Download Building Permit Application

Electrical Permit Application
Washington County, 155 N. 1st AV, Suite 350, MS 12, Hillsboro, OR 97124,
Phone: 503-846-3470, Fax: 503-846-3993/ [email protected]
Inspection Requests: 503-846-3699/www.co.washington.or.us/piro
TYPE OF WORK
New construction
Addition/alteration/replacement
Other:
CATEGORY OF CONSTRUCTION
1- and 2-family dwelling
Multi-family
Commercial/industrial
Master builder
Accessory building
Other:
JOB SITE INFORMATION AND LOCATION
Job no.:
Job address:
City/State/ZIP:
Suite/bldg./apt. no.:
Project name:
Cross street/directions to job site:
Project # ________________________
Permit # _________________________
PLAN REVIEW
Please check all that apply:
Hazardous locations
Service or feeder 400 amps
or more where the available
Service or feeder 600 amps or more
fault current exceeds
Building over three stories
10,000 amps at 150 volts or
Marinas and boatyards
less to ground, or exceeds
Floating buildings
14,000 amps for all other
Commercial-use agricultural
installations.
buildings
Fire pump
Installation of 150 KVA or larger
Emergency system
separately derived system
Addition of new motor
“A,” “E,” “I-2,” “I-3” occupancy
load of 100HP or more
Recreational vehicle parks
Six or more residential units
Supply voltage for more than
Health-care facilities
600 volts nominal
FEE SCHEDULE
Subdivision:
Lot no.:
Tax map/parcel no.:
DESCRIPTION OF WORK
PROPERTY OWNER
TENANT
Name:
Address:
City/State/ZIP:
Phone: (
)
Fax: (
)
Owner installation: This installation is being made on residential or farm property owned by me or a member of
my immediate family. This property is not intended for sale, exchange or rent. (ORS 479.540(1) and 479.560(1).
Owner signature:______________________________________ Date: _____________
APPLICANT
CONTACT PERSON
Business name:
Contact name:
Address:
City/State/ZIP:
Phone: (
)
Fax: (
)
E-mail:
CONTRACTOR
Business name:
Address:
City/State/ZIP:
Phone: (
)
Fax: (
)
E-mail:
CCB lic. no.:
Electrical lic. no.:
City or metro lic.:
Subtotal
Date:
Plan review ( 25% of permit fee)
State surcharge (12% of permit fee)
Authorized
signature:
Print name:
Each additional inspection over allowable in any of the above
107.00
Per inspection
Investigation fee (See compliance)
Other:
ELECTRICAL PERMIT FEES
Supervising electrician
signature, required:
Print name:
*
Description
Qty.
Fee
Total
Residential single- or multi-family dwelling unit.
Includes attached garage.
167.00
1,000 sq. ft. or less
4
47.00
Ea. add’l 500 sq. ft. or portion
Limited energy, residential
107.00
2
(with above sq. ft.)
Limited energy, multi-family
107.00
2
residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
107.00
200 amps or less
2
161.00
201 amps to 400 amps
2
214.00
401 amps to 600 amps
2
321.00
601 amps to 1,000 amps
2
642.00
Over 1,000 amps or volts
2
Temporary services or feeders installation, alteration, and/or
relocation
107.00
200 amps or less
2
161.00
201 amps to 400 amps
2
214.00
401 amps to 599 amps
2
Branch circuits – new, alteration, or extension, per panel
A. Fee for branch circuits with
9.50
above service or feeder fee,
2
each branch circuit
B. Fee for branch circuits
107.00
without service or feeder
2
fee, first branch circuit
9.50
Each add’l branch circuit
Miscellaneous (service or feeder not included)
Each manufactured or modular
113.50
2
dwelling, service, and/or feeder
107.00
Reconnect only
1
107.00
Pump or irrigation circle
2
107.00
Sign or outline lighting
2
Signal circuit(s) or limitedenergy panel, alteration, or
107.00
extension. Describe:
2
TOTAL PERMIT FEE
Date:
This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete
* Number of inspections allowed per permit.
Revision 6/13