Permit OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00346
,444. DEVELOPMENT SERVICES DATE ISSUED: 6/12/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S103CB -10900
SITE ADDRESS: 12165 SW QUAIL CREEK LN
S-U5DIVISION: QUAIL HOLLOW - EAST ZONING: R -4.5
BLOCK: LOT : 067 JURISDICTION: TIG
Project Description: Install (1) branch circuit for AC.
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:
BYRON GEYA • GRF ELECTRIC
12165 SW QUAIL CREEK LN. 15460 SE PARADISE LN
TIGARD, OR 97223 MULINO, OR 97042
Phone: 503524 -8073 Phone: 503 - 829 -4146
Reg #: LIC 76751
SUP 1655S
FEES ELE 3 -484C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 6/12/03 $46.85
[TAX] 8% State Tax 6/12/03 $3.75 Rough -in
Elect'I Final
Total $50.60
•
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 -23 .
Issued By: i/ ;��� , � � Permit Signature:
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: l/4 5 6S
Call 639 -4175 by 7:00pm for an inspection the next business day
Jun 11 03 02:01p GRF Electric 5038295747 p.1
—... � II
Electrical Permit App ' ation
D ate receivedi/ _e Permit no,
„74..'s
..,.1. � ►
City of Tigard ��
g ProjecVappl. no.: Expire date:
City o�gard Address: 13125 SW Hall BI i , OR 9 Date issued: By: I Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 , 1 G O� Case file no.: Payment type:
Land use approval: j 0 � ,\0\ g �
•T /C7
TYPE OF PLIWIIT
- 1 & 2 family dwelling or accessory ❑ Commercial/industrial 0 Multi- family 0 Tenant improvement
O New construction 0 Addition/alteration/replacement ❑ Other. ❑ Partial
.1011 SITE INFORMATION
Job address: % I (y .5 S�J ('? I c . ; l Bldg. no.: Suite no.: Tax map/tax lot/account no.:
Lot: I Block: I Subdivisio r'e.e, k. Lie, r -
Project name: 13 rj ro . c &e J Description and location of work on premises: 1 e �• �,(,� A - G
Estimated date of co pletion/inspection: J4
CON•I'RAC1'OR APPLICATION FEE SCHEDULE
I d U U. Fee Max
Business name: 63-(- e 6 c....-he 1 c. Description Qty. (ea) iotai i no. insp
New residential - single or rosin - family per
Address: I q4-I S, }' r . a c Se dxelliagunitlncludesattacbcdgarage.
City: /Ll i.il r %t O 563 I State: 014. I ZIP: 47 04'2_. Servkeiacluded:
Phone: 51)3-f 7A — 41.1.4e 1 Fax: ( - 57 ,f7 E -mail: ' ) 000 sq. ft. or less 4
b ? ci 1 3 - q g + Each additional 500 sq. fl or portion thereof
CCB no.: Elec. bus. lie. no:
Limned energy, residential 2
City /metro liC. no.: t.f - j Limitedenergy, non-residential 2
Each manufactured home or modular dwelling
Si a of upervrs ng caricidtn (required) Date Service and/or feeder • 2
Services or feeders — installation.
Sup, elect. name (print): A a li 4 . _ .. - i,. t.icettse no: //, alteration or relocation:
PROPERTY OWNER 200 amps or less 2
Name 201 amps to 400 amps 2 • (p runt): r I J r/1 f!7 i / 401 amps to 600 amps 2
J6o ( .. Mailing address: 12.4 � vv tt Q y e :. ( 1 C.. r p. e . f _ Lvt . 601 amps to 1000 amps 2
City: f i I State: . I ZIP: C1-72_2_ 3 Over 1000 amps or volts 2
Phone: 524-- v. 0 - 2 31 Fax: I E-mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services or feeders -
which is not intended for sale, lease, rent, or exchange according to installation, alteration, orrelocation:
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 amps 2
' Branch circuits - new, alteration,
Name: or extension per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2 • City: I State: • • I ZIP: 2. Fee fer branch circuits without purchase
Phone: Fax: E-mail: of service or feeder fee, fuss branch circuit: i ll/ (C 2
• Each additional branch circuit: i
• PLAN REVIEW (Please check all that apply) Mc. (Service or feeder not included):
O Service over 215 amps-commercial O Health-care facility Each pump or iedgation circle 2
O Service over 320 amps - rating of l8c2 O Hazardous location Each signor outline lighting 2
family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) ora limited energy panel,
0 System over 600 volts nominal more residential units in one structure alteration, or extension* 2
0 Building over three stories O Feeders, 400 amps or more *Description:
0 Occupant load over 99 persons O Manufactured structures or RV park Each additional Inspection over the allowable In any of the above:
0 Egress/lighting plan O Other. Per inspection I I 1 1
Snbmlt _ sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
KS
Not all Jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $ Li-to .
O Visa O MasterCard expires if a permit is not obtained Plan review (at — %) $ , .3 . -7 !
aedit.and rumba: / / within 180 days after it has been State surcharge (8%) $ • ...,,,-----------
Espra accepted as complete. TOTAL $ /,
Name of cardholder as shown oo credit card V Q
S
Cardholder rig atme Amount 4404615 tacor-OM)
CITY OF TIGARD 24 -Hour , .
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested AM PM BUP
Location (P j �c L.�Cc.c� r Suite MEC
Contact Person //AA__ Ph ( ) — 06 - 71 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC 3
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing •
Firewall
Fire Sprinkler ✓/
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL.
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
F' : Alarm
- "1., Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
• S • RT FAIL
SITE n Please call for -insp: tion RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date d Inspe or Ext
Other:
Final D • NOT REMOVE this inspection record o m th o b site.
PASS PART FAIL