Permit _ i/
Community Development ELECTRICAL PERMIT APPLICATION
A. 13125 SW Hall Blvd.
Tigard, OR 97223 Planck/Rec. # 95- a7/79a
`� `� Permit # �= ./c9.�= 04/69
, �I Phone (503) 639 -4171 Date Issued to- 49
s r r FAX (503) 684 -7297
CITY OF TIGARD TDD No. (503) 684 -2772 Issued by
Inspection (503) 639 -4175
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development Number of Inspections per permit allowed
Address 6650 S .W Redwood Ln. 1st Floox Service included: Items Cost(ea) Sum
City /State/Zip Tigard, Oregon 4a. Residential - per unit 4
1000 sq. ft. or less $110.00
Name (or name of business) Freeman Assoc . Each al 500 sq. ft. o r 1
portion thereof $25.00
-
Commercial El Residential ❑ Limited Energy $25.00
Each Manufd 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, Inc, 200 amps or less $60.00 2
Address 5 5 S . E Main S t . 201 amps to 400 amps $80.00 2 -
401 amps to 600 amps $120.00 2 -
City Portland . State Or Zip 9721 4 601 amps to 1000 amps $180.00 2
Phone No. 2 3 3-2 0 0 6 Over 1000 amps or volts $340.00 2
-
Contractor's License No. 2 6- 4 51 C Reeonned 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. EIec tie/v 200 amps or less $50.00 2 - License No. 28085 Phone No. 3 -2006 201 amps to 400 amps $75.00
- 401 amps to 600 amps $100.00
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.
Each branch circuit 3 $5.00 15.00 2
Phone No. b) The lee 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 1 $35.00 3 5.0 0 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 circuit(s) or a limited energy 2
Please check appropriate item and enter fee in section 5B. panel, alteration or extension $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 inspection $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:
NOTICE 5a. Enter total of above fees $ 5 0 . 0 0
5% Surcharge (.05 X total fees) $ 2 . 5 0
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $
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 $
COMMENCED. ❑ Trust Account # $
Balance Due $ 5 2.5 0
waEbwnMNN,tyrm.,pp
05/30/2000 Activities for Case #: ELC95 -00464
2:19:31 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELCC001 Application received 10/17/1995 CJS RECD TMP 12/04/1995
ELCC003 Permit created 10/17/1995 CJS RECD TMP 12/04/1995
ELCC700 Ceiling Cover 10/17/1995 TMP 12/04/1995
ELCC720 Wall Cover 10/17/1995 TMP 12/04/1995
ELCC730 Elect'I Service 10/17/1995 TMP 12/04/1995
ELCC799 Elect'I Final 10/17/1995 TMP 12/04/1995
ELCC500 (F)Issue permit 10/17/1995 CJS PASS TMP 12/04/1995
ELCA560 Permit voided 12/13/1995 CJS VIOD TMP 03/07/1996 BACHOFNER ELECTRIC IS
NO LONGER THE
CONTRACTOR FOR THIS
ADDRESS.
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