Permit _q CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2009 -00331
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/06/2009
Parcel: 2S 110BA09200
Jurisdiction: Tigard
Site address: 14127 SW 116TH TER
Subdivision: EVERGREEN SPRINGS Lot: 17
Project: Moss
Project Description: (2) branch circuits for a/c & service outlet.
Owner: FEES
MOSS, JAMES A & Quantity Description Date Amount
KATHLEEN L, 14127 SW 116TH TER 2 crt Branch Circuits 07/06/2009 $53.50
TIGARD, OR 97224 wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 07/06/2009 $6.42
Electrical
Contractor:
GRF ELECTRIC
15460 S PARADISE LN
MULINO, OR 97042
PHONE: 503 - 829 -4146
FAX: 503- 829 -5747
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $59.92
Required Items and Reports (Conditions)
This permit is bject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done ' accordance w approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. TENTION: Oregon -w re• ires you to follow the rules adopted by the Oregon Utility Notif n Center. Those rules are set forth in OAR
952 -0 - 0010th ; gh OAR. -001 -' 100.. You may obtain a copy of the rules or direct questions to OUNC by ng 503.246.6699 or 1.800.332.2344. •
Issu By: �l /U(/� JtZ�/ l Permittee Signature: �(:f9T �����
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'
-.41/ (� /cJ� 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 02 09 10:44a GRFELECTRIC 5038295747 p.1
. .
G EN► He d a but - der -
Electrical ical Permit Application RE Ili rip IAA I' I \I 4l \1.1
p0, D..(8 7 10 , renait.rr..: E/.Ca 9 3 3
City of Tigard 2 2 Rece IM
i 13125 SW [tall Blvd., Tigard, OR 97223 f+lin Rev �v pia P 11'
Phone: 503.619,4171 Fax: 503.598.1960 G' te/B • — Ir., e Sea Face 2 for
In
I ..\ t: 1.1 In tern e t n LUX: 5 83.639.4175 C a rt tv `a R c thud: / 9uPDternenet letotwaeoe
Internet vvww,tigrvacrr.gov ` 1111"
R E VVIEw
e of woxxti E1 r PLAN
Plate check all that apply nott nil 1 acts of pleas ' chneksd below 1
❑ NOW construction (Whim/alteration/replacement ❑ « fader 400 amps or mom ❑ dulldiog over them ator;ea.
❑ Demolition E} Other: when t available fault current ❑ Marlow and boatyards•
CATEGORY OF CONSTRUCTION exceed. 10,000 amp at 1 so woks or ❑ Flemish imiktinse.
lens to poltnd, Of e>zece(Is 11,000 ❑ Commercial -sae a ricalttnil
and 2-family dwelling ❑ Commerciall0dustrial ❑ Accessory building ova for all otherinsollatioat'. buttdirlga.
Q Multi-family ❑Master builder ❑ Other: 0 linesman. El Installation of )5 KVA or
❑ Emergency ;yawn. larger separately clawed system.
iOB SITE INFORMATION AND LOCATION I /4 0 Addition of now seta toad or ❑ "A', "E ••1.2". "t -3".
l ooliP hx . oceapeneY'
Job no.: ! lob site addte5s: i 4F f Z) S 14 ) 0 TG ❑ Sim a more m aore nidcnoN wan. ❑ Itrara+tlanai vehitte parfa.
❑ Nunn-cam Caoiiitia4 0 Supply 101ap fa more than
C1ty /Staae/ZIP: �; `v 4 -7 (�2- 't— ❑ Naaardoas locations. 600 volts notnioat.
S S t S m fencer 600 mina snore.
Suite/bldg./apt stn.: Project name: n4 FEE SCHEDULE _ .-
Cross street/directions to job site: D..eriN.om 1 (Pr. i Fn& 1 T•w I •
Noy reatdeatial single or multi- ramify dwelling unit.
Includes attached garage.
„000 sq. R of l ess 1 45.15 4
Subdivision: l Lot no.: ion 33.40 I ,
E a add' 1 500 sq. ft. of port
Tax map/patrel no.: _ Limited energy, residential 7500 2
DbSCRLJTION OF WORK ( with above. toll)
Limited energy, multi-family 75.00 2
Q(L -7•-r resident'aiSwith -
L td 1 ` Z _A-C- 1 Services or feeders Ilutxtl■tina and/or relocation
200 amps or leu 80.30 1 2
4ROPERIY OWNER - R I a TENANT , 201 amps to 400 amps 106.85 ^ 2 j
401 amps to 600 temps 160.60 1 2
Name: t° m A .S s - 601 amps to 1,000 amps _ 240.60 2
Address: I j Z ) $4) / I �e �� • Over 1.000 amps or volt 454.65 2
l 2f Temporary senicu or (ceders installation, alteration, and/or
City /State /ZIP: 1- ! t �� `� c� L ralnutitan
200 amnpr or Ices 66.1 5 1
1 2
Owner installation: : This installation is being made On property that I Own 201 amps no 400 paps 1 wAich is not 401 amp to 599 amps r 7. 3). ?5 00.30 ' -
intended for sale, Tease. rent, or exchange, according 14 ORS 447, 449, 670, and 701. Snot circuits new. alteration, or =erosion. ter panel
Owner signature: Clue: A. Pet for branch e with
❑ APPT.ICANr I ❑ CONTACT PERSON above service or 'ceder fee, 6.65 2
each branch circuit
Business n401C: B. Fcc for branch circuits
without service or feeder fee, 46,85 ii to _ r i / 2
Contact mime: _ first brands circuit
- — Each add` . branch circuit t 6.55 i v
Address: Miscellane (titmice or (ceder not included) (�
Eaca manufactured tic hnedutu I C it y /State/UP: dwelling. service and/or feeder 94.90 2
Phone: ( ) 1 Fax: : ( ) Reconnect only 66.85 2 i
!
E-mail; Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline li8hing 53.40 2.
n Signal circuit(%) or limited
Business name: 6 1_, E El (2 (.. 1 energy panel. alteration or
extension. Desulbe: Page 2 2
Address: ) (p 0 •C • Pa 1- Cam) •
Etch additional inspection over allowable in an of the above
City /StatdZlP; /� r-4 i t r t / (� -. G] 7 Q z ' Per inspection 6250
Phone: (L�5) 12_9 • y-f Liu I Fax: ( ¢ 9 - 5-7 L'f' / ,. Investigation per hour (t lumin) 62.50
CCB Lie.: '2 6 Electrical Lic.: 2-- {j{• C Suprv. Lic.: , Industrial plant per hour T 73,75
ELECFRICAL FERMTT' FE LS .
Suprv, e e i i s required: �`� I if S ubtotal: 3 ,1
Pi review (25% of permit fee): .- Z
Print name: ' r ( I r l vita S A. ` I Date. ri j d �j • ge (12% v '
I Statn,urchar ]3 craft
Authorised signature: TOTAL PERMIT FEE t ,2 • Thia ornate application empires If • ?omit u mat • huited wut,ie, 1441
Print name: ' Dine days aRer i1 has Imes accepted as 0111411444e.
• Number of inapeetiont snowed per permit.
Leo,itdiµ}rwnitusil to atitAN.loe nu2i.O - ' 44O• 1 67STI I1,0UGOMYw£a