Permit C ITY OF TIGARD GARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00566
e AP DEVELOP I Tigard, OP MENTSERVICES � 50 639 - 4171 DATE ISSUED: 8/8/2005 Hall 13125 PARCEL: 2S 103AA - 03000
SITE ADDRESS: 10485 SW CLYDESDALE PL ZONING: R - 4.5
SUBDIVISION: CLYDESDALE LOT : 010 JURISDICTION: TIG
Project Description: 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:
JANETTE BROWN GRF ELECTRIC
10485 SW CLYDESDALE PL 15460 SE PARADISE LN
TIGARD, OR 97223 MULINO, OR 97042
Phone: 503 - 439 -0793 Phone: 503 - 829 -4146
•
FEES Reg #: LJC 76751
SUP
Description Date Amount 3
ELE 3 -484C
[ELPRMT] ELC Permit 8/8/2005 $53.50
[TAX] 8% State Surcharge 8/8/2005 $4.28 REQUIRED ITEMS AND REPORTS
Total $57.78
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Speaalty 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 OUN C at
503 - 246 -6699 or 1 -'sa -332- 4.
Issued By: �j Permittee Signature: i •
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.
Aug 05 05 03:25p GRF Electric 5038295747 p.1
FC ENED .
,_ Electrical Permit Application • FOR OFFICE USE ONLY
Receive /_ / Electrical r, Go
NW Datc/By P /u� / / permit No�r`�
•
�1 of Ti and Planning A ro 1 Sign
\ g Date/By: Permit No.: ,
"-• 13125 SW Hall Blvd. CV '( O � TIGARD Plan Review Other
• Tigard, Oregon 97223 BUILDING DIVISiOP Date/By: Permit No.:
Phone: 503 - 639 -4171 Fax: 503 -598 -1960 Post- Review Land Use
�V�pily{4'' Date/By: Case No.:
Internet: www.ci.tigard.or.us e i I Contact hi�,r ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name /Method: .Lu/ Supplemental Information.
'•':, , .. q i :11(.E`OFAN , PLAN kEVIEW.(Plea_ se check all:that apply)
H New construction n Demolition 0 Service over 225 amps- ❑Health -cart facility
commercial ❑ Hazardous location
ddition/alteration/replaeement El Other: ❑ Service over 320 amps - rating of ❑ Building over 10.000 square feet,
,, ;a : , • f� }Oh'�'; CO11IS L`RUCT QN 1 & 2 family dwellings four or more residential units in
• I3 . & 2- Family dwelling 11] Commercial/Industrial El System over 600 volts nominal one structure
R Accessory Building El Multi- Family ❑ Building over three stories ❑ Feeders, 400 amps or more
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
Master Builder El Other: ❑ Egress/lighting plan ❑ Other:
; :: : :: 1 ,. t:! �,a'+' ' 1 t _ : , Submit _ sets of plans with any of the above.
:. .. ;fr,xi ,i� �xF4�lt�I AIfJ1Y.an ' dLOCATION
The above are not applicable to temporary construction service.
Job site address: / 0 ` f c S t,) C• / d e_A eflc - E* ? :FE SCHEDULE . • .,
Suite #: Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: J Ai esiription 1 Qty Fee (ems) Total
Cross street/Directions to o site: New residential - sin or multi- family per
l 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 l
Subdivision: Lot #: Limited energy, residential 75.00 2
Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
'i1y.F; ";..,
1 • ; service and/or feeder 90.90 'Y
,a..�a,�P ; .t•:� -.:.: i ,.. :. ��5�`� WORK > ,. ... �.., . ...
Services or feeders - installation,
+` 4 .- c < , `- 1 c-- / Q ( ,Zi alteration or relocation:
200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 _ 2
Deer ;7, 1 v' „.�?:;.? #' ate _ > pp T. . ,A.NT ' , '. . • ; i . 601 amps to 1000 amps 240.60 2
Over 1000 amps or volts 454.65 2
Name: < 1 r,, J.1 c -g- e 6 vv r �� , /, Reconnect only 66.85 2
Address: / D � k- R Sic) �7 d P d 6, / Temporary services or feeders - installation,
alteration, or relocation:
City /State /Zip: �i d .( C t 1 ZZ 3 200 amps or less 66.85 l
F 201 amps to 400 amps 100.30 2
Phone: 3 ° 1 Q ax 401 to 600 amps 133.75 2
IN�F1 i t 4 .C.IINTACT °PERSON"-' ' . :
63 ..51'..Y Branch circuits - new alteration, or
Name: extension per panel:
Address: A . Fee for branch circuits with purchase of each circuit 2
service or feeder fee, eac branch crcuit _
City /State /Zip: B. Fee far branch circuits without purchase of
service or feeder fee, first branch circuit t 46.85 t�
t 6) • 5 2
Phone: i Fax: Each additional branch circuit ( 6.65 j 2
E -mail: Misc.(Service or feeder not included): �
mt , Each pump or irrigation circle 53.40 2
Each sign or outline lighting 53.40 2
Job No: Signal circuit(s) or a limited energy panel,
Business Name: p � QP Description: r extension Page 2 2
ICY” i'�Y"! (^.
Address: 1 Lo S, Pik rf d-( ,
Cl /State/Z1 /� Each additional inspection over the allowable in any of the above:
yJ p Lt / 1 Le, n 1, t ..' 7 (2 1 Per inspection per hour (min. 1 how) 62.50
Phone: 9j3'- y 4 - t f / L� I Fax: 5) 1 3 - 8 Z -. -s ,-1- -7 Investigation fee:
CCB Lic. #: S Lic. #. 3 - ,i l+ C _ Other: • � � ^, `f _.- :.,..,ElectiricaliPerinifFee • .,.•
n -�
Supervising electricia v / �� a S Subtotal $ - 5
r
signature required: � `^ Plan Review (25% of Permit Fee) $ • 1 : 7 c,-
Print Name: W n 1; 4„„ S � Lic. #: ' Le 5 S $ State Surcharge (8% of Permit Fee) $ --�
TOTAL PERMIT FEE $ 'c - i .
Authorized 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 Forms\ElcPermitApp.doc 01/03
.CITY OF TIGARD .
BUILDING DIVISION PERMIT #: ELC2005"00566 . i
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/8/2005
Phone: (503) 639 -4171 4 �'eq�,1uHII�I
Inspection Requests (24 Hrs.): (503) 639 -4175 -MJ' 4 __..
INSPECTION WORKSHEET FOR DATE: 8/19/2005 TIME: 7 :07Am PAGE: 96
SITE ADDRESS: 10485 SW CLYDESDALE PL CLASS OF WORK:
SUBDIVISION: CLYDESDALE LOT #: 010 TYPE OF USE:
PROJECT NAME: BROWN
DESCRIPTION: AC and outlet.
OWNER: BROWN, JANET T E PHONE #: 503. 439 -0793
CONTRACTOR: GRF ELECTRIC PHONE #: 503 - 829-4146
Inspection Request Scheduled For: Date: 8/19/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 013699 -01 503 - 620.7571 Y
Corrections /Comments /Instructions: 2 N\
1
PASS n PARTIAL APPROVAL n CANCEL ❑ NO ACCESS
FAIL CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: V NO3 Le .--'
Date: ‘24 (1' C6 Phone #: (503) 718- 24L �j