Permit 4 6 1 ;$ CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00137
; DEVELOPMENT SERVICES DATE ISSUED: 3/22/04
AIX - I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S134DB-05900
SITE ADDRESS: 11009 SW 110TH PL
SUBDIVISION: JEFFREY ESTATES ZONING: R-4.5
BLOCK: LOT : 018 JURISDICTION: TIG
Project Description: (2) branch circuits for a/c & 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: 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: 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:
CHRISTIAN, K GENE + MICHELE K GRF ELECTRIC
11009 SW 110TH PLACE 15460 SE PARADISE LN
TIGARD, OR 97223 MULINO, OR 97042
Phone: 503 - 684 -8381 Phone: 503 - 829 -4146
Reg #: LIC 76751
SUP 1655S
FEES ELE 3 -484C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 3/22/04 $53.50
[TAX] 8% State Surcharge 3/22/04 $4.28 Rough -
Elect'l Final
Total $57.78
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 0 • = ' - es -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 • 2 -2344.
Is ued By: `a Permit Si nature •
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: �GS S5
Call 639 -4175 by 7:00pm for an inspection the next business day
Elecilical Per i i 1W pWIIVErdn FOR OFFICE USE ONLY
Received ■ Electrical
Date/B : // / f D '{ Permit No.:
City of Tigard MAR 1. 9 2004 Planning Approval Sign
Date/B Permit No.:
13125 SW Hall Blvd. CITY OF TIGARG Plan Review Other
Tigard, Oregon 97223 � Date : Permit No.:
Phone: 503- 639 -4171 Fax R -5 S 6b ' I S I Date/B '' Post- Review Land Use
Fu ,,; 'M / Date/B : Case o.:
Internet: www.ci.tigard.or.us � c •i
_ ®s e page 2 for
24 -hour Inspection Request: 503 -639 -4175 '" "'° Name /Method: /Tea j lemental Information.
' • PLAN REVIEW l' that Apply)'''' '.' ' TYPE :OF'?�V,ORK - :... �.: � '(Please check al
0 New construction ❑ Demolition 0 Service over 225 amps - 0 Health -care facility
commercial ❑ Hazardous location
Addition/alteration/replacement ❑ Other: ❑ Service over 320 amps - rating of ❑ Building over 10,000 square feet,
',' CATEGORY ";OF• C.ONSTRU,CTION '' 1 & 2 family dwellings four or more residential units in
{1 1 & 2- Family dwelling ❑ Commercial/Industrial 0 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: 0 Egress/lighting plan :
ot her•
Submit _ sets of plans with any of the above.
JOB SITE IN$ORMATION and LOCATION* The above are not applicable to temporary construction service.
Job site address: f ,1 /Al/ -= •,..:i lie / • - ` FEE* SCHEDULE '
Suite #: - Bldg. /Apt. #: % -; �, .--z .- ' Number of inspections per permit allowed
(' Zcieriptiou . 1 Qty Fee (ea.) Total 1
/
Project Name: ,1 ; s - .
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 I
Limited energy, residential 75.00 2
Subdivision: I Lot #: Limited energy, non residential 75.00 2
Tax map /Parcel #: Each manufactured home or modular dwelling
service and/or feeder 90.90 2
ESCRIPTIUN..CIFWORK Services or feeders - installation,
_ alteration or relocation:
- 200 amps or less 80.30 2
,- J '• -_ 1. :i i ; ' Z - , -, J . `' - 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
II
:pRO�ERTY'9�'li'NER f ;D TENANT., 601 amps to 1000 amps 240.60 2 Over 1000 amps or volts 454.65 2
Name: /: ! 1 Q. t `.y- ;ri ', f--, ,. •I • Reconnect only 66.85 2
Temporary services or feeders - installation,
Address: :� / ; 'i c..� / / % alteration, or relocation:
City /State /Zip: T - , s _� ' - 1 • 200 amps or less 66.85 1
201 amps to 400 amps 100.30 2
Phone: 6: (7, ' = 0 Fax: 401 to 600 amps 133.75 2
Iii AP:P.LICAN. „ : El CONTACT PERSON, _ Branch circuits - new, alteration, or
Name: extension per panel:
A. Fee for, branch circuits with purchase of 6.65 2
Address: service or feeder fee, each branch circuit
City /State /Zip: B. Fee for branch circuits without purchase of i s• ,
s or feeder fee, first branch circuit 46.85 '-/:.. --. 2
Phone: . Fax: Each additional branch circuit i 6 -65 ,, ` -' 2
E-mail: , Misc.(Service
-mail: Misc.(Service or feeder not included):
Each pump or irrigation circle 53.40 2
OICQR ti 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: G E e .-. ) -f,, t _ , Description:
Address: 19f-Lp 2 S, I p ,/t i ‹_o (�42,t ' Each additional inspection over the allowable in any of the above:
City /State /Zip: ,4'lu / 1 Q (7_. ' 7 17 Li Z- Per inspection per hour (min. I hour) 62.50
Phone: 9) 3 - W , / `f-( /1 Fax: 3 - S' - ! - S ? `-1-'-7 investigation fee:
Other:
CCB Lic. #: 7 to 7 S1 _ Lic- #: 3 - Lt e 4 C Electilcal :I'ermif :Fees
Supervising electrician ^ , ; Subtotal $ t- , ;,-
signature required: �✓' �� Plan Review (25% of Permit Fee) $ c-
S tate Surcharge (8% of Permit Fee) $ ' .,
Print Name: }n/ ,'J 1 ti,,,, �► y� Lic. #: J� . �5 - E' 1 , + �,
TOTAL PERMIT FEE $ ' -` �� '
t Notice: This permit application expires if a permit is not obttalned within
Authorized i r • f , •
Signature: Date: 1 180 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
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1 - d Lt'LSG2BEOS 0i-11.0a d
i3 ��19 SE =ZT .00 6i -+EW
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Receive l & (' s1 Date Requested 2 T PM BUP
Location 1 l() r) ll I'✓ Suite MEC
Contact Person U ,,7d. Ph –) - c:P? ?'- 5z/S70 PLM
Contractor Ph ( ) SWR
BUILDING Tenan rOwne ea 4/-4i)/ 3 7
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Fi rewal I
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
• larm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
` ,* PART FAIL
SIT Please call for reinspection RE: I I Unable to inspect — no access
Fire Supply Line
ADA �( (-' ` *\' 14625 1'
Approach /Sidewalk Date 3 2� - 1 Inspector L T5 Ext
Other:
Final D NOT REMOVE this inspection re rd from the job site.
PASS PART FAIL