Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2000 -00103
r, ���;, DEVELOPMENT SERVICES DATE ISSUED: 3/14/00 •
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S104AA 07700
SITE ADDRESS: 12705 SW KATHERINE ST
SUBDIVISION: BELLWOOD NO. 2 ZONING: R -4.5
BLOCK: LOT : 108 JURISDICTION: TIG
Project Description: Install 1 branch circuit in single family 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:
M ANF 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:
BONNIE ST JERMAINE GRF ELECTRIC
12705 SW KATHERINE ST 15460 SE PARADISE LN
TIGARD, OR 97223 MULINO, OR 97042
Phone: Phone: 503 - 829 -4146
Reg #: LIC 76751 ORIGINAL
SUP 1655S
ELE 3 -484C
FEES Required Inspections
Type By Date Amount Receipt
Elect'I Service •
PRMT KJP 3/14/00 $37.50 0000654 Elect'l Final
5PCT KJP 3/14/00 $3.00 0000654
Total $40.50 '
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws.
All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is
suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC at (5031
246 -1987. /
PERMITTEE'S SIGNATURE ISSUED BY: /C 7-
OWNER INSTALLATION ONLY
. The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY •
SIGNATURE OF SUPR. ELEC'N: ovt_- DATE:
LICENSE NO: /( r-r S
Call 639 -4175 by 7:00pm for an inspection the next business day
05/07/1995 06:48 5038295747 GRF ELECTRIC PAGE 01
CITY OF TIGARD ' RECE giitrical Permit Application Plan Check 11
- 13i26 SW HALL BLVD. Rac Sy
TIGARD OR 97223 MAR 1 3 2000 °*a Reed
Phone (503) 938.4171, x304 Dace to P.E
COMMUNITY DEVELOPMENT Data to CST
Inspection (503)13394175 Print of Type Permit X Etc Zaw - 00 / o0
Fax (503) 59$ -1960 Incomplete or Illegible will not be accepted Calms
1. Job Address: 4. Complete Fee Schedule Below: •
- Nerae.of Development , Number of Inspections per permit allowed
Name (or name of business) R e leg .n e 5!-_ L� �rr� : Service Included: Items Cost Sum 1
Address ! ,1 - 7l?..S S L) f a 41, Er' Si-, 'r. R.ald.raal . per unit
C ty/StaterZip T1) 4 rule 0 2 4 / 22.-g ,000 u. I1. or Iess _ $ 117.75
T Each additional 600 sq. ft. or
Commercial ❑ ReeldertEial won whereof $ 26.26 1
Limited Energy $ 60.00
- . .. . �f* e......._
Each Manufd Horns or Modular
2a. Con r only: DWwiIrg Sonic* or Feeder . $ 72.76 2
(Prior to permit Fssuanok applicants mule prwae contractor license 4b. Service or Fierlsn .
Information for COT dole b ee). c . Installation, alteration, or relation
Electrical Contractor _ !y L 200 amps or less $ 64.25 2
Address ( s [i Q Ira .4 201 amps to 400 amps _ $ 56.60 2
401 amps to 600 amps I 128.60 • 2
Cite . M +•'t t r o . Q g- ,Z11) '7 D V 001 amps to 1000 amps -
$ 192.50 - 2
Phone No. ) - 4-1 4- (Q Oyer 1000 amps or vole $ 963.76 2
Job No. j Reconnect only $ 63.60 2 •
Elec. Corti. Lice, No. Exp.Oate /0 4c. Temporary somas or Feeders
OR State GCB Rep. No. ''1 r. '7 I Exp.Date 00 t' !retaliation, elbn5on, or Mouton
COT Business Tax or Metro No. Exp.Date R 1 / Qu 200 amps or lase $ 53.50 2
201 amps to 400 amps $ 60,23 2
Signature ot Supt. E n N,- vkL. 401 amps to 600 amps $ 107.00 2
C ► CMer 600 amps to 1000 voila,
License No.) S - 1 S Exp. Date i i >, js sea "b' above, •
b, Branch Circuit.
Phone No. Q L t - 'f 1 Nov. ansrabon,or estenslon per panel
PA le- p ?it - $1 4-7 a) ma ore for trench drafts
2b. For owner installations: with purr-Mee of service or
hear Ate
Print Owner's Name . Each branch droll $ 5 . 3 5 2
- dd( - The be for branch circuits
City State zip , ° of service
Ph CC)
one No. . First branch circuit 1 5 37.50 3 '1.
Each addltlonel branch drait ' 5 6.35
The installation Is being made on property I own which Is not 4e. Mi.osllar.o,s .
intended for sale, lease or rent (S.nfos at racer no included)
Each pump or Inipation drde $ 42.75
Owners Signature Each Wan or oU*. aghdn9 8 42.75
_ Signal circuit(*) or a liked energy
put dlon 3. Plan Review section (if required):* Minor , . i1h ( °f °" °r' 5
107.0
Plume cheek appropriate Item and enter tee In section 613. 4f. Each addluonel Irepeceon over
a or more reata.raW units In one structure the allowable In arapr of the above
our h
Service and feeder 226 amps or more Per flour Per tlorr $ 60.00
i 60.00
Sp een over 600 volts nominal In Plant $ 69.00
Classified area or structure oortta)nha special oo .ipancy u
described in N.E.C. Chapter 5 . 5. Fees: 51)
6a. Error total of above fees $ 3 1 . -
* Submit 2 awls of plane with Application veers any of the above apply. D & rchiege (.05X total Lees) $ 3 •
Not required for temporary construction eendose. bD Subtotal 3
ID, Enter 26% of line Is for
NOTICE Plan Reese # r auksd (Sec 3) 3
..__ IF wow OR CONSTRUCTION AUTHORIZED
UMW
IS NOT COMMENCED WITHIN 160 DAYS; ok IF OR , I
WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS Trust Account t J Q) J / �1 ✓
AT ANY TIME AFTER WORK IS COMMENCED. Total balance Due $ 40 .
.......... L\dsts1form.\cicctric.doc
V
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
T Date Requested '7— / 2 -0 0 AM, x PM BLD
Location f a7 0 S f<011 h S 1 Suite MEC RED --
- d 75-
Contact Person Ph &A SL &d PLM
Contractor Ph SWR
BUILDING..: .;` . -�.° , Tenant/Owner ELC .R00 -e(9/-D
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes: f_
Slab SIT
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
PAS PART FAIL
ECHANIC_ L
Post & Beam
Rough In
Gas Line
S oke Dampers
PART FAIL
pOPECTRICAO
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
PART FAIL
SITE
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 `� 62,4.--e: Approach /Sidewalk
Other Date / � a0 Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.