Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00217
dkvta 1 DEVELOPMENT SERVICES DATE ISSUED: 4/29/04
13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171
PARCEL: 1S136AD-02200
SITE ADDRESS: 10450 SW 71ST AVE
SUBDIVISION: VILLA RIDGE ZONING: R -4.5
BLOCK: LOT : 003 JURISDICTION: TIG
Project Description: NC and furnace
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: SIGNALJPANEL:
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: 2 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:
SAMPSON, GENE E AND MARY K GRF ELECTRIC
10450 SW 71ST 15460 SE PARADISE LN
TIGARD, OR 97223 MULINO, OR 97042
Phone: 503 - 244 -3751 Phone: 503 - 829 -4146
Reg #: LIC 76751
SUP I655S
FEES ELE 3 -484C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 4/29/04 $60.15
[TAX] 8% State Surcharge 4/29/04 $4 Elect'I Final
Total $64.96
This Permit is issued subjed 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 (503) 246-6699 or
1- 800 - 332 -2344.
Issued By: ( Permit Signature:. ?J / � I
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 639 -4175 by 7:OOpm for an inspection the next business day
t .. .., .. .., ,
Electrical Permit Application FOR OFFICE USE ONLY
Received Electrical
. . . Date/By: Permit No._e_..2a? Li- oo 0
City of Tigard , . . Planning Approval Sign
Date/By:
Permit No.:
' •
13125 SW Hall Blvd. . Plan Review Other
Tigard, Oregon 97223 „..
” • Date/By: Permit No.V1M-0 9--‘49a / ei
Phone: 503-639-4171 Fax: 503-598-1960 , Post-Review . Land Use
i Nelli 'it\ Date/By: Case No.:
Internet: www.ci.tigard.or.us :, . . , • ' , 2_14; el I Contact Juris.: ISI See Page 2 for
24-hour Inspection Request: 503-6394175. ' : ' -- - --- Name/Method: Supplemental Information.
.. „ . .
' :. .:*.... ::: ' TYPt0F:WORIC:: .• ...,....,, '.'.':::•-•••:.:::•.:•••:::. • :.,PLAN illthat a ply) ' • • .•
D New construction D Demolition 0 Service over 225 amps- Health-care facility
commercial El Hazardous location
Addition/alteration/replacement Other: 0 Service over 320 amps-rating of 0 Building over 10,000 square feet,
tAlI3E9ORY't:i ::CONSTRUCTION !::::f:::•' • • •• •. • • . •-• . 1 & 2 family dwellings four or more residential units in
ao & 2-Family dwelling 1 P Commercial/Industrial 0 System over 600 volts nominal one structure
0 Building over three stories 0 Feeders, 400 amps or more
0 Accessory Building L 1=I Multi-Family 0 Occupant load over 99 persons 0 Manufactured structures or RV park
0 Master Builder 1 0 Other: 0 Egress/lighting plan 0 Other:
:.....: '':•:.. ..-.:-..loa.strEINFoRmAnorstind:LOCATION,.::::•• • -• .: ..:-..:.:': • Submit sets of plans with any of the above.
The above are not applicable to temporaryconstruction service.
Job site address: / 0 *5/9 $ --- i .,.. :)!.... .. ..,:.;:• • - ..:..:.:.':.:.::: ..:,•::. : .F.EE*!:SCHED1J)LS.': • : • 'i • ..' ; ; • •• • . ',-
Suite #: 1 Bldg./Apt.#: ' 1 L' Number of inspections per permit allowed
Project Name: 6 el e_ 9 4 Pl ie , S r? Description Qty Fee (ca.) Total
New residential-single or multl-family per
C_. I i
Cross 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 portion thereof 33.40 1
' Limited energy, residential 75.00 2
Subdivision: 1 Lot #: Limited energy, non residential 75.00 2
Tax map/parcel #: Each manufactured home or modular dwelling
.- ..1:•..:,'.::; -:.' '' ..-: : '' ''....."':'•-'1:-:. servi and/or feeder 90.90 2
us or feeders - installation,
alteration or relocation:
1 200 amps or less 80.30 , 2
..; / -(.. cwt ,1 -1- fi / I /24 ti-i'L' 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Over 1000 amps or volts 454.65 , 2
Name: 29e ,, ( 7_ s co • Reconnect only 66.85 2
•
Address: JO 4 sr Su f.?/ Temporary services or feeders - installation,
alteration, or relocation:
City/State/Zip: .7; , ,, q ..-- ) 2_2,3 - 200 amps or less 66.85 , 1
201 amps to 400 amps 100.30 2
Phone: - 2.. , (4-t - 3 :7 s- fi , Fax: ... 401 to 600 amps 133.75
2
'411 t:;;;:,::.!:...J.:,..EICCINTACT..tgla(g4: .. - .;.,,: ,•., :..• ' Branch circuits - new, alteration, or
Name: extension per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 6.65 2
City/State/Zip: B. Fee for branch circuits without purchase of
- service or feeder fee, first branch circuit I 46.85 1 1 4 1,7 . 2
Phone: , j Fax: Each additional branch circuit
.2___ 6.65 13 3 1), 2
E-mail: .. Misc.(Service or feeder not included):
:.--- , e1. - . .. •...., :. -0-, • ,t • . • . em.rrnr.....' emr •ev i ng. i ..Z! , - ,..,;y!,., ,.: ... ..:.::;:i.::: ;:+1 Each pump or gation circle 53.40 2
::.-!•::::..;'...:'...,;`..::•:tillitatitA*1-3t11S-';. ". • '' • '''. .. ' • ' ''''. ''. . ''` ' . Each sign or outline lighting 53.40 2
w...
Job No: Signal circuit(s) or a limited energy panel,
• alteration, or extension Page 2 2
Business Name: 6 iz-ir Ei ce....b j r_. Description:
Address: 1 511-69 0 S. PArp 14 er 4 4' • -r) Each additional inspection over the allowable in any of the above:
City/State/Zip: M /, •.: Of_ -7 19 LI .-- Per inspection per hour (min. 1 hour) 62.50
_
Phone: g/A , ' , 4 . 1 ", -Q 1 Fax: 51)3- 8 Z-9 - S -P-i-:-1 Investigation fee:
Other
CCB Lic. #: 7 / - 7 s Lic. #: 3 - Lt. ey.. C._ , '',..:.:'.:.::..i::::. :::';.: ...:..:.:. • : ,.
Supervising electrician _.. nr Subtotal $ toe) - 1 G
-(
signature required: • -N -■.,, Plan Review (25% of Permit Fee) $ 9 ... .c
Print Name: W .5 n ii 4,„ < 1 Lic. #: 1 Le C '15 , State Surcharge (8% of Pennit Fee) $ 11" TOTAL PERMIT FEE $
Authorized * Notice: This permit application expires if a permit Is not obtained ivithiri
Signature: Date:_Acab y 180 days after ithas been accepted as complete.
Fee methodology set by Tri-County Building Industry Service Board.
• (Please print name) 1 -- 1 (p
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