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DEPARTMENT OF LAND USE&TRANSPORTATION ,
WASHINGTON LAND DEVELOPMENT SERVICES DIVISION
155 NORTH FIRST,HILLSBORO,OR 97124
a 0_;;;^Ls, — COUNTY, INSPECTION REQUESTS: 503/640-3561/693-4415
OREGON xxxxxxxxx---> 640-34'/0
Page : 1 of 1
Date : 04/24/95
lime 011 : 19
Permit 'Type Ccmmercial. Electrical Permit Permit # ; 05066813
Permit Status APPROVED Applied 04/21/95
Situs Address 10625 SW GREEN13URG KD '1'.L 1-sued 04/21/95 rc:
Permit. 'Title UNl1'ELU VAN LINES C'IRCUI'T Completed
Permit uesc:r. JOB 54'/8U '1'o Expire 10/18/95
Project. '1'ltic UN ' 1'ED VAN LINES CIRCU11' Project # P0049:. 77
Pro_jecc uescr .. JUb ` 4'/8U * EROSION * •
Parcel Number '251'1'1 - Land Use District
° Valuation 0
•
Legal Uescr.
Owner 1NbPEC'VION - 'VIUANU Construction : O'rH
Applicant Name FRAHLER E1,EC'1'RIC C'..ass i f i cation : 900
Applicant: Addr, : illibU SW UREh;N8LJRU RU Occupancy
TIGARU, OR 9'/22:3 Validated by PH
Applicant Phone: 639-4bZ? Inspector Area
Fee description Units Fee/Unit Ext fee Data
--------------------------------------------------------- -----------------------
1st Branch W/out Weeder [Enter #] 1 35 , 00 35 , 00
Subt..otal Electrical Fees : 35 . 00
St-ite Surcharge of 5 1 . 75 `
1'c,tai Electrical Fees : 3b . 7b
*** tees Required *** *** Fees Collected & Credits ***
yMeth.od-Tt:heck # -Recr-,ipt No. Date Payment-- -� - ---��_
CK Z0384 04/21/95 3b . 7b
(lees : :36 . 15
Acl:iustmertt 00 'Total Credits : . 00
'11utal Fees : 36 . '/b 'Total Payments : 3 6 . 115
Balance Due: , UO
Lw
N0710E: This permit becomes null and void If the work or construction for which It Is Issued Is riot commenced within 180 days. Once construction has started,
the permit becomes null and void If construction Is Interrupted(or a period of 180 days. I certify that the Information presentad by the applicant and
his agent or agents In support of title permit Is true and correct to the best of our knowledge. I acknowledge that the Building Department's reliance
upon false and misleading Information may Invalidate this permit. Alt provisions of applicable laws and ordinances governing the construction and use
of tills building or structure will be compiled with whether or not specified on the plbna or notsd on the pians correction sheets. I acknowledge that
the grat ting of a permit does not grant authority to access private property or to use easements. I further act:nowledge that the use or occupancy of k
the structure or building permitted depends upon my calling for Inspections at various times(luring the process o;construction and the building
Inspection staff uer Eying compliance with the various codes. Use or occupancy of the building or structure permitted pr,cr to approval by the
Building Department Is solely at the risk of the applicant and such use or occupancy Is revocable until all Inspection requirements are satisfied and
approval Is given by'he Building Officlal, i further acknowledge that a lien may bd placed on the title of the property upon which the permit Is Issued
specifying that the use or occupancy of the building or structure Is provisional and revocable until the satisfaction of all Inopectlon requlruments.
APPLICANT'S SIGNATURE
_ I
WASHINGTON COUNTY ELECTRICAL PERMIT i
Department of Land Use & Transportation r
j Electrical Inspection Section
%W 155 North First Avenue, #350-12 APPLICATION
Hillsboro, Oregon 97124
Information: (503) 640-3470 Fax: (503) 6934412 Permit S �
Number r _ �/ DatePLEASE-PRINT 4�
/ S
Please complete*all s6ct • • • I
4. Complete Fee Schedule below
1. Location of installation Number of inspections per permit allowed
Address 1 0 6 2 5 SW G k E E N B U R G k 0 A D Service_included: Items Cost(ea.) Slim
Building A. Residential-per unit
City T I G A R D Suite 0.
1000 sq.ft.or loss $110.00 4
Tenant Name l)N ITED VAN LINES Each additional 500 sq.ft
(if commercial) _ or portion thereof $25.00 —
Limited Energy $25.00 1
Map No. Tax Lot Each Manuf'd Home or Modular
Dwelling Service or Feeder $•60.00 2
Thomas Map Book: Page: Section:
Directions----- - — B. Services or Feeders
installatior,alterations or relocation
200 amps or less —.-- $60.00 2 C
Commercial (X Residential 201 amps to 400 amps -- $80.00 _ _ 2 F
401 amps to 600 amps $120.00 2
2 . 601 amps to 1000 amps $140.00 -- 2
a. Con!ractor installation only. Over 1000 amps or volts $340.00 2
Electrical Contractor F N f,,. _E R E L E C T k IC CO . _ Reconnect only - - $50.00 2
Address 1 18 6 0 79-b ffFE7T 77T--R7T9 -
City T I G A R D _ State 0 R ZIP 9 7 2�_3 C. Temporary Services or Feeders
Date 4/2 0/ 9 5 . Job Number 5 4 7 8 0 _ Installation,alteration or relocation
Property Owner 200 gimps or less $50.00 2
Contractor's License No. _ 3 4- 13 C 201 amps to 400 amps $75.00 2
-- 401 amps to 600 amps $100.00 2
Contrac,ior s Board Reg. No. 374 10 Over 600 amps to 1000 volts see'B'above
Signature of Supr. Eler,'n f_ D. Branch Circuits
License No. L.I;1 6$ Phone No. 6 3 9-4 6 2 7 New,alteration or extension per panel
a) The fee for branch circuits with
2b. For owner installations: purchase or service or feeder fee.
Each branch circuit -- $5.00 2
QL:TI IQrii, b) The fee for branch circuits without
nnt�wn e Name �P�L� ii1NDJii purchase of service or feeder lee.
1l�dress -- MON -- First branch circuit I _ $35.00 35 • 00 _ 2
Each add'nl branch circuit $5.00 v 2
Ity tst — TZp - E. Miscellaneous (Service or Feeder not included)
Each pump or irrigation circle $40.00 r.
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
anergy panel,alteration
Owner's Signature -- --__-- or extension �_. $40.00 2
F. Each additional inspection over, the plowable
in any of the above
3. Plan Review section (if required) Per inspection —T $35.00
Per hour $55.00 ---,--.——___--
Please check appropriate hem and enter fee In nectlon 5B. In Plant __— $55.00
_4 or more res'dential unit:, in one structure 5. Fees
Service and feeder, 800 amps or rnore
_—System over G00 volts nominal A. Enter total of above fees $ 3 5 . U U
r 5% Surcharge 05 X total fees
classified area or structure containing special g ( ) $ --1--�-- ,
occupancy as described in N.E.C. Chapter 5 Subtotal $ —
S. 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 construction Subtotal $ _
services. ❑ Trust Account $
Balance Due $ 36 . 75
For Inspections call
This permit becomes null and void H the worts authorized by the permH to not commenced
640-3561 or 693-4415 within 180 days from data of Ian uance of such permit or if the work authorized is
suspended or abandoned at any time after work Is commenced for a Perim, 4-ve.
24-hour recorder, one working day in advance of need Electrical PermRs are non refundable and non-transferable.
P/94
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