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: . WASHINGTON COUNTY ELECTRICAL PERMIT
• Department of Land Use & Transportation
Electrical Inspection Section`
r 155 North First Avenue, #350 -12 ' APPLICATION /1415T "� 517
Hillsboro, Oregon 97124 / o22S SaJi3 er r✓e-vain
r Information: 503 640 -3470 Fax: 503 693 -4412 . ` j - 97 lee.
PLEASE PRINT Project/Perm
-
Please complete all sections, 1 through 5. . Location of Number CS�}���= Date 1 ? - 10 i�
I t • 4. Complete Fee Schedule below
Address
- /2&) s- installat S ) f/ i � t. on OO(f/ 214... Number of inspections per permit allowed
4 /7%I5 I Building Service included: Items Cost(ea.) Sum
. City `°I r A Suite No.
Tenant Name A. Residential - per unit
(if commercial) 1000 sq. ft. or less N $110.00 4
Each additional 500 sq. ft
Tax Lot Map No. or portion thereof $25.00
Limited Energy $25.00 1
Thomas Map Book: Page: Section: Each Manufd Home or Modular
Directions Dwelling Service or Feeder $68.00 , .2
; .�. ... _.. � , ` B. S ervices or Feeders, . . ! __.._ . _ _.._ _ ;
Commercial ❑ Residential ICI ' • Installation, alterations or rel cation I
200 amps or less $60.00 2
2a. Contractor installation only: a 201 amps to 400 amps 20.00
, / o i , 401 amps to 600 amps $1120.00 • ' 2
Electrical Contractor N/(4) Y -C
(f i /- . .- G' 1 C/ 601 amps to 1000 amps $180.00 2
Address , , C • / / Over 1000 amps or volts $340.00 2 '
Date )Z 10 - ''s Job-Number Reconnect only $50.00 2
Property Owner C. Temporary Services or Feeders • •
Contractor's License No. 7 z/- 36/C-
Contractor's Board Reg. No. 5' I alteration or relocation
200 amps or less $50.00 2
201 amps to 400 amps $75.00 2
Signature of Supr. Elec'n • . 401 amps to 600 amps $100.00 • 2 •
License No. 375 y S Phone No. Over 600 amps to 1000 volts see 'B' above •
2b. For owner installations: D. Branch Circuits i
New, alteration or e xtens i on p panel
Print Owner's Name Phone No. a) The fee for branch circuits with
purchase of service or feeder fee. • • .
Address Each branch circuit $5.00 - 2
b) The tee for branch circuits without .
City State Zip purchase of service or feeder fee.
First branch circuit . $35.00 2
The installation is being made on property I own Each add'nl branch circuit $5.00 - 2
which is not intended for sale, lease or rent. E. Miscellaneous (Service or Feeder not included
Each pump or irrigation circle $40.00 ' 2
Owner's Signature _ Each sign or outline lighting $40.00 2
" " .' % Signal circuit(s) or a limited , ;
3. Plan Review section (If re wired • energy panel, alteration /�,ayge. G Q ` ' j '
` • or extension $40.00 fi 2
Please check appropriate Item and enter fee In section 5B.
1 & 2 family dwellings over 320 amps sic meter F. Each additional inspection over the•allowable
-
4 or more residential units in one structure in any of the above
Per inspection $35.00
Service over 225 amps; feeder 400 amps or more Per hour $55.00
System over 600 volts nominal In Plant $55.00
Building over 3 stories in height
Building over 10,000 sq. ft. 5. Fees
.4/,‘, 0
Occupant load over 99 persons A. Enter total of above fees $
- Manufactured Structures Park or Recreational 5% Surcharge (.05 X total fees) $ 0 2, o0
- Vehicle Park; new, addition or alteration Subtotal $
Classified area or structure containing special B. Enter 25% of line A for
-
occupancy as described in N.E.C. Chapter 5 Plan Review if required (Section 3) $
Subtotal $
Submit 2 sets of plans with application where any of the Less Bulk Label Fee $
above apply. Not required for temporary construction ��� ��
services. Balance Due $
For Inspections call This permit becomes null and void If the work authorized by the permit Is 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.
5/93
•
DEPARTMENT OF LAND USE & TRANSPORTATION
WASHINGTON 55 NORTH FIRST, DEVELOPMENT LSBORO, OR 97124
COUNTY INSPECTION REQUESTS: 503/640-3561/693-4415
�,.. PHONE: 503/646 -6761 4O ‘54-70
OREGON
Page : 1 of 1
Date : 12/13/93
Time : 15:08
1Permit Type : Residential Electrical Permit Permit # : 05047915
Permit Status : APPROVED Applied : 12/13/93
Situs Address : 10234 SW RIVERWOOD LN TI Issued : 12/13/93
Permit Title : SFR - ELEC/LIMITED ENERGY Completed :
Permit Descr. To Expire : 06/11/94
Project Title : SFR - ELEC /NEW HOUSE Project # : P0036625
Project Descr. : * EROSION *
Parcel Number : 2S1TI - Land Use District :
Valuation 0 •
I,Legal Descr. •
Owner : INSPECTION - TIGARD Construction : OTH
Applicant Name : BUCKAROO ELECTRIC Classification : 900
Applicant Addr.: 16780 SW UNION MILLS RD Occupancy : R3
MULINO, OR 97042 Validated by : KF
Applicant Phone: 829 -5207 Inspector Area :
CONTRACTOR : BUCKAROO ELECTRIC Lic. C 34 -361C 829 -6768
Fee description Units Fee /Unit Ext fee Data
Limited Entegy /Alter. /Extension 1 40.00 40.00
Subtotal Electrical Fees: 0 40.00
State Surcharge of 50 0 2.00
Total Electrical Fees: 0 42.00
* ** Fees Required * ** * ** Fees Collected & Credits * **
Receipt No. Date Payment
12/13/93 42.00
TOTAL THIS DATE * * * * * * * ** 42.00
Fees: 42.00
Adjustments: .00 Total Credits: .00
Total Fees: 42.00 Total Payments: 42.00
Balance Due: .00
NOTICE: This permit becomes null and void if the work or construction for which It Is Issued is not commenced within 180 days. Once construction has started,
the permit becomes null and void If construction Is Interrupted for a period of 180 days. I certify that the Information presented by the applicant and
his agent or agents In support of this permit Is true and correct to the best of our knowledge. I acknowledge that the Building Department's reliance
upon false and misleading Information may Invalidate this permit. All provisions of applicable laws and ordinances governing the construction and use
of this building or structure will be complied with whether or not specified on the plans or noted on the plans correction sheets. I acknowledge that
the granting of a permit does not grant authority to access private property or to use easements. I further acknowledge that the use or occupancy of
the structure or building permitted depends upon my calling for inspections at various times during the process of construction and the building
inspection staff verifying compliance with the various codes. Use or occupancy of the building or structure permitted prior to approval by the
Building Department Is solely at the risk of the applicant and such use or occupancy is revocable until all inspection requirements are satisfied and
approval is given by the Building Official. I further acknowledge that a lien may be placed on the title of the property upon which the permit is issued
specifying that the use or occupancy of the building or structure is provisional and revocable until the satisfaction of all Inspection requirements.
APPLICANT'S SIGNATURE