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Permit CITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC1999 -00458 _44 �IIi& DEVELOPMENT SERVICES DATE ISSUED: 7/26/99 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 1S133DD-14800 SITE ADDRESS: 11787 SW 128TH AVE SUBDIVISION: VILLAGE AT SUMMER LAKE PARK 4 ZONING: R -4.5 BLOCK: LOT : 185 JURISDICTION: TIG Project Description: First 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: 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: 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: AMY SHAH GRF ELECTRIC 11787 SW 128TH AVE 15460 SE PARADISE LN TIGARD, OR 97223 MULINO, OR 97042 Phone: Phone: 503 - 829 -4146 Reg #: LIC 001015 SUP 3003S ELE 26 -878C FEES Required Inspections Type By Date Amount Receipt Elect'I Service PRMT BON 7/26/99 $37.50 99- 317137 Elect'I Final 5PCT BON 7/26/99 $2.63 99- 317137 Total $40.13 ORIGINAL 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 d irect questions to OUNC at (503) . 246-1987. Permit Signature: O' , ? A l gi d Issued By: 6 / // 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: (AY\ /'t (J, 0 DATE: LICENSE NO: Call 639 -4175 by 7:00pm for an inspection the next business day 07/23/1999 11:18 5038295747 GRF ELECTRIC PAGE 01 CITY OF Tt ®ARD Electrical Permit Application Plan 13125 SW HALL BLVD. Recd By I2 TIGARD OR 97223 Date Redd 1- z3 ' Phone (509) 639.4171, x304 Date to p.E • Print or Type Date to 057 Inspection (503) 639 -4175 Permit ft 1al+ --00451 Fax (503) 684 -7297 Incomplete or Illegible will not be acce Called 1. Job Address: 4 Complete Fee Schedule Below: , Name of Development Number of Inapeeflona S. Wrntt alle* Name (or name of busirlesa) A y 1p r in a Service included: items Coat ' Sum Address ` ( 71 - 7 >W I l0 Alit- Ie. Residential - per unit �* 1000 sq. IL or k ,,,,,,_„_� ola $110.00 4 City/Stata�Dp 1 h l R '7 2 2 Each addltlor+sl 500 sq. n. or Commercial 0 ` ResidentlslP Limes d $36 t — Each Manure! Home or Modutsr 2a. Contractor installation only: ° 8irolai or F..aer 486 I 2 I • (Moroi* copy of ail otarent uaenr�srs 4b. Services or headers Electrical Contractor iCI.P �� I alteration. or reaortation Address 1 S`1-(a 0 A 201 amps or 4 0 0 680 2 — City State 11 Zi g '� � . _ Z _, 4 amps to 8 a� t 2000 2 Phone No. 2 (j — t- -i ... 801 amps to 1000 amp. 6180.00 4— 2 Job No. ow 1000 amps or rang 6340.00 Elec. Cont, lice. No. 2-&' ' '� Exp.Dale Reconnect orgy -- 860.00 2 OR St CCB Reg. No. 147 / Exp.Dats 4c. Temporary Sandra or Foram COT Business Tax or Metro N o. 2 -- Exp.Date in stallation, aherstlon, or relocation 200 amps or lass $30.01 201 amps to 500 amps 676.00 2 Signature of Supr. Eisen 401 amps to !loo amps 6!0 0.00 2 0 3 ` Exp .Date we amps License No. , al Phone No, 24 - -f-1 yL 4a. Branch Circuits . New, ideratfon or extension per panel 2b. For owner installations: a) The fee for !ranch circuits mat ptarnaas of asndlse or Print Owners Name hiede'r Address Each branch circuit 65,00 _�_ 2 City . State Zip b ) TM irmoue branch r pereitsie ml Phone No Flat bran MOW Ise. 4 t drcoult The installation Is being made on property I own which is not Each additional branch circuit 45'11 intended for sale, lease or rent. 4 sesoNlonsous (Service or fesdw rat Included) Owners Signature Each pump of irrigation circle $40.00 - - 2 Each sign or mans lighting $40.00 4 — 2 3. Plan Review section (if rllllquired) :' , awnm climate) a a MOO energy panel, of arauorh or ehasnslon $40.00 4 - _ 2 Minor Weis (10) 6100.00 _H____ Pleas. check appropriate item and enter fee In section SB. 4 or more residential unllo In one sbuctuie 4f. Each additional inspection over Set** and leadW 235 amps or Tors ' fits allowable In any of the above System over 800 volts nominal Per Wpedfon $36.00 — j Ctasa1N mucus area or containing spade) oocupar . , Per hour $ 55.00 se a dsseOiDed h N.E.C. Chapter 5 In Plant — ' Submit 2 arts of plans with application whore any of the above apply. 5. Fees: • Not required for temporary construction sarvloes. Si Enter total of above tees . 6 696 Surcharge (,06 X toted fees) g R m e =cE Ka , Subtotal hrr _ SO. Enter 25% of ilna 6a for PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Pion RtmewIt.aultm (8ec.3) $ - ! ----Y NOT COMMENCED WITHIN 180 DAYS. OR IF CONSTRUCTION OR WORK Subtotal 6 Is SUSPENDED OR ABANDONED FOR A PERI00 OF 180 DAYS AT ANY TIME AFTER WORK IS OOMMENCED, - Account r d ! _� F4rust ld balance Due DEPARTMENT OF LAND USE & TRANSPORTATION WASHINGTON LAND DEVELOPMENT SERVICES DIVISION 155 NORTH FIRST, HILLSBORO, OR 97124 r ;u� COUNTY INSPECTION REQUESTS: 503 /640 3561/693 - 4415 PHONE: 503 /648 -8761 OREGON Page : 1 of 1 Date : 01/04/93 Time : 12:55 Permit Type : Residential Electrical Permit Permit # : 05036474 Permit Status : APPROVED Applied : 01/04/93 Situs Address : 11787 SW 128TH AV TI Issued : 01/04/93 Permit Title : SFR - BURGLAR ALARM Completed : Permit Descr. To Expire : 07/03/93 Project Title : SFR - BURGLAR ALARM Project # : P0028252 Project Descr. : * EROSION * • Parcel Number : 2S1TI - Land Use District : Valuation 0 • Legal Descr. Owner : WALLACE, JOHN /MARY Construction : OTH Applicant Name : BRINK'S HOME SECURITY Classification : 900 Applicant Addr.: 12150 SW GARDEN PL Occupancy : R3 • PORTLAND, OR 97225 Validated by : PH Applicant Phone: 684 -3579 Inspector Area . • CONTRACTOR : BRINKS HOME SECURITY Lic. C 34-166C 684 -3579 Fee description Units Fee /Unit Ext fee Data Limited Energy /Alter. /Extension 1 40.00 40.00 Subtotal Electrical Fees: 0 40.00 State Surcharge of 5% 0 2.00 Total Electrical Fees: 0 42.00 * ** Fees Required * ** * ** Fees Collected & Credits * ** Receipt No. Date Payment 01/04/93 42.00 TOTAL THIS DATE * * * * * * * ** 42.00 Fees: 42.00 Adjustments: .00 Total Credits: .00 Total Fees: 42.00 Total Payments: 42.00 Balance Due: .00 NOTICE: This permit becomes null and void If the work or construction for which it is Issued Is not commenced within 180 days. Once construction has started, the permit becomes null and void if construction Is Interrupted for a period of 180 days. I certify that the information presented by the applicant and his agent or agents In support of this permit Is true and correct to the best of our knowledge. I acknowledge that the Building Department's reliance upon false and misleading Information may Invalidate this permit. All provisions of applicable laws and ordinances governing the construction and use of this building or structure will be complied with whether or not specified on the plans or noted on the plans correction sheets. I acknowledge that the granting of a permit does not grant authority to access private property or to use easements. I further acknowledge that the use or occupancy of the structure or building permitted depends upon my calling for Inspections at various times during the process of construction and the building inspection staff verifying compliance with the various codes. Use or occupancy of the building or structure permitted prior to approval by the Building Department Is solely at the risk of the applicant and such use or occupancy is revocable until all inspection requirements are satisfied and approval Is given by the Building Official. I further acknowledge that a lien may be placed on the title of the property upon which the permit is issued specifying that the use or occupancy of the building or structure Is provisional and revocable until the satisfaction of all inspection requirements. APPLICANT'S SIGNATURE ilk WASHINGTON COUNTY RESTRICTED Department of Land Use & Transportation ' W Electrical Inspection Section 155 North ELECTRICAL ENERGY 155 North First Avenue, #350 -12 Hillsboro, Oregon 97124 APPLICATION Information: (503) 640-3470 Fax: (503) 693 -4412 PLEASE PRINT . • Please complete "all sections, 1 through 5.. . Project Nor ° SZ `73 Permit No. C fff r 1. Location of installation Label No. Date / - 1 --- j {, Issued By _ Office • Address 11`7 `I7 •t,J 12� fwe. City 1 i oct rd , O . Zip Code 0 17223 4. Type of work: , Thomas Map Book: Page Section RESIDENTIAL Restricted Energy Fee $40.00 (for all systems) Directions Check type of work involved: Commercial n Residential IXf Audio and Stereo Systems* Tenant Name urglar Alarm (if commercial) Telephone Systems* This permit becomes null and void if the work authorized by the Garage Door Opener* permit is not commenced within 180 days from date of issuance Fire Alarm of such permit or if the work authorized is suspended or abandoned Heating, Ventilation and Air Conditioning Systems* at any time after work is commenced for a period of 180 days. Vacuum Systems* Electrical Permits are non - refundable and non - transferable. Other 2. Contractor application: J Electrical Contractor - RI Ho wee. Sec.tArt�c� COMMERCIAL Fee for OAR system $40.00 (see OAR 918 - 260 -260) Address 12160 S (4') 'cc rd e.r P 1 . Date ii 1 2 -81 c 0.- Job Number 524 04'12 Check type of work involved: Property Owner "ZoltI r, W A 1 tciCe — Contractor's License No. 34• t to (o C B oiler Controls Contractor's Board Reg. No. 44 I _ 4 2 Clock Systems Phone No. (=2E 35?�I • _ D ata Telecommunications Installations F ire Alarm Installation 3. Owner application: _ H VAC 524 — 04 2. Instrumentation Print Owner's Name Phone No. - Intercom and Paging System 1-0C . A -7 11. O Ni Landscape Irrigation Control* Address = M edical _ Nurse Calls City State Zip _ Outdoor Landscape Lighting* This permit is issued under OAR 918 - 320 -370. The applicant agrees Protective Signaling to make only restricted energy installations (100 volt amps or less) - Other under this permit and to do the following: 1. Only use electrical licensed persons to do Installations where . required. (Certain residential and other transactions are exempt Number of Systems from licensing. These have asterisks, (*). All others need licens- - ing.) * N o licenses are required. Licenses are required for all other installations. 2. Call for an inspection when all the installations under this permit e9 eq are ready for inspection. 3. Purchase separate permits for all installations that are not ready 5. Fees _ permit. inspection when the inspector is out to Inspect under this Enter fees $ 4. Assume responsibility for assuming that all corrections required by the inspector are done, and 5% Surcharge (.05 X total above) $ Z 5. Assume responsibility for calling fora final inspection when all of the corrections are completed. /� The person signing this permit must be the applicant or a person Total $ 4 authorized to bind the applicant. Signature Space below reserved for validation. Authority if other than applicant ° .a For inspections call 640 -3561 or 693 -4415 24-hour recorder, one working day in advance of need • CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 Cy , 3 BUP Date Requested SP C 1/00 Q /00 AM PM -��� BLD Location � t 1 fl 12V (/ Suite MEC i g q q -00; /5 ,J/ Contact Person i� / Of - - Ph 2-3S -C/Or PLM Contractor Ph SWR BUILDING e � �� Tenant/Owner ELC 17i9 r9 _Oc 4 S.? Retaining Wall ELR Footing Access: Foundation FPS r► €- I C J"L Ftg Drain Crawl Drain Inspection Notes: ' . r,, ' SGN Slab Qom► w l LO l 1 V SIT Post & Beam Ext Sheath /Shear 3%(30- Int Sheath /Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc: Final PASS PART FAIL PLUMBING Post & Beam Under Slab Top Out Water Service Sanitary Sewer Rain Drains Final PASS PART FAIL �1G[ECHANICdL� Pos t beam Rough In Gas Line Smoke Dampers • '_* PART FAIL Service Rough In UG /Slab Low Voltage Fire� . �.�. PART FAIL Backfill /Grading Sanitary Sewer Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access ADA Approach /Sidewalk C // / Other Date •J �� (/� Inspector L Ext Final PASS PART FAIL _ DO NOT REMOVE this inspection record from the job site.