Permit WASHINGTON COUNTY ELECTRICAL PERMIT
Department of Land Use & Transportation
f1 Electrical Inspection Section APPLICATION
155 North First Avenue, #350 -12
Hillsboro, Oregon 97124
Information: (503) 640 -3470 Fax: (503) 6934412
PLEASE PRINT / /
Please complete all sections, 1 through 5. • Number - C � 5 - I M Date 4,
1. Location of installation t ion , 4. Complete Fee Schedule below
Address 01-6/4/A///7 •- - ?Gg4Lf--- Number of Inspections per permit allowed
-77-614 Building
City Suite No. Service included: Items Cost(ea.) Sum
Tenant Name y� / X 1 4 0 5 A. Residential - per unit
(if commercial)
SA
[ 00D y �)4 , •5G2. R 0'
1000 sq. ft. or less $110.00 4
Each additional 500 sq. ft
Map No. Tax Lot 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
B. Services or Feeders
Commercial Residential ❑
Installation, alterations or relocation
200 amps or less $60.00 2
2a. Contractor installation only: / 201 amps to 400 amps $80.00 2
Electrical • tractor • 1. _ - . ( J/V 401 amps to 600 amps $120.00 2
601 amps to 1000 amps $180.00 2
Address . 5 j Le.) Over 1000 amps or volts $340.00 2
City P State ��ZIP (":1 `77,/ ') Reconnect only $60.00 2
Date 6 9S Job Number O
7
Prope Owner (4.4 44 S c� _ C. Temporary Services or Feeders
Contractor's License No. - • i 7 C. L S Installation, alteration or relocation
200 amps or less $50.00 2
Contractor's Board Reg. No. / '!�► j
� � 201 amps to 400 amps $75.00 2
Signature of Sur. Elec'n J .A L_'% 401 amps to 600 amps $100.00 2
g -��� Over 600 amps to 1000 volts see "B" above
License No.'5i (`7 Ph.ne No. `7Lf -034
D. Branch Circuits
2b. For owner installations: New, alteration or extension per panel
a) The fee for branch circuits with •
Print Owners 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 -, $40.00 7O v p 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
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
Submit 2 sets of plans with application where any of the A. Enter total of above fees $ ,) 0 Q
above apply. Not required for temporary construction 5% Surcharge (.05 X total fees) $
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) $
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 1 (7
24 -hour recorder, one working day in advance of need
6 35_ el/ 7s BL28.3/95