Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2008 -00336
COMMUNITY DEVELOPMENT
DATE ISSUED: 6/12/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 103DB -00500
SITE ADDRESS: 11015 SW PARK ST ZONING: R-4.5
SUBDIVISION: MIRA PARK LOT : 001 JURISDICTION: TIG
PROJECT: WASHBURN
Project Description: Installing (2) branch circuits for A/C.
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:
RYAN WASHBURN GRF ELECTRIC
11015 SW PARK 15460 S PARADISE LN
TIGARD, OR 97223 MULINO, OR 97042
Phone: 503 - 863 -7493 Contact #: PRI 503 - 829 -4146
FAX 503 - 829 -5747
FEES
Description Date Amount Reg #: ELE 3 - 484C
[ELPRMT] ELC Permit 6/12/2008 $53.50 LIC 76751
[TAX] 12% State Surchar 6/12/2008 $6.42 SUP 1655S
Total $59.92 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 B - s� - i� Permittee Signature: ^ �/f/✓
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.
,iJn_,11 08 11:21a GRFELECTRIC SDIVD 5038295747 p.1
t RE C 1
- Elerical Permit Application , l24 Electrical 1.01.z 0t i It v i ;1• c3,t.,
City of'X'igard ^ A a ' if. '/- cna
pilN: •:- e (-GG�33 to
13125 SW Hall Blvd.,Tigard,OR 97223 f+ OF i ...wkr ll i ' i.. 'twin« �
Phone: 503.639.4171 Flare 503.598.19a' {� 1�csv ∎ - l s DerrJ9 • Map c L/ / __ -��/• i 1) '
1 1 ,....\ 1: 1, lesPCetion Lie: 503.639.4175 Bu1L Data ReedylBy: c 8 Ste Pale 2 for
Internet; www,tigard Notified/MRDod: Ztp Supplemeemllafonaarioa
TYPE OF WORK • PI AN REVIEW
- 0 New construction dditian/aloerationhicp1acemcnt Nous deck all Mat apply ( auAnitamu plans sultans cheated Isla .):
0 Seevict or twin 400 dupe or sore 0 Building ever three stories.
❑Demolition ❑ Other: when t °Main= and boatyards.
CATEGORY OF CONSTRUCTION classed. moo amp, at t SO volts or D Aortic. kidding,.
less to ground, or e:aeds Kam CI Enna rciat ore eric.laret
- and 2-- family 4welling Q Cotnmets:ialfindu iel ❑ Accessory building snore for dl other irsonanose. bcilorp.
❑ Multi•firnily
Master builder [J Other: ne pump. O Inpellaoot of 75 KVA or
JOB SITE INFORMATION AND LOCATION O Malian drew it lager mama* . t.2 . derived 4>
Qgddaienednwsolorlose or Q "A", "R"'„"1.4"."1-3
I lob slot address: ) p sirup a more eee"pwi
Job no.: n
Y ` J 0 1 S St 1J f y k- S't' - o Sir mown rerideo0at wets CI Rearaaeia,a►.Rnie1. wafer
City/Slate/ZIP; 0 1gte.roran facilities. CI Supply roam tor re than
T I Gi fr. ,,,.j,_ ❑Haaordaualouden. 000 unto nominal.
Suite/bldg./apt no.: ,J Project name: W 0.-S 1 10 IA.r ✓1 13 semi or eider 600 rata at Mom
FEE S(
Cross street/directions to job site: anerioti.a I on. I rte. I T.r•t 1 • , ' .
New residential single- or,aulti- fanny dwelling unit.
Include, attached garage.
Subdivision: I Lot no.: 1,000 sq. It or los 145.15 4
Fa atld'I S00 sq. ft. or portion 33.40 1
Tax map/pateel no.: Limited energy, residential
DESCRIPTION Of WORK (w t4. n.) 75.00 (With ebN 2
/� �
/ Limited energy, multifamily
2.- titiY4 iG 1i-c_ f r? ilt�T ! _ residential(with above it n.) 75.00 . 2
&Mots or feeder, Los ta►latian and/or relocation
200 amps or lest 8030 2
‘01 OWNER 1 Cl • TENANT 201 amps to 400 amps I06.85 2
Nasals: /— �( ,. 401 apps to 600 amps ) 60.60 2
A ✓l � dk
✓i r, IA {e 601 amps to 1,000 amps 240.60 2
Address: J i f 01 S CJA) Pie, v k 5t Over 1.000 amps or volts 454.65 2
CityIStatccrzIP: -r t G. r� I ') L L 3 Temporary services or feeders installation, attention. a odor
N . relocation
Phone: ( ) VP - I tar 13 I Fax: ( ) 200 amp, or Tess 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 1 0030 2
intended for sale, scare. rent, or exchange, according Co ORS 447, 449, 670, and 701 40 1 amps to 599 =Pt 133.75 2
linneh circuits- clew. alteratIO or extension. per panel
Owner signature: Date: A. Fee fir branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fcc. 6.65 2
each branch circuit
Business naate: B. Fee for branch circuits
without service or feeder fm, ' 46,85 Lit .,s'a 2 I
Conics name: first branch circuit
Ad4fass: Each add'tluso& circuit - 1 6.65 4 . fl 2 I
Miscellaneous ( service or feeder riot included)
City /StaicIZIP: Each manufactured of modular 90.90 2
dwelling. service and/or feeder
Phone: ( ) I Fax:: ( ) Resernea only 66.85 2
E - mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign outline liglting 53.40 2
Btusiness name: Signal citeuit(i) or limited - 6 (Z- F P . r ! " C _ enet' panel. donation or
Address: j S` 0 Pa 1�a rdf ins-
minion. Daubs: Doge 2 2
cit 71,7 1 to _ r - Q . Q (`- G1 .- a t, f , Each additional Inspection over allowable in an of the above
Pet inspection 62.50
Phone: (L�� ZC • ' a Fax: ( ' 7 j) e - -7 Investigation per hour ( 1 hr rein) 62.50
CCB Lie.: `] W -15 Electrical Lies: 2 'f .. Suprv. Lic.J ip t, 5 -cl. ^ indiansi,l plant per hour 73.75 _
ELEM./CAL P FUS •
Supt. Electrician signature, required: Submial: S. 3 4' b
Print slants. Oats: ill 0 & (Nan review (25% of permit fcek
Y V i l Gt .k,„.1 bN r `l 1 1 State surcharge (12% of permit feck
Authorized signature: TOTAL PERMIT FEE.
Print name: Data 'Ibis permit appbuttier aspires If a pu M rait 4 . ehraierd wit sib rid
days after it asi been aeaptce at enaplece.
• r �
Tiamrt d
b ; N p tt tgns allnwad per permit
ttaoldiatt LC44rwi o,•tee OL2,O0 ' • 4ee.a41 IST111/03/COMIWFa
•
CITY OF TIGARD .
BUILDING DIVISION • PERMIT #: ELC200 8-00336
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/12/2008
Phone: (503) 639-4171 ,11%'
Inspection Requests (24 Hrs.): (503) 639 -4175 ' ' °'I I ..
INSPECTION WORKSHEET FOR DATE: 6/18/2008 TIME: 7:02AM PAGE: 61
SITE ADDRESS: 11015 SW PARK ST CLASS OF WORK:
SUBDIVISION: MIRA PARK LOT #: 001 TYPE OF USE:
PROJECT NAME: WASHBURN
DESCRIPTION: Installing (2) branch circuits for A/C.
OWNER: WASHBURN, RYAN PHONE #: 503 - 863 -7493
CONTRACTOR: GRF ELECTRIC PHONE #: 503 - 829.4156
Inspection Request Scheduled For: Date: 6/1812008 Pour Time:
Code # Inspection Description Confirm # Contact # Message /„ n
199 Electrical final 071515`01 503-557 -2220 Y ' rV I L —
Corrections /Comments /Instructions:
h "wie 0
JJ (9 vb to ..._.___
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL KNO ACCESS
10 FAIL K CALL Fs i INSPECTION El ADDITIONAL FEES ASSESSED
Inspector: Date: wiqo U Phone #: (503) 718
CITY OF TIGARD
BUILDING DIVISION J PERMIT #: - ELC2008 -00336
13125 SW Hall Blvd., Tigard, OR 97223
u .d DATE ISSUED: 61121206112/2000 Phone: (503) 639 - 4171 :Now
Requests (24 Hrs.): (503) 639 -4175 „,. I_..
INSPECTION WORKSHEET FOR DATE: 6/30/2008 TIME: 7:00AM PAGE: 38
SITE ADDRESS: 11015 SW PARK ST CLASS OF WORK:
SUBDIVISION: MIRA PARK LOT #: 001 TYPE OF USE:
PROJECT NAME: WASHBURN
DESCRIPTION: Installing (2) branch circuits for NC.
OWNER: WASHBURN, RYAN PHONE #: 503 - 863-7493
CONTRACTOR: t3RF ELECTRIC PHONE #: 503- 829 -4146
Inspection Request Scheduled For: Date: 6/30/2008 Pour Time:
Code # Inspection Descripti _ Confirm # Contact # Message
199 Electrical final G G 071927 -01 503 -8637493 Y 4 14 /IS
Corrections /Comments /Instructions:
1
IfigEliarigliffill
wim -00-
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ C . LL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: I 1 ' I Date: 61
Phone #: (503) 718- ? y 1 V