Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004- 0016
1� DEVELOPMENT SERVICES DATE ISSUED: 4/6/04
��' 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S103CA 04900
SITE ADDRESS: 11550 SW TERRACE TRAILS DR
SUBDIVISION: TERRACE TRAILS ZONING: R
BLOCK: LOT : 003 JURISDICTION: TIG
Project Description: NC, FURNACE AND OUTLET
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:
BLACK, GAROLD R NANCY E GRF ELECTRIC
11550 SW TERRACE TRAILS DR 15460 SE PARADISE LN
TIGARD, OR 97223 MULINO, OR 97042
Phone: 503 -639 -0294 Phone: 503 - 829 -4146
Reg #: LIC 76751
SUP 1655S
FEES ELE 3-484C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 4/6/04 $60.15
[TAX] 8% State Surcharge 4/6/04 $4.81 Elect'I Final
Total $64.96
This Permit is issued subject to the regulations contained in the Tigard Munidpal 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. . Permit Signature: _Ap/ ' ` /
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 639 -4175 by 7:00pm for an inspection the next business day
Apr 02 04 03:30p GRF Electric _ 5038295747 p.1
w . FO R OFHICE USE ONLY
E tectrrcal Permit A Pon C G1Ved Electrical /��
( � O Date/By: Permit NoECG aon (tee /4 ?
City of Ti and 1 t: LO )k Planning Approval Sign
\ `J g y P Date/By: rm
Date/By: Permit No.:
\ • 13125 SW Hall Blvd. , �= � P+ S Plan Review Other •
. Tigard, Oregon 97223 p` 1 \G ON Date/By: Permit No.(nie 7 4 1 --'d 0i
Phone: 503- 639 -4171 Fax: 503697831 N O \v k�: Post- Review Land Use
\ : Contac Case No.:
Internet: www.ci.tigard.or.us \ \,O ■ i4.. t - i I Contact y:
El Sec Page 2 for •
24 -hour Inspection Request: 503 - 9 -417 Name/Method: Supplemental Information.
•
.. ' - E: OF WORK ,' : ,;- >= . : :... . . •PLAN:!REYIEW (Please check all:that aji )h
❑ New construction . ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous
[ Addition/alteration/replacement ❑ Other: location
❑ Service over 320 amps - rating of 0 Building over over er 10 10,000 square feet,
'.." ';'?S;CATEGORY:OF CONSTRUCT,ION'':::.:. ..' , .::'' . 1 & 2 family dwellings four or more residential units in
I 1 & 2- Family dwelling ❑ 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:
.. JOB. -SI.T INFORMATION:aad:LOCATION :.: +.' ' Submit sets of plans with any of the above.
The above are not applicable to temporary construction service.
Job site address: 1` 1 5 S p 5 c,) 1e- v e , „..::..:: _
. � .FEE *sSCHT;DiIL .
Suite #: Bldg. /Apt. #: Tr S pt'-, Number of inspections per permit allowed
Project Name: 6e v-r t . ,ti 1 :,.i� . 1 - ;,- �� Description . t Qty Fee (ea.) Total
Cross street/Directions to job site: Z 3 New residential-single Incl or multi-family per
7 L 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
Subdivision: I Lot #: _ Limited energy, residential 75.00 2
Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
�, '. service and/or feeder 90.90 2
. - .... •:�: ..•.. �'. ��DF :S.G`'$IPTION,:OF�1,'VORIC ;;...: : r, ... ,.,a
/� ,/ Services or feeders - installation, •
5 C .+Y C.�, a /A-e. /t
/ ,h ,..,,,,we alteration or relocation:
/
200 amps or less 80.30 2
b r 4 *lit— 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
C]:PROURTY- APANER;IV:'-. ∎I;D!IENANT;':i ': ;.:. :.;is` :�! 601 amps to 1000 amps 240.60 2
/ Over 1000 amps or volts 454.65 2
(
Name: ,e )/, o f t / A r }2-_ " Reconnect only 66.85 2
• Address: l i cc-0 - w -re r lr6 G Z TrA, j e _ Temporary services or feeders - installation,
alteration, or relocation:
City /State/Zip: r a 7 2 -Z- 3 f /, - 200 amps or less 66.85 I
3 °f - ej 201 amps to 400 amps 100.30 2
Phone: �, J- 401 to 600 amps 133.75 2
ID APP T.::;a . , LICAN . CONTACT.PER,SOO'`• . Branch circuits - new, alteration, or
Name: extension per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 6.65 2
City /State /Zip: B. Fee for branch circuits without purchase of f . , .—
service or feeder fee, first branch circuit / I 46.85 I N , b 2
•
Phone: I Fax: Each additional branch circuit (A 6.65 1 3, 5o
•
E- mail: , Misc.(Service or feeder not included): 7
,,..,: .:-...:.!.....'.:t.:!;!;;:..'1..: , :, ,; ; i, Each pump or irrigation circle
e �.� (�t�ft�t�� { D{..�,�.e,4�.. 53.40 - 2
53.40
��' :ii ��,���. ,.f�Y, �', r. ..�yfu' AD:h��. �.F'.... .: ,;: i 's , •,� �'.,��. i ' ` ,.,; � Each sign or outline lighting 2
Job No: Signal circuit(s) or a limited energy panel,
• alteration, or extension Page 2 2
Business Na G 1- . P_e, - { - r' I r . Description:
Address: 1 51-Le (' S, " rlr C 4_,/ /-r) • - -
Cl City/State/Zip: /� Each additional inspection over the allowable in any of the above:
ty p: M u / r �2 I c_ q '7 /9 ` Per inspection per hour (min. 1 hour) 62.50
Phone: sz3 0,4 .- Lt / , t-i, Fax: 5b3 - tI zi - 5 '79-7 Investigation fee:
Other.
CCB Lic. #: (� � .Si Lic. #: 3 — y .' :;;" , :', i;! . ^ ;` Electi-ical:Peri :Fees ,.. . ' ; =. '
Supervising electrician � °iii ='? "°
Subtotal $ ,,:, i y i C
signature required: - .,r., � Plan Review (25% of Permit Fee) $
Print Name: AV r7 j; G,,., K 2 I Lic. #: / l c $ State Surcharge (8% of Permit Fee) S / _____7-- If i TOTAL PERMIT FEE S / n g_.• Cj 0
Authorized Notice: This permit application expires if a permit is not obfncd within
Signature: Date: 180 days after it.has been accepted as complete.
*Fee methodology set.by Tri- County Building Industry Service Board.
(Please print name)
i :\Dsts\Permit Forms\ElcPermitApp.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received a 5 2'f' Date Requested Y l 0` 7' / AM PM BUP
Location 1/ n SD 24, O-C's2<- .Q,SaitIL MEC
Contact Person Ph (_. 20C) r 72 PLM
Contractor Ph ( ) SWR
BUILDING Tena Own I L, / c l
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 V P4� V v�J , C j � I
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
- RT FAIL
ECHANIC
Roh-In Beam
Rout ryi� _ � G I'�
ugh /' l /!
Gas Line
oke Dampers
G �►
PART FAIL
Service
Rough -In
UG/Slab r 149
Low Voltage
Alarm
® Reinspection fee of $ _ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PAS P. RT FAIL
SI ❑ Please call for reinspection RE: J Unable to inspect — no access
Fire Supply Line
ADA Dat /� (' / Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL
r