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Permit CITY OF TIGARD ELECTRICAL PERMIT I. . PERMIT #: ELC2000 -00294 11 DEVE 639 -4171 DATE ISSUED: 06/05/2000 PARCEL: 2S 103BB -04100 SITE ADDRESS: 12497 SW KATHERINE ST SUBDIVISION: BROOKWAY ZONING: R -4.5 BLOCK: LOT : 041 JURISDICTION: TIG Project Description: Install one branch circuit in SF dwelling 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: NASH, ERIC A + TRACY DEA GRF ELECTRIC 12497 SW KATHERINE ST 15460 SE PARADISE LN TIGARD, OR 97223 MULINO, OR 97042 Phone: Phone: 503 - 829 -4146 Reg #: LIC 76751 SUP 1655S ELE 3 -484C FEES Required Inspections Type By Date Amount Receipt Elect'l Service PRMT SS 06/05/200 $37.50 0002685 Elect'l Final 5PCT SS 06/05/200 $3.00 0002685 ® i Total $40.50 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 direct questions to OUNC at (503) 246 -1987. PERMITTEE'S SIGNATURE *Q • t • d ISSUED BY 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: ©).) /Ppi c e7' /",w DATE: f- S— Q' LICENSE NO: ./C. 3 SS Call 639 -4175 by 7:00pm for an inspection the next business day 05/22/2000 14:19 5038295747 GRF ELECTRIC PAGE 01 1,-, O F TIGARD Electrical Permit Application Plan Check # . • 13125 SW HALL BLVD. Recd By ssz TIGARD OR 97223 Date Recd 4 -2 - o D Phone (503) 639 -4171, x304 Date to P.E. Date to DST Inspection (503) 639 -4175 Print of Type Permit # 644 20 - 0o29y Fax (503) 598 - 1960 Incomplete or Illegible will not be accepted Called ‘,Se_ /0,r • 4 -Soo 1. Job Address: 4. Complete Fee Schedule Below: • Name of Development Number of Inspections per permit allowed Name (or name of business) En' c...- .4,10,ili Service included: Items Cost Sum Address . i, %L ' i ' 4a, Residential - per unit L 1000 sq. It or less ; 117,75 4 City /State/Zip T/ Q� Each additional 500 sq. ft, or CC''II ��.. portion thereof $ 26.25 1 Commercial CI Residential 1 Limited Energy $ 60.00 Each Manufd Home or Modular 2a. Contractor installation only: Dwelling Service or Feeder $ 72.75 2 (Prior to permit Issuance, applicants must provide contractor license 4b, Services or Feeders information for COT data base)_ D e7 / v e Installation, alteration, or relocation Electrical Contractor G /� ( el . G-1- 1 ^ (� 200 amps or legs, $ 84.25 2 Address I it 0 6 S . lA r (43 e Lin 201 amps to 400 amps $ 85.50 2 t..4 I r o State t? Zip 401 amps to 600 amps $ 128.50 2 City p v 2 601 amps to 1000 amps $ 192.50 2 Phone No. , V-ct - 4-1 4 (07 Over 1000 amps or volts $ 383.75 2 Job No Reconnect only $ 53.50 2 Elec. Cont. Lice. No. . 44' ' Exp.Date u Iff l 1 .4c. Temporary Services or Feeders OR State CCB Reg. No. '1 to 7 5 I Exp.Date `1 rff Od Installation, alteration, or relocation COT Business Tax or Metro No. 3* "12- Exp.Date [i h l 200 amps or less 5 53.50 2 201 amps to 400 amps S ' 80.25 2 Signature of Supr, Elec'n� 401 amps to 800 amps $ 107.00 2 Over 600 amps to 1000 volts, License No.) to S Exp.Date It >-pa B« "b" above. 4d. Branch Circuits Phone No, 2- Y rf 14-4 New, alteration or extension per panel Fly 'IC Sf 251- 5/ '4-7 a) The fee for branch circuits 2b. For owner installations: with purchase of service or ' feeder fee. ' Print Owner% Name . Each branch circuit $ 5,35 2 b) The fee for branch circuits Address without purchase of service City 'State Zip or feeder fee. l ? Phone No. First branch circuit e S 37.5 .3 , Each additional branch circuit S 5,35 The installation is being made on property I own which is not 4e. Miscellaneous intended for sale, lease or rent. (Service or feeder not included) . Each pump or irrigation cirde $ 42.75 Owner's Signature Each sign or outline lighting $ 42.75 Signal circuit(s) or a limited energy if. required):* panel, a alteration or extension $ 60.00 3. Plan Review section (+ q / Minor Labels (10) 5 107.00 Please check appropriate item and enter fee in section 5B. 4f. Each additional inspection over 4 or more residential units In one structure the allowable In any of the above Per Inspection $ 50.00 , Service and feeder 225 ATMs or more Per hour $ 50.00 System over 600 volts nominal • In Plant $ 59.00 Classified area or structure containing special occupancy as • described in N.E.C. Chapter 5 5. Fees: Hw y * Se. Enter total of above fees $ 3 Submit 2 sets of plans with application where any of the above apply. 5% Surcharge (.05 X total fees) $ 3 r --- Not required for temporary construction services. Subtotal $ • sb. Enter 25% of line sa for NOTICE Plan Review If required (Sec. 3) • $ PERMITS BECOME VOID IF WORK. OR CONSTRUCTION AUTHORIZED Sudtot9! $ IS NOT COMMENCED WrrHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS Trust Account # AT ANY TIME AFTER WORK IS COMMENCED, Total balance Due $ i; \dsts \forms \elcetric.doc CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour` Inspection Line: 639 -4175 Business Line: 639 -4171 ,{ BUP Date Requested 7- L AM PM BLD Location / 2 y ? ? - 5 - 4 1./ - 5 - 4 1./ lt4. frk� 1 5-1 Suite MEC Contact Person Ph 5 2- ' �/ 24 3 PLM Contractor Ph SWR BUILDING : Tenant/Owner ELC 0 2 U !<Y� -- 60 2 9 ( Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes: Slab SIT Post & Beam Ext Sheath /Shear 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 MECHANICAL Post & Beam Rough In Gas Line Smoke Dampers Final PASS PART FAIL ervice Rough In UG /Slab G Low Voltage ifre Fire Alarm V P ART 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 Other D ate ..-2//73 Inspector Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.