amps to 1000 amps $180.00 2
Addr - . , _ d ia • . s4-(> Over 1000 amps or volts $340.00 2
City iJ a '• State Q ZIP C_- Reconnect only $50.00 2
Date Job Number
Property Owner _ C. Temporary Services or Feeders
Contractor's License No. IWW ■IF- Installation, alteration or relocation
/J<��m� ∎∎RIM - 200 amps or less $50.00 2
Contractor's Board Reg. No .aj�Z _-s.7iieissue
. � 201 amps to 400 amps $75.00 2
�3 `� =` 401 amps to 600 amps $100.00 2
Signature of Supr. Elec'n ..i Over 600 amps to 1000 volts see "B" above
License No. Cic, Phon- o 4 ....-,......,,
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 n 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
amps or more Per inspection $35.00 N
Service and feeder, 800 am
P Per hour $55.00
System over 600 volts nominal In Plant $55.00 ,n.
Classified area or structure containing special
occupancy as described in N.E.C. Chapter 5 5. Fees 0° (N)
Submit 2 sets of plans with application where any of the A. Enter total of above fees $ '��. ° 1
above apply. Not required for temporary construction 5% Surcharge (.05 X total fees) $ 2.
services. Subtotal $
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) $ � rr
if the work authorized is suspended or abandoned at any time after work Subtotal $ ZS
is commenced for a period of 180 days. Electrical Permits are non- $
refundable and non - transferable. ❑ Trust Account
For inspections call Balance Due $ hi 2,
681 -3699 or 681 -3698
24 -hour recorder, one working day in advance of need
BL28 • 3/95