Permit 1CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00196
DEVELOPMENT SERVICES DATE ISSUED: 3/31/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1S125DB-08600
SITE ADDRESS: 09496 SW SHADY PL ZONING: R -4.5
SUBDIVISION: THE RAZBERRY PATCH LOT : 006 JURISDICTION: TIG
Project Description: 1 branch circuit to 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:
WORLEY, RONALD L + KATHERINE E GRF ELECTRIC
9496 SW SHADY PL 15460 SE PARADISE LN
TIGARD, OR 97223 MULINO, OR 97042
Phone: 503 - 452 -1890 Phone: 503 - 829 -4146
FEES Reg #: LIC 76751
Description Date Amount SUP 3-48 5
ELE 3 -484C
[ELPRMT] ELC Permit 3/31/2005 $46.85
[TAX] 8% State Surcharge 3/31/2005 $3.75 REQUIRED ITEMS AND REPORTS
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 ;00 - -2344. '
Issued By:,. �. I i , / Permittee Signature: D)- a. j fLJ- Ca z 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.
n
Ele Permit App FOR OFFICE USE ONLY
iteceivedtz Electrical /•�
•
. ^ Date/B 4. % / Permit NoL �■ 00 �C Z ,44
City of Tigard RECEIVED Planning ppro • Sign
Date/By: Permit No.:
-- 13125 'SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 " t „ 25t15. Date/By: Permit No.:
Phone: 503 -63 -4171 Fax: '5 )3 -598 -1960 Post- Review Land Use
/Gsr�, � ;' D ontac t Case No.:
Internet: www.ci.tigazd.or. TIGARD e� Contac .lur}'s See Page 2 for
24 -hour Inspection Reque UL l{# T t�I�i §NO Name/Method: • / / Supplemental Information.
•
• ;'.4 ::.,y`,.kl'i "4:. ,a. .,,,, • `:i' li?.::.;';', * +;'':. PLAN•'REVIEW(Please'clieck alf;that`aPP1A'
• :�•`�t•;:. • . .,.:�•. , ,s /���'•TYPE1QR�liY9)�C . • ' .::�. : ; .�.
New construction Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
Addition /alteration/replacement ❑Other: ❑ Service over 320 amps - rating of ❑ Building over 10,000 square feet,
. r {�''U y ?:i.'iij . `k; Y dwellings _ �i•_ � I�GQR 'Y;IgF.%GON,'S�RUG�'1 " "` � " �' : '• 1 & 2 Tamil dwellin four or more residential units in
1 & 2- Family dwelling 0 Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
' {•;;x l an : = • Submit sets of plans with any of the above.
,r.:. n : aB<SI2 II!I 1(Q1Y; dLO:QAT1iON ` '
The above are not applicable to temporary construction service.
Job site address: -. e $ IAJ - % L•, < t a y ,.. ,
PL � °' EEE' SCHEDULE;: , • :;•;�:i.; , . : : •
Suite #: I Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: �(J l/' I e ....pt.., • 1 Qty Fee (ea.) Total l 1
New residential - single or multi - family per
Cross street/Directions to job site:✓ dwelling unit. Includes attached garage.
Service included:
1000 sq. ft. or less 145.15 4
• Each additional 500 sq. ft or portion thereof 33.40 l
Limited energy, residential 75.00 2
Subdivision: I Lot #. Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling ,
���� 31 F ,( gc n���.�!�/�1�T t,+ py� '� •;,;i:•' ••��.' service and/or feeder �•�
`: e." Y;" :'IKk�9F:Ls�f�t67i1t= (:sY�74tF Twin +,4�++R:Of;"' r1., ,.. i:.�i r '.r . 1
Services or feeders - installation,
I
e �� r �vt 4-C--- alteration or relocation:
200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
� :•.. '601 amps to 1000 amps 240.60 2
'.tt ' , w• '� • '''•' tAi' ' TFi111A.1 s':'a: : :rr':; ;'a': ,F�' r, 454.65 2
;1 =;; Q}`,�. ,i ,:u+ :i ,. Over 1000 amps or volts
Name: i2' o r vi d v- 1 (9, ,j • . Reconnect only 66.85 2
•
Address: q - G Le S II (,4) S Y l / /1.r , P !� , - Temporary services or feeders - installation,
J alteration, or relocation: 66.85 l
City /State/Zip: Tt t , ) / J c 7 '7 2 , 2_ 3 200 amps or less
201 amps to 400 amps 100.30 2
Phone: 0 Fax: . 401 to 600 amps 133.75 2
1 3'a ig!�l) a i"b ; Y -`,01: s: l• COI r,r./#CT RERSONI:'•�: -.cj : =3i ;•:
Branch circuits - new, alteration, or
• Name: extension per panel:
A. Fee for branch circuits with purchase of 6.65 2
Address: ,v service or feeder fee, each branch circuit .
• B Fee for branch circuits without purchase of
City/State/Zip: service or feeder fee, first branch circuit I 46.85 _4(p• -s 2 •
Phone: I Fax: Each additional branch circuit 6.65 2
Misc.(Service or feeder not included):
E-mail:
V r! Each DtnnP or irrigation circle 53.40 2
t Sl�ifafti,S� i"t�]AI .C�`J'lQ t ;.t: . _;t :.^'y, - , 2
�^ ''� �' ` " °'1y�. °' `'`" Each sign or outline lighting 53.40
4 0 Signal circuit(s) or a limited energy panel,
- Job No: a alteration, or extension Page 2 2
:,,, :Business Naive: 6,4 .6) e zr i f . Description:
Address: 1-L, () S, Pi. Y ( Lw� P Each additional Inspection over the allowable in an of the above:
r City /State /Zip: Mu 1 t Of- -7 f) LI Z Per inspection per hour (min. 1 hour) 62.50
Phone: • 1)3 ' 9,,et Li- / `f(. i Fax: ')3 - 8 Z1 C-, 7,t-'7 Investigation fee: • 1_. CCB Lic. #: -) 1 5 Lic. #: 3 - ` y C- D7 h O :f3: Fry • z . : El :P F 5 x : 1 ! ' °.? ' , . :
Supervising electrician . -t Subtotal $ 4
signature P ture required: w' ` \ o Plan Review (25% of Permit Fee) $ � , '��_
Print Name: V. '1 J' r G,,,, r ,. ,.? St Surcharge (8% of Permit Fee) $ "7� Lic. #: t $ TOTAL PERMIT FEE >;/ 0 Co G
Authorized -7- / 1 - V Notice: This permit application expires If a permit Is not ob ned within .
Signature: �m A I
N, fi vin S _ Date: ' 3 0 f (! 180 days after it.has been accepted as complete.
. *Fee methodology set. by Tri- County Building Industry Service Board.
• - . (Please print name)
t- Dsts\Permit Forrrts1ElcPcrtnitApp.doc 01/03
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CITY OF TIGARD _
BUILDING DIVISION PERMIT #: ELC2005 -00196
1 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/31/2005
Phone: (503) 639 -4171 J �hp°I I IhI1\
Inspection Requests (24 Hrs.): (503) 639 -4175 `'__..
INSPECTION WORKSHEET FOR DATE: 4/7/2005 TIME: 7:14AM PAGE: 95
SITE ADDRESS: 09496 SW SHADY PL CLASS OF WORK:
SUBDIVISION: THE RAZBERRY PATCH LOT #: 006 TYPE OF USE:
PROJECT NAME: WORLEY
DESCRIPTION: 1 branch circuit to AC.
OWNER: WORLEY. RONALD L + KATHERINE E. PHONE #: 503.462 -1890
CONTRACTOR: GRF ELECTRIC PHONE #: 503.829 -4146
Inspection Request Scheduled For: Date: 4/7/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 003942 -01 603. 557 -2220 Y
Corrections /Comments /Instructions:
( .
kf ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
I
Inspector: .. D ate: T �- v Phone #: (503) 718-