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WASHINGTON COUNTY E L �� /� PERMIT R�'�
Department of Land Use & Transportation A G
�---� Electrical Inspection Section APPLICATION
155 North First Avenue, #350-12
Hillsboro, Oregon 97124
Information: (503) 640.3470 Fax: (503) 6934412
Permit
Number �L �1 5 _ 0� _ Date
PLEASE PRINT
Please complete all sections, I through
4. Complete Fee Schedule below
1. Location of installation -_Number of Inspections per permit allowed
Address I S11 G G 6 tr t `}' -_ Service included: Item4 Cost(ea.) Sum
Building A. Residential-per unit
City T 1�_N t� p Suite No.
.000 sq,ft.or less $110.00 4
Tenant Name Each additional 500 sq ft
(it commercial) or portion thereof $25.00 _
Limited Energy $25.00 ____ 1
Map N0. Tax Lot -- Each Manut'd Home or Macular
Dwelling Service or Feeder $68.00 2
Thomas Map Book: Page: Section:_._
Directions_ -- ---- B. Services or Feeders
-- Installation,alterations or relocatio E '
200 amps or less $6000 - %- 2
Commercial ❑ Residential 201 amps to 400 amps t80.00 - 2
401 amps to 600 amps $120.00 2
2a. Contracior installation only: 601 amps to 1000 amps --- $180.00 - 2
1 Y Over 1000 amps or volts $340.00 _ 2
Electrical Contractor lrii��`�t-��� (� '� Reconnect only $50.00 2
Address .,%t,4 5.
,
City ,!A, �4Tf, „, State ZIP C. Temporary Services or Feeders
Date Job Number _-_ Installation,alteration or relocation
Property Owner N I^`i A t- bZJ r (L%• 200 amps or less $50.00 2
Contractor's License No. 3-1 y (_ _ 201 amps to 400 amps $75.00 _ 2
Contractc,-'s Board Re No. ,A 5y�' 401 amps to 600 amps $100.00 2
Reg, Over 600 arnps to 1000 volts see'B'above
Signature of Supr. Elec'n ,� D. Branch Circuits
License No. 1TPhone No. '` - = � Now,allera;ion or extension per panel
3G.( . a) The foe ior branch circuits with
2b. For owner installations: purchase or service or feeder fee.
Each branch circuit $5.00 2
b) The fee for bi anch circuits without
Print Owner's ams one a purchase of service or feeder fee.
dfess First branch r ircuit $35.00 2
Each add'nl branch circuit $5.00 _ 2
city tato V-dip - E. Miscellaneous (Service or Feeder not included)
Each pump or irrigation circle $40.00 2
The installation is being made on property I own Each sign or outline lighting $40.00 _ 2
which is not intended for sale, lease or rent, signal circuit(s)or a limited
energy panel,alteration
Owner's Signature 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 _
Per hour $5500
Please check approF ate Nem and enter fee In section 5B. In Plant $55.00
__ a nr more residential units in one structure 5. Fees
Service and feeder, 800 amps or more Qo
r_S'ystem over 6:00 volts nominal A. Enter total of above fees $ _
_C'assitied area or structure containing Special 5% Surcharge (.05 X total fees) $
occupancy as described in N.E.C. Chapter 6 Subtotal $ (Q3,00 _
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 constructior Subtotal $
services. [.1 Trust Account $
--.-----• Balance Due $ co 3 A
For Inspections call This Permit t-comes null and void 11 the wor%suihorbed by the permit In nal commenced
within 180 days from dale or Issuance or such permll or If the work authorlt•d is
v wapended or abandoned of any time after work is commenced lot a period of 190 days.
24-hour tecordhr, one working day in advance of need EledticalPermitsat,non-relundsbleand non
dnnelenMe.
co 39 Y/ 75 8,514