Permit V
Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd. .
Tigard, OR 97223 Planck/Rec. # 4s- )69.X.1 I
Permit # Fit' 95 r3.2� )
is ' A l' ii 1 Phone (503) 639 -4171
Date Issued R • 1/- 9S
"'�'` ' I " FAX (503) 684 -7297
CITY OF TIGARD TDD No. (503) 684 -2772 Issued by charier -re ,.. ; di
Inspection (503) 639 -4175
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development Number of Inspections per permit allowed
200
Address 6650 S.W Redwood Lane suite - Service included: Items Cost(ea) Sum
City /State/Zip Tigard Oregon 4a. Residential - per unit 4
1000 sq. ft. or less $110.00
-
Each additional soo 64.11. or
Name (or name of business) Imagebuilders
portion thereof $25.00 1
Commercial ® Residential ❑ Limited Energy $25.00 - Each Manurd Home or Modular 2
Dwelling Service or Feeder $68.00
2a. Contractor installation only:
4b. Services or Feeders
Installation, alteration, or relocation 2
Electrical Contractor Bachofner Electric 200 amps or less $60.00 2
Address 5 5 S . E Main S t . 201 amps to 400 amps $80.00 2
City Portland State or Zip 9721 4 401 amps to 600 amps $120.00 2
City p sot amps to 1000 amps $180.00 2 -
Phone No. 2 3 3-2 0 0 6 Over loon amps or vans $340.00 2
Contractor's License No. 2 6- 4 51 C Reconned only $50.00
Contractor's Board Reg. No. 4 4 5 6 9 4c. Temporary Services or Feeders
Installation, alteration, or relocation 2
Signature of Supr. Elec'n i.,_ , , __fa 200 amps or less $50.00 2
License No. 1 7 6 9S Phone No. 2 3 3 e i 0 6 201 amps to 400 amps $75.00 2
401 amps to 600 amps $1 00.00
Over 600 amps to 1000 volts
2b. For owner installations: see •b' above.
4d. Branch Circuits
Print Owner's Name New, alteration or extension per panel
Address a) The fee for branch circuits with
City State Zip purchase of service or feeder fee. 2
Each branch circuit $5.00
Phone No. b) The fee for branch circuits without
The installation is being made on property I own which is purchase of service or feeder fee. 2
not intended for sale, lease or rent. First branch circuit $35.00 2
Each additional branch circuit $5.00
Owner's Signature 4e. Miscellaneous
(Service or feeder not included) 2
3. Plan Review section (if required): Each pump or irrigation circle $40.00 2 - Each sign or outline lighting $40.00
Signal cimuit(s) or a limited energy 2
Please check appropriate item and enter fee in section 5B. panel, alteration or extension 1 $40.00 40.00
4 or more residential units in one structure Minor Labels (10) $100.00
-
Service and feeder 225 amps or more
System over 600 volts nominal 4f. Each additional inspection over
Classified area or structure containing special occupancy the allowable in any of the above
as described in N.E.C. Chapter 5 Per inspectio $35.00 -
Per hour $55.00
-
In Plant $55.00
Submit 2 sets of plans with application where any of the above
apply. Not required for temporary construction services. 5. Fees:
5a. Enter total of above fees $ 40.00
NOTICE 5% Surcharge (.05 X total fees) $ 2.00
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $ 2.00
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5b. Enter 25% of line A for
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Plan Review if required (Sec.3) $
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal $ 42.00
COMMENCED. ❑ Trust Account # $
Balance Due $ 42.00
rpdbor dhMMcpm.arp
6 /10 /99 Activities for Case #: ELC95 -00321
1:15:53 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELCC001 Application received 8/11/95 CJS RECD TMP 12/14/95
ELCC003 Permit created 8/11/95 CJS PEND TMP 12/14/95
ELCC500 (F)Issue permit 8/11/95 CJS PASS TMP 12/14/95
ELCC800 Case Finaled 3/8/96 MJR YES MJR 3/11/96
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