Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00403
"'^g-FI TA.• It DEVELOPMENT SERVICES DATE ISSUED: 6/10/2005
`--'' 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S109DA -06900
SITE ADDRESS: 15089 SW GREENFIELD DR ZONING: R -7
SUBDIVISION: SUMMIT RIDGE LOT : 046 JURISDICTION: TIG
Project Description: Branch circuit to AC.
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:
DAVID .FLOCEY GRF ELECTRIC
15089 SW GREEN FIELD FDR. 15460 SE PARADISE LN
TIGARD, OR 97224 MULINO, OR 97042
Phone: 503 - 887 -3972 Phone: 503 - 829 -4146
FEES Reg #: LIC 76751
SUP 1655S
Description Date Amount ELE 3 - 484C
[ELPRMT] ELC Permit 6/10/2005 $46.85
[TAX] 8% State Surcharge 6/10/2005 $3.75 REQUIRED ITEMS AND REPORTS
Total $50.60
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws.
All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is
suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
rules are set forth in OA952- 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at
503 - 246 -6699 or 1 -8I. 32 -23
Issued By: Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
•
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
. 7 . in 1 0 05 1 1 : 18a GRF Electric 5038295747
0. p . 1
r FOR OFFICE USE ONLY
Electrical Permit Applieati�� Re ,— A ∎ Electrical �m,�
-- Da te/B • 0 / 4 01' Permit No.:( C 9 06 7Z
� � Planning • pp •val gi)
City t Li UV t. Si
1..X� Of Tigard Date/By: Pem,i[ No.:
• 13125 -SW Hall Blvd. Plan Review Other
Date/By: Permit No.:
- . • Tigard; Oregon 97223 Ii 111 1 n 005 Post-Review Land Use • •
Phone: 503 -639 -4171 Fax: 503- 598 -19b �,,� � fi ; . • � Contact l Sec Page 2 toy
24 -hour Inspection Request.
53'631 5 V Name /Method: I Supplemental information.
BUILDING DIVISION,
; ,::,• PLAN:RE�?IEW (Please all'that aPP ""
...,...::, �.�.�..� tl °�+'$t' E1QF�'W01tIC:'`' ''�•. 225 ' �''1 `• • "' •' �`�" " ' `'''''• "' � ❑ Service over amps- ❑ Health -care facility
lIl New construction' ID Demolition commercial ❑ Hazardous location
1 r ddition/alteration/replaeement I El Other: ❑ Service over 320 amps - rating of ❑ four d Building 10,000
more re feel,
r• I & 2 family dwellings in
❑ System over 600 volts nominal one structure 1 & 2 -Famll dwellin: la Commercial/Industrial ❑ Building over three stories ❑ Feeders, 400 amps or more
• ■ Accesso Buildin: rU Multi-Famil ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Egress/lighting Master Builder fl Other: Blan 0 Other:
Submit sets of plans with any of the above.
�, •
5" D q Q ( pdr OC.'ATION +'< 1:: The above are not applicable to temporary construction service.
• Job site address 'f 6 0 is _A) G r e_ e n
q S L . ` el- J. •TEE* SCIIED.TLLE'::: :' : : . ........ "
Suite #: 1 Bldg. /Apt. #: h ( Number of inspectio per permit allowed
Qty Fee (ca.) Total Dcacriptiou .
Project Name: r New residential- single or multi- family per
Cross street/Directions to job site: dwelling unit. Includes attached garage.
Service included: 1000 sq. R or less 145. LS
- 35.15
Each additional sq. ft. or portion thereof 75.00 Limited energy, residential 75.00
Subdivision" I Lot #' Limited energy, non residential
Each manufactured home or modular dwelling 90 90
Tax ma / arcel #: :3 _ .ty; ;� fF; service andlor feeder
`73 r , u�gp,IQjX,iO YVORK ::'; "i t ' Services or feeders - installation,
`` alteration or relocation: 10.30
1 ��/� (4.. r 200 amps or less
201 amps to 400 amps - 106.30
160.60
5
401 amps to 600 amps 260.60
,� ;, .. ; �r y ,u� 601 amps t0 1000 amps 454.65
'r,�F' tCl�1 i��tj:"(.�;, a l'�. E 14N:' r. ,;:, dt. .. Over 1000 amps or volts
_ 66.85 60
Name: () GI V 1 d • L - 1 o re A • • Reconnect only
1 a Temporary services or !ceders - installation,
Address: ► �'t���t S C1✓ 6 re "r �� a alteration, or relocation: 6S.>35
Ci /State/Zip: t G � �n� 91 Z2 200 amps or less 100.
d 201 amps to 400 amps 133.75 30 00
Phone: 3q Fax: .. 401 to 600 amps
Branch circuits - new alteration, or
extension per panel:
Name: A. Fee for branch circuits with purchase of 6.65 I
service or feeder fee, each branch circuit
Address: B. Fee for branch circuits without purchase of t--(1_
• . City/State/Zip: a6.ss ` t�..
service or feeder fee, first branch circuit
Phone: . I Fax: Each additional branch circuit 6.65
. • Misc.(Service or feeder not included): 53.40
E -mail: c1 R, Each .um• or irri:•tioncircle
tv .. o or outline li • htin: 53.40
'''.' , ii,r, K�� t ;f< = i ..:( .? . Each si.
J . r.• . �: ,
Job No: Signal circuit(s) or a limited energy pa nel,
Pa e 2
�± p • alteration, or extension
Business Name: e - q. ►` - 0 ex �- r . Description:
Address: -v ( S • Peti KI , d A 4 l Each additional ins colon over th allowa in an of the above:
q ClCity/State/Zip: ate/7ilp n i � !' f._ 17 L i 1 t t„ L Per ins. -coon . r hour min. 1 hour
62.50
1
Phone: a1,61, , . n Fax: '51) 3 - 8 " S - 7 ,-t-•7 Investi anon fee:
Other: r :y�: ;•':
;• 1,' •? ;∎ i - "iEtettrica Peria it:Fes!t 4 i '��= -`; << "°
CCB Lic. #: -7 � `� Sl Lic. #: 3 - � ,(� 4 �...�.; .,r•:; :t` � t �
fi r\ / •t:;:,,..''::.:: Subtotal $ �- •
signature eq required: . "+ \ (. A Plan Review 25% of Permit Fee $ •
_ signature required: 1 ` � � W _
State Surchar: a 8% of Permit Fee •$
Prinf Name: ♦ i .. , . _ Lic. #: , " TOTAL PERMIT FEE $ i j i '
• N otice: This permit application expires if a permit is not ob ned withil
S jg� gturyre: i)3 ed Date: 180 days after it. has been accepted as complete.
•Fee methodology set.by Tri - County Building Industry Service Board.
•
' . • (Please print mix)
is \Dsts \Permit Forms\EtcPernutApp.doe 01/03
CITY OF TIGARD , `.f
BUILDING DIVISIO PERMIT #: ELC200�00403
13125 SW Hall Blvd., Tigard, OR 97223 ISSUED: 6/10/2006
Phone: (503) 639 -4171 � amino( hI 1
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 6/27/2005 TIME: 7:09AM PAGE: 66
SITE ADDRESS: 15089 SW GREENFIELD DR CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 046 TYPE OF USE:
PROJECT NAME: FLOCEY
DESCRIPTION: Branch circuit to AC.
OWNER: FLOCEY, DAVID PHONE #: 503 887 -3972
CONTRACTOR: GRF ELECTRIC PHONE #: 503- 829 -4146
Inspection Request Scheduled For: Date: 6/27/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 010157 -01 . 503 - 6566 N '
Correctio s /Comments /Instructions:
k G P*V/c� , ..50 # - za °
/V , fl r1 n/4`7& c7 *1(
. .h L C-0 A./ Ale
lC 7--7 e_D f - L -
5 PASS PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: Z / � C-Phone #: (503) 718-