Permit WASHINGTON COUNTY ELECTRICAL PERMIT
', Department of Land Use & Transportation
Electrical Inspection Section
APPLICATION
155 North First Avenue, #350 -12
Hillsboro, Oregon 97124
Information: (503) 640 -3470 Fax: (503) 693 -4412 � �IP
PLEASE PRINT Permit
Please complete all sections, 1 through 5. Numbe c lS - gif13 D ate Cu 13019:5
1. Location of installation qln 6 /7 ad) , 4. Complete Fee Schedule below
Address Washington Square ;1al1 fd. Number of inspections per permit allowed
Building
City Tigard Suite te No. Space ;rFC - 9 Service included: Items Cost(ea.) Sum
Tenant Name A. Residential - per unit
(if commercial) 1 rF7wart
1000 sq ft. or less $110.00 4
Map No. Tax Lot Each additional 500 sq. ft
p or portion thereof $25.00
Thomas Map Book: Page: Section: Each Energy $25.00 1
P 9 Each h Manuf'd Home or Modular
Directions Dwelling Service or Feeder $68.00 2
Commercial "" Residential ❑ B. Services or Feeders
Installation, alterations or relocation
200 amps or less $60.00 2
2a. Contractor installation only: 201 amps to 400 amps $80.00 2
401 amps to 600 amps $120.00 2
Electrical Contractor Atlas Electrical • 601 amps to 1000 amps $180.00 2
Address 4403 SE Roethe Road Over 1000 amps or volts $340.00 2
City iii lwaukie State OR ZIP 97267 • Reconnect only $50.00 2
Date 6/28/95 Job Number 3426
Property Owner A mar Pacific C. Temporary Services or Fee
Contractor's License No. 3 - 2C Installation, alteration or relocation
Contractor's Board Reg. No. :12/ 200 amps or less $50.00 2
201 amps to 400 amps $75.00 2
Signature of Su Elec'n eat_ I � 401 amps to 600 amps $100.00 2
g p r. Over 600 amps to 1000 volts see "B" above
License No. 1486S Phone No. 659 -2212
- D. Branch Circuits
2b. For owner installations: New, alteration or extension per panel
a) The fee for branch circuits with
Print Owner's 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 _1 $35.00 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
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
Per inspection $35 00
Service and feeder, 800 amps or more Per hour $55.00
System over 600 volts nominal In Plant $55.00
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 $ 3r1,. 00
above apply. Not required for temporary construction 5% Surcharge (.05 X total fees) $ 1.75
services. Subtotal $
This permit becomes null and void if 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) $
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 $ 36.75
681 -3699 or 681 -3698
24-hour recorder, one working day in advance of need
BL28 • 3/95