Permit J WASHINGTON COUNTY RESTRICTED Z
Department of Land Use & Transportation E D
linVi Electrical First Avenue, Sect ELECTRICAL ENERGY
155 North First Avenue, #350 -12 •
Hillsboro, 503)64 Oregon 97124 APPLICATION
Information: (503) 640 -343470 0 Fax: (503) 693 -4412
PLEASE PRINT
Please complete all sections, 1 through 5. Permit No. E Le15- 002_0
1. Location of installation e Date /j - 20
Address 9g 57 560 W 4$}I. Sc All )
city �! 4 , n Zip Code 7 7223 4. Type of work:
, 1 ,
Map No. I SI --4� Tax Lot I to 7. RESIDENTIAL Restricted Energy Fee $40.00
Thomas Map Book: Page Section (for all systems)
Check type of work involved:
Directions
Audio and Stereo Systems*
Commercial Residential ❑ = B Alarm
T elephone Systems' — Tenant Name _ G • arage Door Opener*
(if commercial) Lis / L — Fire Alarm
H eating, Ventilation and Air Conditioning Systems*
2. Contractor application: = Vacuum Systems
Other
Electrical Contractor fr?1d2
Addres 2 * A /t- A./ - T COMMERCIAL Fee for each system $40.00
City MEI State • ; Zip g72_ (see OAR 918 - 260-280)
Date 6 / p Job Number Check type of work Involved:
Property awn- r
Contractor's License No. 24.- 6 6tet -i:
Contractor's Board Reg. No. s rGG 75-- Boiler Controls
Clock Systems
Phone No. 3'ST 3 '7 ��� 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 Zip Outdoor Landscape Lighting*
This permit is issued under OAR 918 -320-370. The applicant agrees tective 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 I 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 $ 4/ . U-0-
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) $ 42 • ere
the corrections are completed.
The person signing t ;, perm st be the applicant or a person Trust Account $
authorized to bind e . • • II ,
Signature /it` Total $ � 'U0-
Authority if other than applicant 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