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Permit ELECTRICAL PERMIT 1 ® PERMIT #: ELC2001 -00405 41 1 , 41 4 ' DEVELOPMENT SERVICES DATE ISSUED: 08/07/2001 * 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 1 S136DD -00801 SITE ADDRESS: 11565 SW 67TH AVE SUBDIVISION: WEST PORTLAND HEIGHTS ZONING: MUE BLOCK: LOT : 003 JURISDICTION: TIG Project Description: Installation of (1) temporary service. RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS 1000 SF OR LESS: 0 - 200 amp: 1 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: 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: MERCER, ROSS L + VICKI L GRF ELECTRIC 11535 SW 67TH 15460 SE PARADISE LN TIGARD, OR 97223 MULINO, OR 97042 Phone: Phone: 503 - 829 -4146 Reg #: LIC 76751 SUP 1655S ELE 3 -484C FEES Required Inspections Type By Date . Amount Receipt Elect'I Service PRMT CTR 08/07/2001 $66.85 2720010000( Elect'I Final 5PCT CTR 08/07/2001 $5.35 2720010000( Total $72.20 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 -0080. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699 or 1-800-332-2344. Permit Signature: i Issued By: 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: T`1J/, P a T L //7' DATE: LICENSE NO: 1 h s - S Call 639 -4175 by 7:OOpm for an inspection the next business day Rug C3 01 06:49a GRF Electric 5038295747 p.1 Electrical PermatAp • ®n Datereceived••M1111 Permit no.: F/t,3,00/ —a24/05" ll IiI!= City of Tigard Project/appl. no.: Expire date: CiryofTigord Address: 13125 SW Hall Blvd, Tigard, a ' ' 23 Date issued: By: 6 ' Receipt no.: Phone: (503) 639 -4171 Fax: (503) 598 -1960 Case file no,: Payment type: Land use approval: r -'" r' �, ' ;e -,` TYPE. OF.PER;)11T 0 1 & 2 family dwelling or accessory ..1(Commercial/industrial 0 Multi- family 0 Tenant improvement 0 New construction 0 Addition/alteration/replacement 0 Other: 0 Partial ' JOB SITE INFORI\MATION Job address: 5' 'T' Bldg. no.: Suite no.: Tax map /tax lot/account no.: Lot: Block: Subdivision: _ Project name: j V t. (- p el Jr, 1 Description and location of work on premises: , Estimated date of completion/inspection: -}- C a , di. 5 I . f. '4 ..r .. _ � , '' ; CONTRACTOR APPLICATION - - � � _ FEE.SCIIEDULC rani:to: Fee Max Business name: G (Z (= CI e. c--f- t t~ c.. Description I a fry. (ea) ( t otai I no. insp New residential - single ormulli family per Address: ( ritf /all 5. P ra t`SP Lt., dwellinguniLlncludesr atmdtedgarage. City: /1/14 We/ o 923 � I State: Oft_ (ZIP: go t jc( -2 Serviccmcluded Phone: 5b3 -fzq "'I-144/431 Fax: e7S1 -6-7f71 E-mail: 1000 sq. ft. or less 4 CCB no.: — 2 10'7 91 I Elec. bus. lic. no: 3 - ti. g , C Each additional 500 sq. ft. or portion thereof Limited energy, residential 2 City /metro lic. no.: 2.- Limited energy, non- residential ___ 2 , a i` ; © Each manufactured home or modular dwelling Signs a of upervrs ng ectrici • (required) sane Service and/or feeder ■■ 2 Sup. elect name (print): , ,7 r; y _ , - ir ,, License no: //, S .C Services orfeeders installation, IIII a TROPE• RTY O%VNEIt 2 n p s or less Name (print): J 0 L (9 fee y l Jr, 201 amps to 400 amps Mailing address: f 5 I j S (y 7 401 amps to 600 amps 601 amps to 1000 amps ___ 2 City: Z t I .� ( I State: [ZIP: Over 1000 amps or volts 2 t Phone: -7 u— frog (IFax: 1E Reconnect only I Owner installation: The installation is being made on property I own Temporary services or feeders - _ : which is not intended for sale, lease, rent, or exchange according to insre 'll't1°", °Iterpeon,orreloeation ORS 447, 455, 479, 670, 701. 200 amps or less 1 ' 2 " 201 amps to 400 amps 2 Owner's signature: Date: 401 to 600 am.s 2 t ''�° ':' ENGINEER:' Branch circuits- new, alteration, or extension per panel: Name: A. Fee for branch circuits with purchase of Address: service or feeder fee, each branch circuit 2 City: B F for branch ci n without purchase • of service or feeder fee, first branch circuit: 2 y I State: I �r l' : Phone: F ax: E-mail: Each additional branch circuit: ' "' ' PLAN .REVILWV =: (Please check all that ap Misc . (Service or feeder not included): 0 Service over 225 amps- commercial 0 Health-care facility Each pump or irrigation circle 2 0 Service over320 amps - rating of 1 &2 0 Hazardous location Each sign or outline lighting 2 family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) ora limited energy panel, 0 System over600 volts nominal more residential units in one structure alteration. or extensions 2 0 Building over three stories 0 Feeders. 400 amps or more *Description: 0 Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable in any of the above: 0 Egress/lightingplan 0 Other. Per inspection I 1 1 Submit sets of plans with any of the above. Investigation fee The above are not applicable to temporary construction service. Other / C Not ail jurisdictions accept aedit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $ �D t! 6 0 Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $ 5-, 3 S Credit card uumber. I 1 within 180 days after it has been State surcharge (8%) $ T Expires accepted as complete. TOTAL $ Na credit card �] , l � $ ( / Cardholder signature Amount 4615 (6I00ll'OM) • , C ITY OF TIGARD BUILDING INSPECTION DIVISION IH .. - 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 p� BUP • Date Requested a --/' AM PM BLD Location / / <S S 67 `" Suite MEC Contact Person (,_��-UI" d Ph f `7 T4 PLM Contractor 6-k. F Ph SWR BUILDING Tenant/Owner ELC a6V/c9D l 'G, Retaining Wall ELR Footing • Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes: Slab .SIT Post & Beam ' Ext Sheath /Shear Int Sheath /Shear Framing Insulation 7 4._ £_ r /4 c-- Drywall Nailing � ` %�� o Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc: . Final PASS .PART FAIL • PLUMBING • Post & Beam - Under Slab Top Out Water Service Sanitary Sewer Rain Drains Final PASS PART FAIL togi MECHANICAL Post & Beam Rough In Gas Line . . Smoke Dampers Final PASS PART FAIL • ELECTRICAL Commusw,011 . Service �,� ,/ Rough In C_e�' „mod 0 UG /Slab Low Voltage p • Fir- • Iarm a= U d /e(- 1 ' PART FAIL Backfill /Grading Sanitary Sewer Storm Drain • [ ] Reinspection fee of $ required before ne. ' pection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line . [ ] Please call for reinspection RE: a [ Unable to inspect - no access ADA —�� , / Approach /Sidewalk Other Date / Inspectors ■ xt Final _ PASS PART FAIL DO NOT REMOVE this inspection record from the job site. •