Permit • CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00404
1 DEVELOPMENT SERVICES DATE ISSUED: 6/10/2005
. „i 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 - 4171
PARCEL: 2 S 112 BA -09400
SITE ADDRESS: 14450 SW PENNYWORT TERR ZONING: R -12
SUBDIVISION: BONITA TOWNHOMES LOT : 030 JURISDICTION: TIG
Project Description: 1 branch circuit.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HM/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
VICKI BALLARD GRF ELECTRIC
14450 SW BALLARD 15460 SE PARADISE LN
TIGARD, OR 97224 MULINO, OR 97042
Phone: 503 - 624 -0865 Phone: 503 - 829 -4146
FEES Reg #: LIC 76751
SUP 1655S
Description Date Amount ELE 3 - 484C
[ELPRMT] ELC Permit 6/10/2005 $46.85
[TAX] 8% State Surcharge 6/10/2005 $3.75 REQUIRED ITEMS AND REPORTS
Total $50.60
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws.
All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is
suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at
- 246 669 r 0 3344.
Issued
Issued By: ( � c Permittee Signature: d'?Z_
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO: •
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
` FOR OFF'IC'E USE ONLY
Electrical Permit l. licatian Receive , ,, Eiec , y l,
1 �; D armin �� /(I Per No.: T k. /4. 4 ' " /
City of Tigard fff��� �1 V ® Date/
Planning Apprdva1 P mit No.:
Pero :
• •• 13125 Hall Blvd. Plan Review Other
. Tigard, Oregon 97223 • • s 1 / DatrJBy: Permit No.:
Phone: 503 -639 -4171 Fax: 503 - 5 �5 Post - Review Land Use
'., T i a l 4 9 4. , i � Date/By: Case No.:
Internet: www.ci.tigard.or.us $UILo, Of �--I �
Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503 -639 -41 ."--" t.-t VfY Name/Method: Supplemental Information.
•
r• .• :, , •., ;;. ,,.°-.;, !; : , PL y AN V (Please Please check all•that, r .
�,
. .. ^• .f ` '. •y + =Y"_q "i q • • .QJ'��0�`? .N.; ; ��:. 1 r.••. . i : , • h ":ir:•; r{i::�i?�' .♦,
i t:•' .;_,: . .. • ..., i - p•
^-. ' •
❑ Service over 225 amps- ❑ Health -care facility
1111 New construction 111 Demolition commercial ❑ Hazardous location
!(►_' • • ' lion/alteration/re • lacement IN Other: ❑ Service over 320 amps - rating of ❑ Building over 10,000 square feet,
�'� i7 rt s� - to .,
••��� ,- tin , • O • TICT • N <''r' ` •. :-1.. .i•: .:� :':' 1 & 2 family dwellings four or more residential units in
1 & 2 -F amil dwellin: [N Commercial/Industrial ❑ System over 600 volts nominal one structure
I .._ ❑ Building over three stories ❑ Feeders, 400 amps or more
i t Access° Buildin: `. Multi -Famil ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
Master Builder • Other: ❑ Egress/lighting plan Other.
_ . , Submtt sets of plans with any of the above.
�}� �,, �r r "i t; :: .HO' `•i E` t •�.i 11 4 err "01'�1►TION %''1'..A " "r* .;" The above are not applicable to temporary construction service.
Job site address: • - 1 e- .. , 'e fi .',:+;" . • • ',.-•.'''.;: -::"'. , .. .. •FEE/ $CIEDU. .; ::. .:1.''..• .:;
I:E % ...
Suite #: Bld:./A. t. #: Te-r • Number of inspections per permit allowed
- Dcacriptio•u Qty Fee (ea.) Total i
Pro ect Name' G ' New residential - single or multi- family per
Gross street/Directions to job site: dwelling unit. includes attached garage.
• Service included:
• • 1000 sq. ft. or less 145.15 4
• Each additional 500 sq. ft. or ponion thereof 33.40 1
Limited energy, residential 75.00 2 • Subdivision: Lot #• Limited energy, non residential 75.00 2
Each manufactured home or modular dwelling
T ai( ma • /' arcel #' service and/or feeder 90.90 -. 2
�t yu, i- ti:•�- cl Q•� 1' Y i �"tT cc,'.� ;5�;';'Na�i�:`\ .. �`.
( '�"� �3•a�+��r ..e��+1' . , ' ' Servkes or [ceders - installation,
• alteration or relocation:
200 amps or less
80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
601 amps m 1000 amps 240.60 2
�T ul l � ` i,`" : � � � _ t lk� � "� Over 1000 amps or volts 454 ---..
2 .. Name: ! . L 4 /. _ , t Reconnect only 66.85 2
•
1 f Temporary services or feeders - installation,
AddreSS: S L alteration, or relocation:
i. .trL
200 amps or less 66.85 1
201 amps to 400 amps 10030 2
Phone: e: (� - 5 Fax: 401 to 600 amps 133.75 2
rl
�' rt �.`�Y�� i Branch circuits -new, alteration, or
Name: • extension per panel:
• A. Fee for branch circuits with purchase of 6.65 2
Address: ` service or feeder fee, each branch circuit
Ci /State/Zl . • B. Fee for branch circuits without purchase of 1 46 85 (Q • � 2
• service or feeder fee, fast branch circuit 1
Phone: Fax: Each additional blanch circuit 6.65 2'
E-mail ,• Misc.(Service or feeder not included): 53.40 2
, qi. ` L.' , :r u Fi)f ¢•3 a •y �qgr' . 1 x Each pump or on irrigati circle 53.40 2
i'i: Fkrl tl. �' ' Each sign or outline lighting
• Job No: Signal circuit(s) or a limited energy panel, 2
• Address: Al,
• alteration, or extension Page 2
Business Name: / ;_; 0 - Description:
, • ' ,
- � E additional inspection over the allowable in aaYof the above:
r U Per inspection per hour (min. 1 hour) 62.50 I
' one: lY�q:� Fax: 5D3- . Investigation fee: i Usher: J ..
CCB Lic. #: 70%- M , F :� . 4 ;:; 3) . I 1 S : - .
j I -" its eCt[it l' ertiuit:F�es"t . ;'_',":a i : ^ ^,
Supervising electrician � C . Subtotal $ L ,
si i • : Wre • uired: w '. ( Le 101 Plan Review (25% of Permit Fee) $
State Surcharge (8% of Permit Fee) $
Pi inti Name: t i . _ _ TOTAL PERMIT FEE $ . rl G)
Signer rind
Notice: This permit application expires if a permit Ls not obtai thin
Date: 180 days after Ulm been accepted as complete.
Sty *Fee methodology set by Tri -County Building Industry Service Board.
. • - ' ; print
i
- i mi s sTertnit ForunlElcPemt 01/03 .
I'd Li 0 tuloaI3 del9 E9fr.:II SO OI unr
CITY OF TIGARD 0-
BUILDING DIVISION PERMIT #: ELC2005 -00404
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/10/2005
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 6/17/2005 TIME: 7:11AM PAGE: 82
SITE ADDRESS: 14450 SW PENNYWORT TERR CLASS OF WORK:
SUBDIVISION: BONITA TOWNHOMES LOT #: 030 TYPE OF USE:
PROJECT NAME: BALLARD
DESCRIPTION: 1 branch circuit.
OWNER: BALLARD, VICKI PHONE #: 503 - 6240865
CONTRACTOR: GRF ELECTRIC PHONE #: 503829-4146
Inspection Request Scheduled For: Date: 6/17/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 009509-01 503-557 -2220 Y
Corrections /Comments /Instructions:
r �
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: - �`_ Date J�
`�3 Phone #: (503) 718-