Permit •
ELECTRICAL PERMIT
. � CITY OF TIGARD PERMIT #: ELC2002 -00300
Al DEVELOPMENT SERVICES DATE ISSUED: 7/5/02
` — 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1 S 136CA -02900
SITE ADDRESS: 11155 SW 79TH AVE
SUBDIVISION: FRIENDLY ACRES ZONING: R -4.5
BLOCK: LOT : 020 JURISDICTION: TIG
Project Description: Installation of sub panel (200amp /less) and 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: 1 W /SERVICE OR FEEDER: 1 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:
BICKLE, ROBERT JAMES SR GRF ELECTRIC
AND BETTE A 15460 SE PARADISE LN
11155 SW 79TH AVE MULINO, OR 97042
TIGARD, OR 97223
Phone: Phone: 503 - 829 -4146
Reg #: LIC 76751
SUP 1655S
ELE 3 -484C
FEES Required Inspections
Type By Date Amount Receipt Rough -in
PRMT CTR 7/5/02 $86.95 2720020000( Wall Cover
Elect'l Service
5PCT CTR 7/5/02 $6.96 2720020000( Elect'l Final
Total $93.91
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: (-� ,0 . �f� Issu By: / ` /
n�nn 'r /lid,' / .._
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: i /0. )16,1 / DATE:
LICENSE NO: /j,56
Call 639 -4175 by 7:OOpm for an inspection the next business day
#, /1 p D.3 3if X32 •
/j
Electrical Permit Application
Date received:7 — - -- Permit no.. �� '(�i3O0,..2. -0030
s,:/ i t ) 1 ,
,.: ,..� � City of Tigard Projecdappl. no,: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By Receipt no.:
Phone: (503) 639 -4171 •
Fax: (503) 598 -1960 i .- 0 Y Case file no.: Payment type:
Land use approval:
•
• TYPE OF PERMIT '
li & 2 family dwelling or accessory 0 CommerciaUindustrial 0 Multi - family 0 Tenant improvement .
0 New construction 0 Addition/alteration /replacement 0 Other: 0 Partial
JOB SITE INFORMATION
Job address: 1 ) J c5 5 /,) ''7 4' R- , Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: ] ( Block: Subdivision:
Project name: 13 G /4_1 P 1 Description and location of work on premises: -
E s mat::d date of c ompIctior%inspe : tion: 5 G
. 'CONTRACTOYt�APP Y O"l� = r 4 ..._ ._
Job no: Fee Max
• [
Business name: G (LF e') CC- 4-y -`� Description Qty. (ea.) Total no.insp
1 � New reitiential -single orrtailH- family per
Address: ) 5 t-- [o C) S. Pic R Fi! r S L ec tit e dwelling unit. Includesattached garage.
City: MIA l 1 ✓t 0 - sr- I State: 0(LI ZIP: qr 0 Z Serticeincluded:
y: Phone: SSZA .`I1`tly IFax: g2A�57 * E - mail: 1000 sq. ft. or less 4
! ate ( I r . Each additional 500 sq. ft. or portion thereof __ �
CCB no.: Elec. bus. lic. no: 1 Limited energy, residential __ 2
City /metro lic. no.: 3 0_ Limited energy, non - residential __ 2
a. -'. • / / 0 Z Each manufactured home or modular dwelling ■■
Signature of supervising elechician (required) D to Service and/or feeder
-
Sup_ elect. name (print): A ) �� �� i l0 5 5 -S Services n or relocation:
installation,
Li cense no:
alteration or relocation:
; :PR OPERTY OWNER 200 amps or less 1 � , 3 D 2
Name (print): jQ j . r3 ; G ter.--I e, 201 amps to 400 amps 2
_ 401 amps to 600 amps 2
Mailing address: ` 53 s Gj /I-1;C . 601 amps to 1000 amps __ 2
City: F 0 Ph 0 • ' y O `Fri State: I ZIP: 2 3 Over 1000 amps or volts • ■■ 1
2
Phone: -; `-.� _'_' r;1' • : �� E-mail: Reconnectonl
Owner installation: The installation is being made on property I own Temporary servicesorfeeders -
which is not intended for sale, lease, rent, or exchange according to installation, alteration,urrelocation
200 amps or less 2
' ORS 447, 455, 479, 670, 701.
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 amps 2
ENGINEER Branch circuits - new, alteration,
1 or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit i I, ( 5 2
City: State: 1 ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: 2 •
Phone: Fax: E Each additional branch circuit:
PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included):
0 Service over 225 amps- commercial 0 Health-care facility Each pump or irrigation circle 2
0 Service over 320 amps - rating of I &2 0 Hazardous location Each signor outline lighting 2
family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
0 System over 600 volts nominal more residential units in one structure alteration, or extension* 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 Egiess/lightingplan 0 Other. Per inspection I 1
Submit _ sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other �
Not all jurisdictions accept credit cards, please call jurisdiction for mole information. Notice: This permit application Permit fee $ t r ta—
0 Visa - 0 MasterCard expires if a permit is not obtained* Plan review (at _ %) $ /, r„
Credit card number. / / within 180 days after it has been State surcharge (8%) , f
Expires accepted as complete. TOTAL $
credit Name of cardholder as shown on edit card
$ _
Cardholder signature Amount \..° * � l (6vU0/COM)
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