Permit • CITY O F TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00265
• DEVELOPMENT SERVICES DATE ISSUED: 5/14/2004
411 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S 114AD -01900
SITE ADDRESS: 16622 SW 88TH PL
SUBDIVISION: WAVERLY ESTATES ZONING: R -12
BLOCK: LOT : 018 JURISDICTION: TIG
Project Description: 2 branch circuits for AC.
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: 0 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:
HJELM, ROXANNE GRF ELECTRIC
16622 SW 88TH PL 15460 SE PARADISE LN
TIGARD, OR 97224 MULINO, OR 97042
Phone: 503 -268 -1524 Phone: 503 - 829 -4146
Reg #: LIC 76751
SUP 1655S
FEES ELE 3 -484C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 5/14/2004 $53.50
[TAX] 8% State Surcharge 5/14/2004 $4.28 Rough -
Elect'I Final
Total $57.78
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Speaalty 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. Q�
Issued By: Permit Signature: gyi c ''�: y�
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 7:00pm for an inspection the next business day
Mai 13 04 10:27a GRF Electric 5038295747 p.1
•
, ' FOR OFFICE USE ONLY
l P ep la tion Electrical
, Date/13
: I ig Permit No , i i S, —00- -.•
\ City of Tigard h 5 2004 Planning • 'pro al sign
1 DateB Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Gip( OF T ►GP RD Date/B : Permit No.:
Phone: 503- 639 -4171 F tE �tihte 0 Post- Review Land Use
Internet: www.ci.tigard.or.us 4a'I�) Contact : Case No.:
l �, Contact Su See Page 2 for
24 -hour Inspection Request: 503 -639 -4175 Name /Method: Su lemental Information.
TYPE -OF =WORK PLAN REVIEW (Please check all that apply)
O New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
- Addition/alteration/replacement 111 Other: commercial ❑ B uilding s over 10,000 I i T ❑ Service over 320 amps- rating of El Building over 10,000 square feet,
_
CATEGORY OF CONSTRUCTION 1 & 2 family dwellings four or more residential units in
1 & 2- Family dwelling _ ❑ Commercial/Industrial R
Accessory Building over 600 volts nominal one structure
un {-� Multi-Family ❑ Building over three stories ❑ Feeders, 400 amps or more
ry Bildi g ❑ y ❑Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder El Other: ❑ Egress/lighting plan ❑ Other:
' JOB SITE INFORMATION and LOCATION' - Submit _ sets of plans with any of the above.
The above are not applicable to temporary construction service.
Job site address: I i fn 22- Sf..) /' g p f TEE* SCHEDULE
Suite #: Bldg. /Apt. #: T S+r Number of inspections per permit allowed
Project Name: H ' e ii , I . t ,.,
r i.scriptiot, t Qty Fee (ca.) Total I i
r
New residential - single or multi - family 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
Subdivision: Lot #: Limited energy, residential 75.00 2
Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
'' DESCRIPTION. OF WORK' ■ >` service and/or feeder 90.90 s , 2
) Services or feeders - installation,
d (ip _Ye` (fit [ /7-c.- lrt.r .g .c alteration or relocation:
200 amps or less 80.30 2
201 amps to 400 amps 106.85 r 2
401 amps to 600 amps 160.60 2
ROPER Y OWNER "1. Q TENANT 601 amps to 1000 amps 240.60 2
t Over 1000 amps or volts 454.65 2
Name: � ?)(' f I ' 1 ? .p, 1- r L_ iA Ki _ Reconnect only 66.85 2_
Address: / th ep ZZ 5 i,t) a p (,. Temporary services or feeders - installation,
alteration, or relocation:
City /State /Zip: ` F l_r ., � , �' 7 .-Z■ 9 200 amps or less 66.85 1
Phone: Z V 4c-15 `r Fax: 201 amps to 400 amps 100.30 2
401 to 600 amps 133.75 2
oAP.PLrICANT p CONTACTP;ERSON .. Branch circuits - new, alteration, or
Name: t., l r, zt ot-; f - f-r ,-1' S extension per panel:
A. Fee for branch circuits with purchase of
Address: .55--. G a b e l t ,) service or feeder fee, each branch circuit 4.65 2
City /State /Zip: B. Fee for branch circuits without purchase of t 46.85 5 1: --- 2
service or feeder fee, first branch circuit
Phone: Fax: Each additional brunch circuit 1, 6.65 1.0 2
E -mail: Misc.(Service or feeder not included):
CONTRACTOR Each pump or irrigation circle _ 53.40 2
_„ Each signor outline lighting 53.40 _ 2
Job No: Signal circuit(s) or a limited energy panel,
r alteration, or extension Page 2 2
Business Na G / -f a) e_- c, Description:
Address: I ( o S, Pk re (LAA/ L+1 ,
Each additional inspection over the allowable in any of the above:
City /State /Zip: /ALA `1 2 O C rJ 1' L — . Per inspection per hour (min. 1 hour) 62.50
Phone: 913 - (.,m .ti. / ' f, , Fax: 3b3 8Z-9 ^ S -1,-t-7 Investigation fee
CCB Lic. #: b S 1 Lic. #: 3- c fi e 14 C Oth
. "•" Electrical:Permif`Fees* _
Supervising electrician ` ^� Subtotal $ 53 i -; U -
signature required: � '`\ Plan Review (25% of Permit Fee) $ lT
Print Name: / t ) ); A„„ < , -� Lic. #: l 7 $ State Surcharge (8% of Permit Fee) $ J � n
TOTAL PERMIT FEE $ ° � - f b -
Notice: This permit application expires if a permit is not ob ed within
Signature: Date: 1 k) rn 180 days after It has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
- (Please print name)
i :\Dsts\Permit Forms \ElcPermitApp.doc 01/03
CITY OF TIGARD 24 -Hour JI
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line! (503) 639 -4171 MST
BUP
Received I Z • 2 Co P Date Requested - 1 ) AM PM BUP
Location /&70 (D 2 Z ,' 5 "L )0/ Suite MEC •
Contact Person - �.►.�� q Ph ( • 9 - PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELCA:V4/ ?
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
-rm
PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
' Please call for reinspection RE: 111 Unable to inspect — no access
Fire Supply Line
ADA +� p
Approach/Sidewalk Date \ I - 0 Inspector �S N ( `, Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL