Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2000 -00371
w ;�� DEVELOPMENt SERVICES DATE ISSUED: 7/5/00
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S101 DB -00709
SITE ADDRESS: 07330 SW VARNS ST
SUBDIVISION: ROLLING HILLS ZONING: R -3.5
BLOCK: LOT : 029 JURISDICTION: TIG
Project Description: Installation of (2) branch circuits for NC and furnace
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:
DORMER, ROBERT C AND GRF ELECTRIC
KATHRYN E 15460 SE PARADISE LN
7330 SW VARNS ST MULINO, OR 97042
TIGARD, OR 97223
Phone: Phone: 503 - 829 -4146
Reg #: LIC 76751
SUP 1655S
ELE 3 -484C
FEES Required Inspections
Type By Date Amount Receipt
Elect'l Final
PRMT JMT 7/5/00 $42.85 0003448
5PCT JMT 7/5/00 $3.43 0003448 ORIGINAL •
Total $46.28
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 -0080 You may obtain copies of these rules or direct questions to OUNC at (503)
246 -1987.
PERMITTEE'S SIGNATURE ISSUED BY: / (.1
G'
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
06/30/2000 13:09 5038295747 GRF ELECTRIC PAGE 01
CITY Ot:TIGARD . - .. Plan Check
13 SW HALL BLVD. Electrical Permit Application Recd By . /dt I (-A-.
TIGARD OR 97223 (.7 Date Recd O' -3 ° • '174' Phone (503) 839 -4171, x304 Date to P E.
Date to DST
Inspection (503) 639 -4175 Print of Type Permits L r 2 - 063/
Fax (503) 598 -1960 p r ?D /0) Incomplete or illegible will not be accepted Called Mr,/. ; I -t 4
1. Job Address: . ci.A..cZ fif4 4. Complete Fee Schedule Below:
Name of Development Number of Inspections per permit alloyed
Name (or name of business) ` / Service included: Items Cost Sum l
Address 3 3 0 S Lr Y c, re's -5t 4a Residential - per unit
City /State/Zip 1 fo 0 R - di 72-2- 1000 sq. ft. or less $ 117.75 4
J Each additional 500 sq. R. or
portion thereof E 26.26 1
Commercial ❑ Residential umlted Energy $ 80.00
/ Each Monad Home or Modular
2a. Contractor installation only: Dwelling Service or Feeder $ 72.75 2
(Pilor to permit Issuance, applicants must provide contractor license 4b. services or Feeders
information for GOT data base). Installation. alteration, or relocation
Electrical Contractor (" +1.1`-c..- 200 amps or less $ 64.26 2
Address 1$ Q S, f F a r a 4 i 41- 201 amps to 400 amps $ 86.50 2
City State 2I • 'V 7 Z
401 amps to 800 amps 128,50 2
i 601 amps to 1000 amps $ ps $ 192.50 2
Phone No. 2-9 - f--I i f-to A. fj29 - 5 7 4-7 Over 1000 amps or volts $ 363.75 2
Job No. Reconnect only $ 53.50 2
Elec. Cont. Lice. No. ,S_4- $ Lt C. Exp.D to / 0 Oa . 4c. Temporary Services or Feeders
OR State CCB Reg. No. 7 to '7 S Exp.'s ate Installation, alteration, or relocation
COT Business Tax or Metro No. ,7 ti l xp.Date
9' i r o 0 zoo amps or 400 lass $ 63.50 2
201 amps to amps $ 10.25 2
Signature of Supr. Elec'nam, 1 �1 401 amps to 500 amps
Over 600 amps to 1000 volts, S 107,00 _ 2
see "b" above.
License No. Exp. D e I (>- r)..)„, ` dd. Branch Gutsier
Phone No. -�'/ `f-169 New, alteration or extension per panel
a) The fee for branch omits
2b. For owner installations: with purchase of esrvice or
feeder fee.
Print Owners Name Each branch circuit $ 6.36 2
Address b ) The fee for branch circuits
without purchase of service
City State / p or feeder fee. 37 5'17
Phone No. First branch circuit I $ 37,60
Each additional branch circuit $ 5.35 S �S.---
The installation is being made on property I o n which is not de. Miscellaneous
intended for sale, lease or rent. (service or feeder not Included)
Each pump or Irrigation circle 5 42.76
Owners Signature Each sign or outline lighting S 42.75
Signal circuits) or a limited energy
panel, alteration or extension $ 80.00
3. Plan Review section (if requi = d): Minor Labels (10) $ 107.00
Please check appropriate item and enter f, , In section 5B. 4f. Each additional Inspection over
a or more residential units In one structure the allowable In any of the above
Service and feeder 225 amps or more Per Inspection S 50.00
Per hour 5 50.00
System over 600 volts nominal In Plant 5 59.00
_ Classified area or structure containing special occupancy as -
described in N.E.0 Chapter 5 5. Fees: ��
Se. Enter total of above fees S
• Submit 2 sets of plans with application where any of the above apply. 5% Surcharge ( 05 X total fees) 5 3
Not required for temporary construction services. Subtotal S
NOTICE Sb. Enter 25% of One 1a for
Plan Review If required (Sec. 3) S
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED Subtotal $
IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR
WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS Trust Account s If-
AT ANY TIME AFTER WORK IS COMMENCED. Total balance Due $ 6i, ��
I \dsls\forms \electric.dnc
Case Activity Listing 11/16/2004
11:49:01 AM
TIDEMARK Case #: ELC2000 -00371
COMPUTER SYSTEMS. INC.
Assigned: Done' Updated
Activity Description Date 1 =Date 2 Date 3 - • {Hold Disp To - By By Notes -
ELCA001 Application received 6/30/2000 None RECD FAX 7/5/2000
GWL
ELCA003 Permit created 7/5/2000 None DONE GWL 7/5/2000
GWL
ELCA799 Elect'I Final 7/17/2000 None PASS CD 7/17/2000
HAP
ELCA500 (F) Issue permit 7/5/2000 None DONE GWL 7/5/2000
JMT
ELCA800 Case Finaled 7/17/2000 None DONE HAP 7/17/2000
HAP
Page 1 of 1 CaseActiviry rpt
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested — '7 00 AM X PM BLD
[
Location 3 V 'O ' Suite MEC 2G9 a4 ` 7 Nlo 3
Contact Person tea y Ph r y— O d PLM
Contractor Ph SWR
BUILDING Tenant/Owner
ELC c7-4745 37/
Retaining Wall ELR
Footing Access: /
Foundation � FPS
Ftg Drain
Crawl Drain Inspection Notes: /� D g SGN
Slab (° (� SIT
Post & Beam
Ext Sheath /Shear a4/1 P `' 110 1
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
j k
Post & Beam �,�
Under Slab A /N b'
Top Out
Water Service ) J
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
AMWO:AL
Post & Beam
Rough In
Gas Line
Smoke Dampers
•SI/ •ART FAIL
RIC
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
di al PART FAIL
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: ] Unable to inspect - no access
ADA
Approach /Sidewalk
Other Date 7 f7 Inspector r Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.