Permit ELECTRICAL PERMIT
- f - CITY OF TIGARD
PERMIT #: ELC2007 -00474
COMMUNITY DEVELOPMENT DATE ISSUED: 7/12/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 109AA -02100
SITE ADDRESS: 14472 SW 130TH AVE ZONING: R -7
SUBDIVISION: WOODFORD ESTATES LOT: 009 JURISDICTION: TIG
PROJECT: SCOTT
Project Description: Install (2) branch circuits for a/c and furnace units.
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:
REGGIE SCOTT GRF ELECTRIC
14472 SW 130TH AVE 15460 S PARADISE LN
TIGARD, OR 97224 MULINO, OR 97042
Phone: 503 - 214 - 2072 Contact #: PRl 503 - 829 - 4146
FAX 503 - 829 -5747
FEES
Description Date Amount Reg #: ELE 3 -484C
[ELPRMT] ELC Permit 7/12/2007 $53.50 LIC 76751
[TAX] 8% State Surcharge 7/12/2007 $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.
\ �/ / // Perm Signature: S J ) Q_ r(�Q n
Issued = / c f .
� Pl
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 11 07 01:05p GRF Electric 5038295747 p.1
�� ar e 1E FOR OFFICE. USE ONLY
Electrical Permit A 1 t ic9a.•>1 Received , Electrical
n s Date/By: t / / S L Permit No.: ELC2Co9 -00431
I Planning Approval Sign _
City of Tigard ' .'l_ 1 2 P Q1 Date/By: I Perr allo.: MtC ZOO) - - r 39-ci
\` 13125 SW Hall Blvd. it t ��f OF �t /'tFt� Plan Review Other
� Date/By: PemtitNo.:
Tigard, Oregon 97223 p,t III (n'SING ► MK NI Post - Review Land Use
Phone: 503 -639 -4171 Fax: 503 - 598 -19110 d, r .t0,,, tv. & Date/By: Case No.:
w
Internet: ww.Ci.tigard.Or.uS , , e !I'I Contact Juris.: - ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 "• Name/Method: i I & Supplemental Information.
'::, ';
TYPE WORK ::'. � : • . °.c . ' . . - .. ... .., .; PL:AN:RENTEW (Please check all that .apply)?'`
❑ New construction ❑ Demolition ❑ Service over 225 amps - ❑ Health -care facility
commercial ❑ Hazardous location
[ Additionlalterationireplacement I n Other: ❑ Service over 320 amps - rating of ❑ Building over 10,000 square feet,
CATEGORY :OF CONSTRUCTION ., i & 2 family dwellings four or more residential units in
0 1 & 2- Family dwelling 7 Commercial/Industrial ❑ 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 0 Manufactured structures or RV park
❑ Master Builder ❑ Other: D Egress/lighting plan ❑ Other:
' JOB SITEINFORMATION and LOCATION' •).; • : Submit sets of plans with any of the above. •
The above are not applicable to temporary construction service.
Job site address: ) -7'Z $ LJ i , / ) - - • r : : :.• SCHEDULE',',`
Suite #: Bldg. /Apt. #: I Number of inspections per permit allowed
Project Name: 5 .X i pt ] or, t Qty Fee (ea.) Total I !
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 1 4
Each additional 500 sq. ft. or portion thereof 33.40 1
Limited energy, residential 75.00 2
Subdivision: 1 Lot #: Limited energy, non residential 75.00 2
Tax map /parcel #: home or modular dwelling 90
•-•': ., ; Each service an d'or manufactured
- DESCRIPTION. OF•' W ORK ' ;' :. : - .. 2
Services or feeders - installation,
alteration or relocation:
{� 200 amps or less 80.30 2
( G � `` t ^ �/�r 201 amps to 400 amps 106.55 2
401 amps to 600 amps 160.60 2
PROERT7t'`OWNER`: :. ` " 1 CJ
601 amps to woo amps 240.60 2
' i. Over 1000 amps or volts 454.65 2
Name: Ct e a S c: _ .0 .1 - • Reconnect only 66.85 2 Address: j 1 -4- X1--'7 2 S w / D l Temporary services or feeders - installation,
aeration, or relocation:
City/State/Zip: ' f /,‘„,?„, - '7 z.-2.- t}' 200 amps as less l
20 amps to 400 amps 100.30 2
Phone: (co— z - Fax:
&f 401 w 600 amps 133.7 $ 2
0 .. ' -. .: • ❑ CONTACT'PERSON', . '" .
Branch circuits - new, alteration, or
Name: extension per panel:
A. Pee for branch circuits with purchase of
Address: " • service or feeder fee, each branch circuit 6.65 2
City /State /Zip: B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit ' 46.85 if c i'Li 2
Phone: I Fax: Bach additional branch circuit t - 6•G5 b vt _ 2
E -mail: Misc.(Service or feeder not included):
Each pump or irrigation circle 53.40 2
.. .a CON' RACTOR`. : .. .....' .. a 2
. . Each sign or outline lighting 53.4
job No: Signal eircuit(s) or a limited energy panel, •
/� alteration, or extension Page 2 2
• Business Name: 6 Cam / Ir _ I ( C Description:
Address: 1 -(p n S. P ri d-r2-� Le) I J
,/� E ac h a dditional inspection over the allowable in an of the above:
City /State /Zip: /14 / a . • 0 1� - 0 LI Per inspection per hour (min. I hour) 62.50 I
9)3 ��g Fax: 51) 3 - Y; S-74-7 Investigation fee: I
Phone - `f � -
CCB Lie. #: I4 cif ,- y- c' Other
Llc #: 3"
'..,.. .. : • -, ;; ' ` Electrical Per Fees *: ``:�. _
Supervising electrician D 1 Subtotal S C 3. 5 b
signature required: w' � � /� ! 1 01 Plan Review (25% of Permit Fee) $ t,� L r
Lic. #: 3 State Surcharge (8% of Permit Fee) $ ��
Print Name: , ), ��,., �n-�7ll r S TOTAL PERMIT FEE $ �S 1, g
Authorized � l Notice: This permit application expires if a permit is not obtained within
Signature: Date: 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 Fornts\ElePcrmitApp • doc 01/03
CITY OF TIGARD 3 d
BUILDING DIVISION b 4 , 5 ' PERMIT #: ELC2007-00474
13125 SW Hall Blvd., Tigard, OR 97223 lit � DA ISSUED: 7/12/2007
Phone: (503) 639 -4171 r vit
Inspection Requests (24 Hrs.): (503) 639 -4175 '
INSPECTION WORKSHEET FOR DATE: 10/310007 TIME: 7 :00AM PAGE: 03
SITE ADDRESS: 14472 SW 130TH AVE CLASS OF WORK:
SUBDIVISION: WOODFORD ESTATES LOT #: 009 TYPE OF USE:
PROJECT NAME: SCOTT
DESCRIPTION: install (2) branch circuits for Wc and furnace units.
OWNER: SCOTT, REGGIE PHONE #: 603- 2142072
CONTRACTOR: GRF ELECTRIC PHONE #: 503 829.4146
Inspection Request Scheduled For: Date: 10/31/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message ""
199 Electrical final 068704 -01 503.557 -222Q Y AV ‘,„,q)
Corrections /Comments /Instructions:
1
M a/)) 1-/cL.
CY PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
ii
Inspector: r. Date: f 'hone #: (503) 718 -