Permit V
i llik WASHINGTON COUNTY RESTRICTED
IPP Department of Land Use & Transportation
Electrical F en Section ELECTRICAL ENERGY
155 North First rst Avenue, #350 -12
Hillsboro, 503)64 Oregon 97124 APPLICATION
Information: (503) 640 -3434 70 D Fax: (503) 693-4412
PLEASE PRINT
Please complete all sections, 1 through 5, Permit No. e2- 2... Q 5- 005 Z.
1. Location of installation Date - Z ) I q 19.5
Address ( q 3 S \COL/ 12
t I PI c.. 1-
f City F,, A Zip Code 97 22-3 4. Type of work:
Map No. 15 10 - DD Tax Lot 01 000 RESIDENTIAL Restricted Energy Fee $40.00
(for all systems)
Thomas Map Book: Page Section
Check type of work involved:
Directions
— Audio and Stereo Systems*
Commercial AI Residential ❑ ^ Burglar Alarm
- Telephone Systems*
Tenant Name ‘ / I E Garage Door Opener*
(if commercial) 0 S7'o N K I TEN Fire Alarm
Heating, Ventilation and Air Conditioning Systems*
2. Contractor application: - Vacuum Systems*
r Other
Electrical Contractor k / h T v khg- L-- Ct edt krz 0 (fr>J
Address 57/0 NC SA-A /D tf R(J/D COMMERCIAL Fee for each system $40.00
City rO TZ- /D State diZ Zip 9`12 -13 (see OAR 918 - 260-260)
Date ( i.S/ lr Job Numb r / 'n 7 7 ,),,,3
Property caner 1�0 s To,�
� j Ni �4./ Check type of work Involved:
Contractor's License No. a — .Sl 0 L-C" ^ goiter Controls
Contractor's Board Reg. p No. -4 o 6 0 _
Phone No. 5m3, of FA • • .3 x/3 Clock Systems
1 " Data Telecommunications Installations
- Fire Alarm Installation
3. Owner application: - HVAC
- Instrumentation
Print Owner's Name Phone No. — Intercom and Paging System
- Landscape Irrigation Control*
Address — Medical
— Nurse Calls •
City State Zp — Outdoor Landscape Lighting*
This permit is issued under OAR 918-320-370. The applicant agrees Protective Signaling
to make only restricted energy installations (100 volt amps or less) Other
under this permit and to do the following: '—'
1. Only use electrical licensed persons to do installations where
required. (Certain residential and other transactions are exempt ( Number of Systems
from licensing. These have asterisks ("). All others need licens-
ing.)
2. Call for an inspection when all the installations under this permit " No licenses are required. Licenses are required for all other installations.
are ready for inspection.
3. Purchase separate permits for all installations that are not ready 5. Fees
for Inspection when the inspector is out to inspect under this
permit. Enter fees $ l0
4. Assume responsibility for assuming that all corrections required
by the inspector are done, and
5. Assume responsibility for calling for a final Inspection when all of 5% Surcharge (.05 X total above) $ 2-
the corrections are completed.
The perso signing this permit must • e the applicant or a person
Trust Account $ ..---
authorize: ,,ind the applicant. , q )---
Signature _ ��,��V A • Total $
Authority if other than applicant )-3 T�-E This permit becomes null and void if the work authorized by the
permit is not commenced within 180 days from date of issuance
For inspections call of such permit or If the work authorized is suspended or abandoned
640 -3561 or 693 -4415 at any time after work is commenced for a period of 180 days.
Electrical Permits are non - refundable and non - transferable.
24 - hour recorder, one working day in advance of need BL24 - 114
f