Permit COUN 1
WASHINGTON
Department of La nd
i on k
Electrical spection n Use Sectio & Transportation n ELECTRICAL PERMIT
I
155 North First Avenue, #350 -12
Hillsboro, Oregon 97124 APPLICATION
Information: (503) 640 -3470 Fax: (503) 693 -4412
PLEASE PRINT Permit
Please complete all sections, 1 through 5. Number �,L C� q O I 0 Date �o Z 35
1. Location of installation 4. Complete Fee Schedule below
Address 6 Gt) G �/J Die. Number of inspections per permit allowed
/3 6 Building •
City f��j r Suite No. Service included: Items Cost(ea.) Sum
Tenant Warne A. Residential - per unit
(if commercial) // 4
1000 sq. ft. or less 1_ $110.00
Ma No. Tax Lot Each additional 500 sq ft / / /
p or portion thereof "]" $25.00
.....---y
Limited Energy $25.00 1
Thomas Map Book: Page: 695 Section: Each Manuf'd Home or Modular
Directions Dwelling Service or Feeder $68.00 2
l Installation, Services or Feeders
Commercial ❑ Residentia
jj�-`` Installation, alterations or relocation
200 amps or less $60.00 2
2a. Contractor i stallation only: ,, 201 amps to 400 amps $80.00 2
401 amps to 600 amps $120.00 2
Electrical Contractor ■a
601 amps to 1000 amps $180.00 2
Addres Ii i J , Over 1000 amps or volts $340.00 2
City W d State i ZIP _ • Reconnect only $50.00 2
Date -/ - Job Number
Property Owner D n 7)741(-6$"e-//,' 19i"1 S C. Temporary Services or Feeders
Contractor's License No. ,-W., - .- Rje_ _..0 Installation, alteration or relocation
Contractor's Board Reg. No. 200 amps or less $50.00 2
201 amps to 400 amps $75.00 2
Signature of Supr. Elec' �.� 401 amps to 600 amps $100.00 2
Over 600 amps to 1000 volts see "B" above
License No. 3S9, Phone No. a 12 - D7 e ( 1
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'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
g Signal circuit(s) or a limited
energy panel, alteration
3. Plan Review section (if required) or extension $40.00 2 lv
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 i
Classified area or structure containing special
occupancy as described in N.E.C. Chapter 5 5. Fees 1)
Submit 2 sets of plans with application where any of the A. Enter total of above fees $p�/ c0
above apply. Not required for temporary construction 5% Surcharge (.05 X total fees) $ _ 7.7. , 5Z a
services. Subtotal $
This permit becomes null and void it 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) $ Q'
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 $ ? SD
681 -3699 or 681 -3698
24-hour recorder, one working day in advance of need
BL28 • 3/95