Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00205
DEVELOPMENT SERVICES DATE ISSUED: 4/21/2004
1'3125 SW Hall Blvd.. Tivard. OR 97223 (503) 639 -4171
PARCEL: 2S111 CC -18300
SITE ADDRESS: 10425 SW GREENLEAF TERR
SUBDIVISION: SUMMERFIELD NO. 5 ZONING: R-12
BLOCK: LOT : 242 JURISDICTION: TIG
Project Description: (2) branch circuits.
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:
GEURINK, MARLIN & BARBARA WEST SIDE ELECTRIC CO INC
10425 SW GREEN LEAF TERR 1834 SE 8TH AVE
TIGARD, OR 97224 PORTLAND, OR 97214
Phone: 503 - 620 -0193 Phone: 231 -1548
Reg #: LIC 13306
SUP 2663S
FEES ELE 26 -135c
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 4/21/2004 $53.50
[TAX] 8% State Surcharge 4/21/2004 $4.28 Rough -in
Elect'I Service
Total $57.78
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.
Issued By: / Permit Signature: CA/1_,
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. ELECN: DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
, . -ti _ ". i ECElVED
Electrical Permit Application FOR OFFICE USE ONLY ' .
APR '4 0 , r `i �/t rteuery d > / /
T` J :r (i Tigard 2004 t -/a / I�� Permit N„. ._r �.,/.�
1 :11 1.:i NW hall Illv<L,'I'ig<n) >I5. ui22•t pla Rev .._ .. - -- . `ODDS
��' S" O1..54)R , r plan p Review oilier I`crnlit:
Phone: 5()3.(x37.4171 tax: Sr196(�G
Yt("� it I1 r7 -
r Jl
luspccliolr I .ine: y03.63,5340kDING DIVISION A ' ... Dirty Itt:ady /rty .... -- -- - Juri, td Set fake 2lor —
IPICr'nwi Www,ei,ligill'd,nr LIS N,Niticd /Mcths.d: S..pplc...r:.. I.I hdor,,,.r'
TYPE OP WORK DEAN REVIEW
❑ Now eonstructiori Addition /alteration /replacement Please check all that apply:
❑ 1)Cntolili0tl ❑Cabot: ❑Service over 225 amps, conlm'1 Ul Iaz, idulrc location
❑Scr•vice over :120 amps rating ❑lBuildng over i 0,000 se 11.,
CATEGORY O■ C:'ONSTRUCPION o1• 1- and 2- family dwcllinfc 4 or itawe new rclideotiol
I - and 2 - fatuity dwelling El C'onulwrcial /industrial El Acccssur building rf System over nob volts nominal units in one structure
❑Buildin over three stories ❑I•eeders, 400 amps or more
El Multi- lentils ❑ master builder ❑ Other: —_ ❑Occupant load over 99 persons CiM:rnuf:.ictru•tsI s'lrnelme, or
JOII SITE INFORMATION AND LOCATION ❑lit+t'css /IiLliiinu, plim RV park
LIZ
Ict) no.: v ) )9 2 �` Job site C1 J ''- ❑I101th -care facility ❑OUIU. ...._ .. ..........
' .. 1 ale address .. ess -. ) .. cc. C ^,.ez„ lo�. r4 Sa„„il 2 sets of plans with t„,y ul abuvc:
C;Ity /St 1te /%I h ��y) 7�i„7�1 t r c.. CA. L:• 9 7 t 4 4" ( 'fate above arc not applicable to temporary construction service. ^___,
ano.: � `.• ,, /C1. ._ .. ii ii . FEE* SC •
Suite/bldg. /apt, no.; Project -
1
_.----- ...- -- 1 �'.� ' vt ! L
• i nexcrlptlou oty. Far. r'norl
- - - -- 1 .... 1 — . _ L .. : .. . 1
Cross strcct/dircctions to.job sitc: ( ' ' l "T ..... Nc:w r Pti:r) r$ngle. or r(llrlli- I /lnrlly dwl4Oin1, tin-k. .. .. • --- --- • ---•"•• •• __.-- ....- _- - - -- Includes attached garage..
1 ,000 8q. 0. ur less 1 45.1 t 4
• ..._
Subdivision: Ian no.: ha. add'I 500 sq. II. or portion 33.40 I
-- " - - — 1.imited energy, residential 75.00 2
Tax map /pared no,: .... -. .._._. . ._..... - -• -•- • -- -_.... _._.._... .
i.imited cncrp,y, non - residential 75.00 2
i lF,ti(:R11"(I(N OF WORK l.?,c:h m,muftcaurcaf or rnodul:u
-
• dwelling, service and /or li:eder 901)0 2
,` ■L ....._ i. _ , f 4—ti ` t _ �_` - Ser'Viehti Or ft..01ler'.c install:11inrr, altl!ratinn, and /Or r! :i a hint
-
200 amps or less — 80.30 2
J Plt()Pl'E2'1 V OWNER 201 amps to 400 amps I00.it5 2
• El '('INAN'P __......
- — 401 ;imps to 600 tulips I (>0,00 2
Name: N 1 G(_^ I. r eti V I 601 amps to 1,000 amps 240.00 2
Address: e Over 1,000 amps or volts 454.65 2
°1.. VI/ - - . — . —.._.. -- Reconneet only 66.85 2
City /Stale/ %I })' Temporary services or feeders installation, alteration, and/or -
Ihone: ) / �' z - 0I gi 1 r"x:( ) 200 ..... -_ . -
1'1 .. ... -- - - ....— _....... - -° amps km 66.85 1
ant to 400 amps ei - -- 100.10
Owner installation: This inslulla Ion is being, made on property that I own which is not o 201 1 1 • 2.
intended li)r stile, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 i,,,,Is 01 . 000 amps - - - I i3 '/
Owner signature: Date: Itr aitch circuits nhw, alteration,. t r
........ ....__ .. _.._.....- _- - - -• -- - - -• -- --- �-- • - - • - -... r t: > • exult a(,n, per ■:)met
n APPI JCAN'1 ❑ CONTACT PERSON A. fee li>r branch circuits with
_--- ---- _- -.. �_..__.-- -.._.. I __...... __....__..- .._ ....... ......... service or feeder fee, each
6.(>_5 2
Ilutiiness name: branch circuit
- it. Fee tbr branch circuits
Contact name:
withow service or feeder fcc, '
• ..... .. . • _ __. --- _..._. -- --• -- 46.85
Ac7dr'CSS: eac branch circuit 2
-._- -_ — ._....._.- . -..... _..__ _ .
Hach add'I branch circuit 6.6.5 L
City/State/ZIP: Misccllunc.)us (service or feeder not included)
Pump or irrit'atiorr circle 5140 2
Phone: ( ) Pa,x:: ( ) - ._.. - - -.. _. . .. .
- -- ....._.. —._ Simi or outline lighting 5.1.40 2
li- nrlil:
_ .__..._... __ —• -_ Signal circuits) or limited-
_ _ CONTRA("1'OI( cuergY panel, alteration, or
extension. Describe: ['age 2 2
11(Isinc s name; WEST SIDE ELECTRIC CO.
Address: 1834 SF 8 111 AVE. Each additional inspection over allowable in any of the above
-- ' - -- - -- . - ... Per inspection 02.50
.fly/Slate/ZIP: PORTLAND, OR 97214 Investipation per hour (1 hr min) 62 „50
Phone: (503) 231 -1548 - l pax: (503) 736 -0677 Industrial plant per hour 73.75
ELECrRICAI, PERMIT FEES”
('Cil Lie.: 13106 -- r•,icclrie;tl It • 26 -I35C Suprv. Lie,; 26(63S (-. v
Subtotal
Suprv. lil eCtriciall .S ignature, reiluirtsl: / , / Plan review '2S%n of permit fee)
of permit I
Slate surcharge (
Print nname; 8%n fee) . Z 3
l uatc L
I PERMIT FEE � 7 ` _
Attllppfl %gd signature; v This permit application expires if a permit is not obtained within 180
— - days Alin' it has lien at:ecpled an complete
Print n : I Date: • Fee nicthudulogy set by'rri- Cuua(y IRuitdinC Industry Service numd
• • . . — • •• Number of inspections per per mil allowed.
i U . . i l ;lP, ,mi xll i.t .t • NI mil App ■ i,, . I ?!n1 4411.451 Si( ' I INi>:/('l )M /What 5
z •d LL90 -9EL IEOS) •o0 ot-v c,aj3 aptS 1.sa(n e2E :60 4,0 02 JdH