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DEPARTMENT OF LAND USE&TRANSPORT 4TION
WASHINGTON LAND DEVELOPMIENT SERVICES DIVISION
^1 155 NORTH FIRST,HILLSBORO,OR 97124
COUNW3 INSPECTION REQUESTS: 503/640-3561/693-4415
OREGON
NOTICE: This permit becomes null and void If the work or construction for which it Is Issued Is not commenced within 100 days. Once construction has started,
the permit becomes null and void If construction Is Interrupted for a period of 100 days. I certifr. 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 rur knowledge. I r4cknowledge that the Building Department's reliance
upon false and misleading Information may invalidate this permit. All provisir.no of applicable laws and ordinrnces governing the construction and use
of this'Nullding or structure will be compiled with whether or not•r-efffed�,o the plant or noted on the plans correction sheets. I acknowledge that
the granting of a permit does not grant authority to access private prop.rrty 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 It 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 previsional and revocable until the satisfaction of all Inspection requirements.
T-9 M60VATURE
�VA5tment of
ELECTRICAL PERMIT
Department of Land Use & Transportation
Electrical Inspection Section� APPLICATION� 155 North First Avenue,#350-12
Hillsboro,Oregon 97124
lnforrnatir,n: (503) 640-3470 Fax- (503) 693-4412
. . Permit
/ J
Nur,��er t:�C fj" r! `�_ CtatP
. • . . through = —
,,. Location of installation 4. Complete Fee Schedule below
Address. ` Sw x_'7 h k __ Number of inspections per permit allowed
Building Service included: Items Cost(ea.) Sum
City' '►d'- rf Suite No.-, —�_
Tenant Name A. Residential -per unit
(if commercial)
1000 s%h.or less $110.00 a
Map No, ___ .. __-__Tax Lot Each additional 500 sq,ft
or portion thereof $25.00
Limited Energy $25.00 _ 1
Thomas Map Book: Page: -� - __ Section:-- Fach Manuf'd Home or Modular
Directions__._-}g.jL ry l� '�''o f!tr Dwelling Service or Feeder _ __.____ $68.00 2
Commercial❑ Residential S. Services or Feeders
Installation,alterations or relocation
200 amps or less $60.00
2a. Contractor installation* only; 201 amps to 400 amps $80.00 _- 2
Electrical Contractor� 11Ti,r,c t 601 amps to 100 amps $120.00 2
I l �—�e`��"�t1 sot amps to 1000 amps —_. _ $180.00 2
Address
� SL1/ -s.�l_1..LfL1._ � Over 1000 amps or volts $340.00 _-_ 2
City _ --__ State c7 42 ZIP_ Reconnect only $50.00 —_.__. ____ 2
Date._ S Job Number
Property Owner _ C. Temporary Services or Feeders
Contractor's License No. - `1 -yam_C- Installation,alteration or relocation
Contractor's Board Rey. No. _. 200 amps or less $5000 ___.__ 2
201 amps to 400 amps $75002
- --- ---------
Si nater ofu r. Elec'nt 21. 401 amps to 600 amps -- $100 00 _ 2
License No. <_.• Phone No. '7 / y Over 600 amps to 1000 volts see"13"above
_ ._ �_
D. Branch Circuits
2b. For owner installations: New,alteration or extension per panel
a) The fee for branch circuits with
PlintOwner's Name f�Tione Aon purchase of service or feeder tee.
_ Each branch circuit __-_ $5.00 __ 2
iCddreSs b) The fee for branch circuits without
__ __ __ ___ purchase of service or feeder fee.
--3tAte �i 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 �__ 2
---- --- — Signal circuit(s)or a limited
energy panel,afteration
3. Plan Review section if required) or extension $4000 --_^ __ 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
_Service and feeder, 800 amps or more Per inspection $35.00
- p Per hour _ $55.00
System over 600 volts nominal n,Plant -__- $55.00
_Classified area or structure containing special
occupancy tis described in N.E.C. Chapter 5 S. Fees
CY
Submit 2 sets of plans with application where any of the A. Enter total of above fees $
above apply. Not required for temporary construction 50,o Surcharge (.05 X total fees) $ _
services. Subtotal $ ----- _�____
This permit becomes null and void If the work authorized by the permit is B. Enter '159/,, of line A for
not commenced within 1 ao days from date of Issuance of such permit or Pian Review if required (Section 3) $ ----------.If the work authorized Is suspended or abanloned at any time after work Subtotal $
Is commenced for a period of 180 days. Electrical Permits are non- $ — ----
refundable and non•trensferable. El Trust Account -
For Inspections call Balance Due $
681-3699 or 681-3698
24-hour recorder, one working day In advance of meed
BL28 3'95
i
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DEPARTMENT OF LAND USE&TRANSPORTATION
WASHINGTON LAND DLVELOPMENT SERVICES DIVISION
155 NORTH FIRST,HILLSBORO,OR 97124
COUNTY, INSPFCTION REQUESTS: 503/640-3561/693-4415
OREGON
NOTICE: This permit becomes null and void It the work or constr fiction for which It Is Issued Is not commenced within 180 days. Once construction has started,
toe permit becomes null and void If construction Is Inl errupted for a period of 180 days. :certify that the Information presented by the applicant and
He agent or agents In support of this permit Is t :nd correct to the best of our knowledge. I acknowledge that the Building Department's reilanre
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 thoperty upon which the permit is Issued
specifying that the use or occupancy of the building nr structure Is provisional and revocable until the safisf tion of all Inspechon feg4rements.
P CA T' SIO URE
WASHINGTON COUNTY USL
Department of Land Use&Transportation ELECTRICAL PERIiiIT
fes_ Electrical Inspection Section ��
APPLICATION "��
155 North First Avenue,#350-12 12.9ti'
Hillsboro,Oregon 97124
Information: (503)640-3470 Fax, (503) 693-4412
PRINT Permit �U('i 1 l
Plumber - `-_ D,ite
• • . through
1. Location of installation 4. Complete Fee Schedule below
Address r r r (�F �l \rJ Number of Inspections per permit allowed
`� Buildingg
Cit O Iv Suite No.. Service included: Items Cost(ea.) Sum
Tenant Name A. Residential—per unit
(if commercial) - 1000 sq.ft.or less - $11000
Each additional 500 sq.ft
Map No.. �.f D —Tax Lot __ or portion thereof - - $2500 --
Book: Page:—,-- Section:, Limited Energy -_-_ $25 00
Thomas Ma
PEach Manuf'd Home or Modular
Directions`_ Dwelling Service or Feeder $69.00
B. Services or Feeders
Commercial❑ Residential[, ] ` Installation,alterations or relocation
2VJ amps or less -- $6000 - -- 2
2a. Contractor irtsllatio/� or�l�': 201 amps to 400 amps $80.00 _� 2
/1 I 401 amps to 800 amps $120.00 2
Electrical Contractor_ bJ1 amps to 1000 amps _ $1 e0.00 _ _ 2
Address _ Over 1000 amps or volts $340.00 2
City __ _ Slate 1 ZIP. Reconnect only $50.00 —_ 2
Date-_._.�c_�.;1 ob Number _
Property Owner - L _ C. Temporary Service or Feeders
Contractor's License No. - installation,afteration or relocation
Contractors Board Reg. o.
200 amps or less $50.00 c- ' 2
1 201 amps to 400 amps `— $75.00 2
i 401 amps to 600 amps $100.00 2
Signature of Supr. Elec'n -" "�'�
Licence No. h ne n. Over 600 amps to 1000 volts see"B"above
_�1 - _�/.,� S
D. Branch Circuits
2b. For owner installations: New,alteration or extension pei panel
,a) The fee for branch circuits with
print Own Nerna _ one o. purchase of service or feeder tee.
Each branch circuit _. $500
A cess h) The fee for branch circuits without
purchase of service or feeder fee.
First branch circuit $35.00 _ s 2
Each add'nl bra xch circuit_ $5 oo 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 ^._ $4000 2
Fach sign or outline lighting $4000 2
Owner's Signature - --- Signal circuits)or a limited
energy panel,alteration
3. Plan Review section (if required) or extension $40.00
Please check appropriate item and enter fee In sectlun 53. F. Each additional inspection over the allowable
4 or more residential units in one structure in any of the above
_Service and feeder. 800 amps or more Per inspection $3500
hour - $5500
TSystem over 600 volts nominal In Plant - $5500
.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 $ —}-
above apply. Not required for temporary construction 5% Surcharge (.05 X tofal fees) $ ✓' �.;
services. Subtotal $ _
This permit becomef null and void it the work authorized by the permit is S.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 atter work Subtotal $
is commenced for a period of 1 a days. Electrical Permits are non- $
refundable and non-transferable. C] 1 rust Account
For Inspections call r
681-3699 or 681-3698 Balance Due $
24-hour recorder, one working day In advance of steed
BL28 3.95