Permit iq CITY OF TIGARD - . ELECTRICAL PERMIT •
PERMIT #: ELC2007 -00750
r ' 11 .?' , COMMUNITY DEVELOPMENT DATE ISSUED: 11/8/2007
(TIGARD . 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 25101 DC -05700
SITE ADDRESS: 13495 SW 74TH AVE ZONING: R -3.5
SUBDIVISION: PACIFIC RIDGE LOT : 009 JURISDICTION: TIG
PROJECT: WALDEN
Project Description: 2 branch circuits: AC and outlet.
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: SIGNAUPANEL:
MANF HM/ SVCI 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: 1 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:
WAYNE WALDEN GRF ELECTRIC
13495 SW 74TH AVE. 15460 S PARADISE LN
TIGARD, OR 97223 MULINO, OR 97042
Phone: 503 - 620 -6842 Contact #: PRI 503 - 829 -4146
FAX 503 - 829 -5747
FEES
Description Date Amount Reg #: ELE 3 -484C
[ELPRMT] ELC Permit 11/8/2007 $53.50 LIC 76751
[TAXI 8% State Surcharge 11/8/2007 $4.28 SUP 1655S
Total $57.78 REQUIRED ITEMS AND REPORTS
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 503.246.6699 or 1.800.332.2344.
Issued By: _e� , �.�, _ k�„ Permittee Signature: 7- '- d.,___
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.
' Nov 07 07 01:13p GRFELECTRIC 5038295747 p.1
Electrical Permit lication FOR OFFICE USE ONLY
Received Electrical n
City of Tigard WEI
Date/By: �(/ i / 1 3 PetPermit t No. A L �O� /�
Planning Appr al Sign ` Date/By; Permit No.;
^' 13125 SW Ha1L.81vd. NOV 7 /O Plan Review Other
Tigard, Oregon 97223 CIT Date/By: Permit No.:
Phone: 503- 639 -4171 Fax :; ' ; 6610 i Past-Revie land Use .
Internet: www.ci.tigard.or.us OW 1 rr ;ire �� ?t + +e Date/By: Case No.:
r t j !t e • J I Contact Juris.: ® Sec Page 2 for
24 -hour Inspection Request: 503 -639 -4175 1 "` Name/Method: , Supplemental Information,
•
':;:. TYPE•.OF WORK PLAN REVIEW (Please check &that aPply) _
Q New construction ❑ Demolition ❑ Service over 225 amps- I ❑ Health -care facility
commercial ❑ Hazardous location
' Addition/alteration/replacement ❑ Other: ❑ Service over 320 amps - rating of ❑ Building over 10,000 square feet,
'' CATEGORY "OF.CONSTRUCTION'' .. 1 & 2 family dwellings four or more residential units in
Et 1 & 2- Family dwelling ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
❑ Accessory Building [] Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egressf1ightiteg plan ❑ Other: .
Submit sets of plans with any of the above.
]OB SITEIINFORMATIO�I' and LOCATION The above are not applicable to temporary construction service.
Job site address: f 3 9 C 5(..c...) •7 -
- ' . . . , FEE* %SCHEDULE; .: .;
Suite #: 1 Bldg. /Apt. #: _ Number of inspections per permit allowed
Project Name: Wpt. ( (1 i.-11 D.,.. iptiou 1 Qty 1 Fee (ea.) l Total l 1
New residential - single or multi- famlly per
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: Lot #: Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
L : ; .." 'DESCI PTION Or WORK " service and/or feeder 90.90 2
Services or feeders - installation,
alteration or relocation:
�'` 200 amps or less 80.30 2
2 - L'�( ` P � .(,,,- A C- / Utz ' - f' . - 201 MIN: to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
601 amps to 1000 amps 240.60 2
PAOPERTX'OWNIw$ ` 5 ;� t ) �-� � TENANT Over 1000 amps or volts 454.65 2
m
Nae: VV 4 ,- e \/i/ i . ) A r --t) e) Reconnect only 66.85 2
/�,_, , y Temporary services or feeders - installation,
Address: 5 LA) y�l t! 1 alteration, or relocation: 66.85 1
City/State/Zip: ; / e ,) 9 e ? 2 _ 200 amps or less
201 turps to 400 amps
Phone: to Z-0 -- 0Q. - ?, Fax ]00.30 2
401 to 600 amps 133.75 2
APPLICANT.• ;V*. ' ® . CONTACT :PERSON "' - Branch circuits - new, a 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
46.85 c ( y , a '
service or feeder fee, first branch circuit 2
. Phone: I Fax: 1 Each additional branch circuit 6.65 �
c
E -mail: Misc.(Scrvice or feeder not included):
Each pump or irrigation circle 53.40 2
e , ;;;, r {: i ICQNTRACT %' . '.. Each sign or outline lighting . 53.40 _ 2
Job No: Signal circuit(s) or a limited energy panel,
alteration, or extension Page 2 2 -
Business Name: e j'-f ei eC'.,-,-Y . Description: __
Address: t j-( ( S, PA ri , f ia4,e 1-r) ,
Each additional inspection over the allowable in an of the above:
City /State/Zip: Mi I, , .; 0 1 C —7 0 L-j Per inspection per hour (min. 1 hour) 62.50
. Phone: 9y3 - 1..,ef , t-{ j Y-Lfi Fax: 513- 8 L - s -pet-7 Investigation fee:
Other:
CCB Lic. #: - 3 f9 - i s Lic. #: .3 - 'f T' 9- C '; ; : ; - ' ! Elecfrical Perii~it'Fees* ..:: ; _
Supervising electrician Subtotal 3 4 0
signature required: � � N. 1) ' ?1 0 Plan Review (25% of Permit Fee) S
Print Name: , t A„ Lic. #: 1 -5 1 State Surcharge (8% of Permit Fee) $
_ w � ' y " .5 -71- 1 TOTAL PERMIT FEE $ o
Authorized Notice: This permit application expires if permit is Rot obtained within
Signature: Date: 180 days after It has been accepted as complete.
"Fee methodology set by Tri -County Building Industry Service Board.
(Please print name)
isfDsts .PcrmitForms"ElcPermitApp.doc 01103
CITY OF TIGARD • ,
BUILDING DIVISION PERMIT #: E1.,C20O7-Ot)T5O
13125 SW Hall Blvd., Tigard, OR 97223 • DATE ISSUED: 1118/24007
Phone: (503) 639 -4171 �imav li
Inspection Requests (24 Hrs.): (503) 639 -4175 r"__., .
INSPECTION WORKSHEET FOR DATE: 11131') TIME: 7 :00AM PAGE: 77
9Z- t ko
SITE A DRESS: ( 13!195 SW 74TH AVE: r CLASS OF WORK:
SUBDIVISION: PACIFIC RIDGE LOT #: ()09 TYPE OF USE:
PROJECT NAME: WALDEN
DESCRIPTION: 2 branch circuits: AC and outlet.
OWNER: WALDEN, WAYNE PHONE #: 503.62 342
CONTRACTOR: GRF ELECTRIC PHONE #: 503 - 8294146
Inspection Request Scheduled For: Date: /11912007 Pour Time:
Code # Inspection Description Confirm # Contact # Message �t/�
199 Electrical final 05932 -01 503557 -2220 0 f '
Corrections /Comments /Instructions:
Ale_- e P ,1 qs A-itv7 t)f<
1041 (A cP<
4. !`' PAS i PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
FAIL �� CALL FOR INSPECTION 1 1 ADDITIONAL FEES ASSESSED ir)
Inspector: _ �_ — Date: I1 1 7 Phone #: (503) 718 - Z-6 1/