Permit c //s CITY OF TIGARD ELECTRICAL PERMIT
, 31 1 I ii,
PERMIT #: ELC2007 -00497
COMMUNITY DEVELOPMENT DATE ISSUED: 7/19/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1S134DC-05000
SITE ADDRESS: 11660 SW 113TH PL ZONING: R -4.5
SUBDIVISION: MUTTLEYS ADDITION LOT : 025 JURISDICTION: TIG
PROJECT: PANASEWICH
Project Description: Wire 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: 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:
PANASEWICH, MICHAEL R + BILLIE D GRF ELECTRIC
11660 SW 113TH PL 15460 S PARADISE LN
TIGARD, OR 97223 MULINO, OR 97042
Phone: Contact #: PRI 503 - 829 - 4146
FAX 503- 829 -5747
FEES
Description Date Amount Reg #: ELE 3 -484C
[ELPRMT] ELC Permit 7/19/2007 $53.50 LIC 76751
[TAX] 8% State Surcharge 7/19/2007 $4.28 SUP 16555
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: ,A__„,.. _A" Permittee Signature: 'r
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.
Jul 19 07 10:01a GRF Electric 5038295747 p.1
- ectrical Permit A�� Cd k i Received 7/' FOR OI:F[CE USE ONLY
CAa ,�� Electrical -�
Date/By: 1 1 613 Permit No ev ! "Ba * 7
y
City of Tigard JUL 1 9 2 0 7 Planning Approval Sign
\ Date/By: Permit No.:
'-'' 13125 SW Hall .Blvd. . , - - E , Plan Review Other
Tigard, Oregon 97223 �' ° `�' ` I u �� Date/By: Permit No.:
ll!' MI L. J l Post-Review Land Use
Post- R
Phone: 503- 639 -4171 Fax: 503 -5 8- 19' At I M,('4 ;,, Post -R y: Case No.:
Internet www.ci.tigard.or.us e.' I Contact Juris.: El See Page 2 for
24 -hour Inspection Request: 503 -639 -4175 Name/Method: Supplemental Information.
•
•
.:. YPE OF IE (Pl
. - .
._.. . ..-T RIK� . . , � . . ....�:� ; .. , , , . � • PIL:'AN�REY W � ease c6'eck till that apply} ..
New construction Q Demolition ❑ Service over 2 2 5 amps - 0 Health -care facility
commercial ❑ Hazardous location
ddition/alteration/re lacement Other: Oth p 0 Service over 320 amps - rating of ❑ Building over 10,000 square feet,
• • _ ' _ ' : CATEGORY OFCONSTRUCTI;ON . - ' - 1 & 2 family dwellings four or more residential units in
& 2- Family dwelling ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stones ❑ Feeders, 400 amps or more
ID Accessory Building ❑ Multi- Family . _ ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
0 Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:_
.JOB SITE ?INFORMATION and ((LOCATION' .. :! ` '' '.! Submit sets of plans with any of the above.
The above are not styplicable to temporary construction service.
Job site address: ! I tie (� .5 r J I 3 hl . .., ..: IEE2:SCREDULI7 <: ' - ,: _::.,
Suite #: / ldg. /Apt. # Number of inspections per permit allowed
Project Name: rot ✓} GL T e f A! i (�_ ) r.;,.. option, t Qty Fee (ea.) Tow 1
Cross street/Directions to job site: New residential -single or multi - family per t
dwelling unit. Includes attached garage.
Service included: •
1000 sq. ft. or less 145.15 4
Each additional 500 sq. R. or portion thereof 33.40 1
Subdivision: Lot #: Limited energy, residential 75.00 ' 2
Limited energy, non residential 75.00 2
Tax map /parcel #i : Each manufactured home or modular dwelling
•. , ;, ... ,' • ..;
.^
f,,s;,,. •.. ....,''..7.1 :..:' •,;: DESCRIPTxON:OFWORK'.:�,;,,: °'.' �. ,.�. :.;�`:= ':.::.:::`. service and/or feeder 90.90 2
_ / Services or feeders - Installation,
2 — ( ./ e ', / f C_ 1 e 2 (�-h -.e- '- alteration or relocation:
� L 200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
.. ID - PROJ'ERTY' OWNER`: >' ;I`:D TENAINT.,:i:'. ,i; `.:.: >` `. . „ 601 amps to 1000 amps 240.6D 2
L. � " ' Over 1000 amps or volts 454.65 2
Name: { .Q_ G ' � �� , 1 Reconnect only 66.85 2
Address: / 9 (. C, 0 5 f-) / r 3 f" .. Temporary services or feeders - Installation,
alteration, or relocation:
City /StCity/State/Zip: 7 i L � _ 6 17 Z 2-3 200 amps or less 66.85 I
201 • amps to 400 amps 100.30 2
Phone: -��p 3 2_ FaX: 401 to 600 amps � 133.75 2
❑`APPLIC ' _ 1 ,.. . . ' :[D :CONTACT , i ... • 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 i 6.65 2
City /State/Zip: B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit t 46.85 - k, � �
. _
Phone: I Fax: Each additional branch circuit t 6.65 , L (h
E -mail: Mise,(Service or feeder not included): i
. -: Each pump or irrigation circle 53.40 2 •
1 1
";ii 1;; ',_+ '-, :. :t CONTRACTOR: . , !` '"; :e "' ». ""
l. , ':. •' 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 r Description:
Address: t 5 O S , Pik y /L r/ -c/1 1
G �, 2-- Each additional inspection over the allowable in an of the above:
Clt /StatCfZl
p : M .% f • to C0 l f � -! —7 1' ' Per inspection per hour (min. I hour) 62.50
Phone: 953 -ERG 1. j •i-(,Q Fax: 5b 3 - ?I z.1 - S -7,4_7 investi fee: • •
CCB Lic. #: 7 b c Lic. #: 3- if 4 � ' Other: . ': ''`'iEltecti cia :Perii:It `Fee`i' . ; -``'` - :
Supervising electrician t Subtotal S 5 3 ` c a
signature re uirtl: �✓'�^�L-:„... --Ibq I Plan Review (25% of Permit Fee) S
S tate S urcharge (8% of Permit Fee) $�
Print Name: , J, ,,,� �vy� - �� Lic. #: (� , S S TOTAL PERMIT FEE $------
Authorized Notice: This permit application expires if a permit is not obtalned witltin�
Signature: Date: 180 days after it.has been accepted as complete.
'Fee methodology set.by Trl- County Building Industry Service Board.
-
(Please print name)
i :\Dsts\Pe rmit Forms\EicPerrni tApp.d oc 01/03
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2007 -00497
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/19/2007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 __ma
• - `INSPECTION WORKSHEET FOR DATE: 9/6/2007 TIME: 7:00AM PAGE: 44
SITE ADDRESS: 1 ' 1 3TH PL CLASS OF WORK:
SUBDIVISION: MUTTLEYS ADDITION LOT #: 025 TYPE OF USE:
PROJECT NAME: PANASBM
DESCRIPTION: Wire AC and outlet.
OWNER: PANASEWICH, MICHAEL R + BILLIE D, PHONE #:
CONTRACTOR: GRF ELECTRIC PHONE #: 603 -629 -4146
Inspection Request Scheduled For: Date: 9/612007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical 066236 -02 603 -235 -9083 N
Corrections /Comments /Instructions:
X PASS I PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
❑ FAIL n CA L FOR INSPECTION ADDITIONAL FEES ASSESSED
Inspector: Date: 7Phone #: (503) 718 -