Permit 'e CITY OF TIGARD. ELECTRICAL PERMIT
PERMIT #: ELC2006 -00431
I� DEVELOPMENT SERVICES DATE ISSUED: 8/4/2006
"II 13125 SW Hall Blvd., Tigard, OR 97223 503 - 6394171
PARCEL: 1S133AD
SITE ADDRESS: 12723 SW SORREL DOCK CT ZONING: R - 7
SUBDIVISION: SUMMER LAKE LOT : 021 JURISDICTION: TIG
Project Description: (3) branch circuits for NC & air handler.
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: 2 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:
CHRISTIAN LARSEN GRF ELECTRIC
12723 SW SORRELL DOCK CT 15460 SE PARADISE LN
TIGARD, OR 97223 MULINO, OR 97042
Phone: 503 - 521 - 0298 Contact #: PRI 503 - 829 - 4146
FAX 503- 829 -5747
FEES
Description Date Amount Reg #: ELE 3 -484C
[ELPRMT] ELC Permit 8/4/2006 $60.15 LIC 76751
[TAX] 8% State Surcharge 8/4/2006 $4.81 SUP 1655S
Total $64.96 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: ',���,4 J
� Permittee Signature: ... 3...' it
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 - 6394175 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.
Aug 04 06 07:29a Grf Electric 503 -829 -5747 p.1
A.
y FOR OFFICE USE ONLY e lectrical Permit, ,A _ [':; "ion � : C / � / Electrical i �.� y �
' t --1 t i iN • atuB / V 0 pt../ Permit No..
(� Planning Approval Sign
City of Tigard ` � � Daie/B . Permit No.:
• 13125 SW Hall Blvd. 0C3 u l L' "' AU 2006 Plan Review Other
Tigard, Oregon 97223 Date/B • Permit No.:
Post- Review Land Use
Phone: 503-639-4171 Fax: 503-5R8-1 , 6. ,; . e as t , . •, I )- Lpate/B : Case No.:
d� Sec Page 2 for
Internet: vvww.ci.tigard.or.u;i 3`f 1 -0 2! ' �• _� .. o nt a ct IM P ®
24 -hour Inspection Reque lr'- 39 -417 ame/Method: IMP Su elemental Information.
. TYPE .OF•WORK . ; ., . PLAN. REVIEW (Please check all tliat iptilA `.'', '
❑ New construction ❑ Demolition T ` Serviceover225 amps- ❑ Health-care facility
commercial ❑ Hazardous location
i.ddition/alteration/replacement ❑ Other: ❑ Service over 320 amps - rating of ❑ Building over 10,000 square feet,
•: 'CATEGORY.OF;CONSTRUCTION ' . : ,:.... ` • . I & 2 family dwellings four or more residential units in
Ki 1 & 2- Family dwelling ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure
Building over three stories ❑ Feeders, 400 amps or more
0 Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
Submit _ sets of plans with any of the above.
J011 SITE INFORMATION and.LOG'ATZON '.' '': The above are not applicable to temporary construction service -
Job site address: ) 2.-7 2...3 , t,J S Q r r e.d 1 . . ' FEE-*. SCHEDULE : ; :'
Suite #: I Bldg. /Apt. #: hor it, (. . Number of inspections per permit allowed
Description ' QIY Fee (en.) Total
Project Name: �t r s P yI 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 1
Limited energy, residential _ 75.00 2
Subdivision: Lot #: Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling 2
service and/or feeder 90.90 DESCRIPTIU WORK'i S ervices or feeders - lnstaOation,
^ t, -- i� re - t-�' 1 �6'� -9 -k) ' alteration or re l oc at ion:
di. C.- {/Y�{, t-t 200 amps or less 80.30 2
Y >r 1 1.1 a 1 e. 201 amps to 400 amps _ - 106.85 2
401 amps to 600 amps 160.60 2
F .. 601 amps to 1000 amps 240.60 2
ROPERTY03i'1!iER'`:' ; :: "] d TEN�U!Ir: r ' + '' Over 1000 amps or volts 454.65 2
Name: C,1--,0-; j r / 4 el 1♦a r (' pi Reconnect only 66.85 2
Address: 1 7 . 3 5 L 5O r re l i pot ,'� t5t . Temporary services or feeders - Installation,
alteration, or relocation: 66.85 1
City /State /Zip: ' ) i y�6 �L "i ZZ3 200 amps or less
201 amps to 400 amps 100.30 2
2
Phone: � u Q L' Fax: ,. 2 01 amps tomes 133.75
0 APPLICANT • - • .: .: C jCONTAC 'PERSON; . ;. Branch circuits - new, alteration, or
Name: extension per panel:
A. Fee for branch circuits with purchase or 6.65 2
Address: service or feeder fee, each branch circuit
City /State /Zip: B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46.85 i & 2
Phone: I Fax: Each additional branch circuit
6.65 2
E-mail: Misc.(Service or feeder not included):
•.. .,, ... '• t. .; _v .r -', 2_
,.;_�:;.:::.7-:....!7., ......: .....:':....CONTRAC�'OR ...'
..... ":'. ` . .. ne 1iphtinge 53
Each pump ar irri
- � , Each sigrt ar outli
Job No: Signal circuit(s) or a limited energy panel, /
1` 2
� f � alteration, or extension Page 2
Business Name: G -4 El C . Description:
Address: f J (7 S S. ,G► r(/ ( 1, 4 _ 4 , ' / -4) ' Each additional inspection over the allowable In any o the above:
City /State/Zip: Ml, I, 0 N— �'7 I7 `f Z Per inspection per hour (min. 1 hour) 1 62.50 I
Phone: 9)3 - g �.61- if / („/l� Fax: •51)3 - 8y - S•7 -7 - I h fee: 1
CCB Lic. #: - 7 g 5 Lic. #: 3 - t. • C. . . .. , . •' . • Electrical[P.e.i it Fees *:' ', i•••:''''
' `. ,
Supervising electrician l ``1 Subtotal $ 4 0 , i 5
signature required: "`+'‘ 1 � r''1 Plan Review (25 %of Permit Fee) $
J ( Lic. #: 1 1 5 5 - State Surcharge (8% of Permit Fee) $
Print Name: , ��.., TOTAL PERMIT FEE $ q Authorized Notice: This permit application expires If a permit Is not obta ne within
D ate: 180 days after it.has been accepted as complete.
Signature: *Fee methodology set by Tri -County Building Industry Service Board.
(Please print name) •
i :tDsts\Permit Forms\ElcPermitApp.doc 01/03
__
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2006 -00431
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/4/2006
Phone: (503) 639- 4171�� � ' I I A
Inspection Requests (24 Hrs.): (503) 639 -4175 s' °..
INSPECTION WORKSHEET FOR DATE: 11/3/2006 TIME: 7:01AM PAGE: 80
SITE ADDRESS: 12723 SW SORREL DOCK CT CLASS OF WORK:
SUBDIVISION: SUMMER LAKE LOT #: 021 TYPE OF USE:
PROJECT NAME: LARSEN
DESCRIPTION: (3) branch circuits for A/C & air handier.
OWNER: LARSEN, CHRISTIAN , PHONE #: 503. 521-0238
� CONTRACTOR: GRF ELECTRIC PHONE #: 503-829-4146
Inspection Request Scheduled For: Date: 11/3/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 039183 -01 503 - 2359083 V
Corrections /Comments /Instructions:
•
t �
A PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: e4-11? Date: 1 f/v /O y Phone #: (503) 718- 7t?
�/ y