Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2007 -00299
COMMUNITY DEVELOPMENT DATE ISSUED: 5/2/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S109DA -09700
SITE ADDRESS: 15262 SW OAK VALLEY TERR ZONING: R -7
SUBDIVISION: SUMMIT RIDGE NO. 2 LOT : 086 JURISDICTION: TIG
PROJECT: NGUYEN
Project Description: Branch circuit (1) to a/c unit.
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:
LONG NGUYEN GRF ELECTRIC
15262 SW OAK VALLEY TERR 15460 S PARADISE LN
TIGARD, OR 97224 MULINO, OR 97042
Phone: 503 - 781 -0374 Contact #: PRI 503 - 829 -4146
FAX 503 - 829 -5747
FEES
Description Date Amount Reg #: ELE 3 -484C
[ELPRMT] ELC Permit 5/2/2007 $46.85 LIC 76751
[TAX] 8% State Surcharge 5/2/2007 $3.75 SUP 1655S
Total $50.60 REQUIRED ITEMS AND REPORTS
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: mwild, / / // Permittee Signature: app >j�/`C J
OWNER INSTALLATION ONLY v ` j"
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.
May 02 07 10:48a GRF Electric 5038295747 p.1
FOR OFFICE USE ONLY
ectri Permit Application Received Electrical
Da Permit No.: ELC. I ~ COZ - t 1
Planning Approval Sign
City 01 Tigard ►., Date/By: Permit No.:
•.,• 13125 SW Hall -Blvd. RECEIU �. .:.:0 Plan Review Other
on 97223 Date/By: Permit No.: M E G2�1 - i �
Tigard, O� — L O ] Post - Review Iand Use
Phone: 503 - 6394171 Fax: 503 -598 - � 2 wn„r,..,. i ;� i ri Date/By: Case No.:
Internet www.ci.tigard.or.as q ,, L ' ' s
ON - l Contact Juris.: ® See Page 2 for
�� ' D I I S 4 Name/Method: Supplemental Information.
24 -hour Inspection Request: 503 -639�E
, N: .•TYPF,W
OF ORIO. t '"' ` :!tit..........-*: :' '`cg's':" ∎': PL•'ANFREVIEW (Please c ieck.alhtbat pply)'
. • ❑ Demolition ❑ Service over 225 amps- 0 Health -care facility
E New CAnstrLLCtion commercial ❑ Hazardous location
ddition /alteration/replaeerllent I 0 Other: ❑ Service over 320 amps - rating of ❑ Building over 10,000 square feet,
_ . .. _ _ dwellings four or more residential units in I & 2 fam dwellin
g
•. •; -.. CATEGOSY'.OF":CONTS7' '��'• `:.; � .:- g
❑ System over 600 volts nominal one structure
1 & 2- Family dwelling ❑ Commercial/Industrial ❑ Building over three stories ❑Feeders, 400 amps or more
Accessory Budding ❑ Multi- Family ❑ Occupant load over 99 persons
0 Manufactured structures or RV park
❑ Other. ❑ Egress/lightiug plan ❑ Other:
Master Builder - Submit sets or plans with any of the above.
s'::J.OB: SITE IIITFORIVI�ITXO�Y:�rid;OC�ITION °� `•' Submit
are not applicable to temporary construction service.
1 !v - 2 s w 0A L V u > ta► :.ouED
sI<J :. : t ::... .,..
Job site address: p �/I �� .:�:' , �'' : • - .. ° �;;�`: • ..`
Suite #: I Bldg. /Apt #: Number of inspections per permit allowed
�.cacrlptlOn Qty Fee (ea.) Tout
Project Name: n1 j,,f . L.J� �'✓1 New resldeatial-single or multi-t'amlly per 1
Cross street/Directiot jou site: dwelling malt. Includes attached garage.
Service Included: 145.15 4
1000 sq. 8. or less
Each additional 500 sq. ft. or portion thereof 33.40 1
Limited energy, residential 75.00 2
Subdivision: I Lot #: Limited energy, nonresidential F 75.00 2
Tax :� ;' ' ,: pN.QF:WURK' ,a m ap/Parcel #' Each manufactured home or modular dwelling 90.90 2
fi2DLSCRIRCI •' ` + ;' service and/or feeder ` . a - "k Services or feeders - Installation,
alteration or relocation:
/+ 2
�,�• � ✓ 2 am o 4 00 amps
1 /� �iLww� 106.30
85 2
401 amps to 600 amps 160.60 , 2
RO ..c• . s, : .. .,, • • ' � 601 amps m 1 000 amps 240.60 2
RERTY .`A�)NER''it,..,1;x;TFNiAN't.- `'::'.:: ; n: .:. ,.a '.a 454.65 2
A) Over 11100 amps or votes 66.60 2
Name: L /'j A) r V 1 et', Reconnect only
Address: $ z- 2 -I S f Q/a k-•- VA-11 e'j Temporary services or feeders - installation,
alteration, or relocation:
City /State/Zip: , ,.
,.,�, , c7 7 .7 7 -Y - / P7"i�" 200 amps or Ices 66.85 I 201 amps m 400 amps _ 100 .30 2
Phone: 1 -( ` - 0 : I F : _ , �. 401 amps tomes 133.75 2
A - .cotaACT:PERSONj Branch circuits - new, alteration, or
Name: • extension per panel:
A. Fee for branch c with purchase of 6.65 2
Address: service or feeder fee, each branch circuit
City /StateIZip: B. Fee for branch circuits without purchase of fir ` 46.85 � �� . 2
service or feeder fee, fast branch circuit 6.65 Phone: I Fax: • Each additional branch circuit
Misc.(Service or feeder not included): 2
E-mail y y ,, �. t 4 , : , ' Each pump or irrigation circle - 53.40 • 2
...•, ., „: . Y o t Each shin or outline IigMi 4
53 na
Job No: Signal circuit(s) or a limited energy Panel. Page 2 • 2
• alteration, or extension
Business Name: G -f t ! O
Cc-4-y- Cc-4-y- r . y Description:
Address: I ii S . t� t �' Investigation fee:
PA r0 d A4,/ ' " ] / Each additional inspection over the allowable In any of the above:
City /State/Zip: M L) �.. q 7 0 L[ -- Per inspection per hour (min. 1 Four) 62.50
Phone: SU3 Q�G - / (�� Fax: 5b3 - ?! 674-7
C -7 S 'L Y °. Lt Fetes *- :'':�,_ M::.. - . ::.!
CCB Lic. #: � � Lic. #: • .7 � � �C 7• �v _`-} ` F r ; x , . ,•. . . Etectilc:�l;Perm �� ...:,t.• .:,. , .
Supervising electrician r-C Su 1 b Fee) $
� ( p . ^ k- 5
�, \ <)Z� 7 Plan Review (25% of Perms ) c
signature required: State Surcharge ova of Permit Fee) $ --�
Print Name: �/ n } r u�, S Lic. #: � �$ TOTAL PERMIT FEE S --7 . / �_ e
Notice: This permit application expires if a permit is not obt�it witltl
Authorized 180 days after it. has been accepted as complete.
Signature: Date: *Fee methodology eat 6y'M- County Building industry Service Board-
.
. (Please print name)
i:\13stsWertrtit 01/03
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2007 -00299
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/2/2007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 �&.. 1.
INSPECTION WORKSHEET FOR DATE: 5/4/2007 TIME: 7:00AM PAGE: 56
SITE ADDRESS: 15262 SW OAK VALLEY TERR CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE NO. 2 LOT #: 086 TYPE OF USE:
PROJECT NAME: NGUYEN
DESCRIPTION: Branch circuit (1) to a/c unit.
OWNER: NGUYEN, LONG PHONE #: 503 - 781 -0374
CONTRACTOR: GRF ELECTRIC PHONE #: 503 -B29 -4146
Inspection Request Scheduled For: Date: 5/4/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Me - _ •=
199 Electrical final 047634 -01 503. 557 -2220
Corrections/Comments/Instructions:
K PASS 2 PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL E LL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: moo/ . ■. _ Date: _ 5 / 1 //07 Phone #: (503) 718- 2-C,