Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00388
. 1 DEVELOPMENT SERVICES DATE ISSUED: 6/8/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 6394171
PARCEL: 2S 104AA -11300
SITE ADDRESS: 12375 SW 128TH AVE ZONING: R -4.5
SUBDIVISION: BELLWOOD NO. 3 LOT : 132 JURISDICTION: TIG
Project Description: (3) branch circuits.
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:
SUSAN GOODHART GRF ELECTRIC
12375 SW 128TH AVE 15460 SE PARADISE LN
TIGARD, OR 97223 MULINO, OR 97042
Phone: 503 - 590 -0978 Phone: 503 - 829 -4146
FEES Reg #: L1C 76751
Description Date Amount SUP 1655S
ELE 3 -484C
[ELPRMT] ELC Permit 6/8/2005 $60.15
[TAX] 8% State Surcharge 6/8/2005 $4.81 REQUIRED ITEMS AND REPORTS
Total $64.96
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: /14 Permittee Signature: .5.e- c 3\N
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.
Jun 07 05 11:26a GRF Electric 5038295747 p.1
• • Electrical Permit Application FOR OFFICE USE ONLY
Received // _p r � — �/jQ Electri , �_ p
DatDate/12y: 0 d V ��'t/r` Permit No.ca %„Z G{� /1
City of Tigard C E r\ E 1l Planning Approval Sign
Date/By: Permit No.:
'- 13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 ]UN 07 2005 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 5Q3- 598- •1.96Q L4 apd Post - Review Land Use
Y ll Y U.,,,' - 1 lut'i► � � a� I)ate/By: Case No.:
Internet: www.ci.tigard.or.usC.. I•.rn Coney ^ e .,� I1 1 Contact Ju ® See Page 2 for
• B5.03�-
24 -hour Inspection RequestG39 -4 `� Name /Method: 1 / Supplemental Information.
•
/ leased heck�alFthat a 1 )
- ,.:. , ..,,...: t - , ��. * :e ^,.' • PL'AN REVIEW ( P P Y ' . . ,
ri!Vpp 11L� p� ,:i
.tt.ji..•,'!. u'i+.•F+�ti[i!���F�+�. ._:1 ".. ° i.y :: : :' . . . :�1r:. :.n,`. - /.,.�.,�
111 New construction ❑ Demolition ❑ Service over 225 amps- El Health -care facility
commercial ❑ Hazardous location
it Addition/alteration/re • lacement ❑ Other: ❑ Service over 320 amps - rating of El Building over 10,000 square feet,
, 'i; t t ._ o • • ,'•• f,'.• - ,OAt1I • RUCTION '' ' '' - : s• : ` 1 & 2 family dwellings four or more residential units in
1 & 2 -Famil dwellin: ■ Commercial/Industrial 0 System over 600 volts nominal one structure
�. 0 Building over three stories ❑ Feeders, 400 amps or more
11 ACcesso Buildm: r� 0 Occupant load over 99 persons ❑ Manufactured structures or RV park
III Master Builder • Other: 0 Egress/lighting plan 0 Other: • Submit sets of plans with any of the above.
�St 4 tut ^wr' !' Il a'') 0 •i ' :
• "" .--' •.
$, �........i..�. Ll�.., ' 'rid: 'O CATION '. .,; ' . ,;
The above are not applicable to temporary construction service.
Job site address: • Z S S c.-L7 i v Av-e.. • . ,.'• . '1FEEIi SCITEDX7,I%E'`' : � • . _
Suite #: Bid! . /A •t. #: Number of inspectiodi per permit allowed
Pro•ect Name: Doaeriptiau I Qty , Fee (ea.) Total I 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 •
•
Each additional 500 sq. ft. or portion thereof 33.40
Limited energy, residential 75.00 .
Subdivision. • Lot #: Limited energy, non residential 75.00
• T ma • / • arcel #: E ach manufactu ed home or modular dwelling
p ���� , � {t[ �•��� t � , .m;.,,, ; ,, service and/or feeder 90.90 ■
tt! yc� j Z d.'ILYF.' `4:i•. ! .1: . .111 a - (0)H:'tWORIC'. s': r. >!`�: .. 5, ?., '
iiiiii. Services or feeders - instillation,
alteration or relocation:
200 amps or less 80.30 - ,
iiiii -� - - 201 amps to 400 amps 106.85 •
401 amps to 600 amps 160.60
Di a Y a• • :? u • '., �� 601 amps to 1000 amps 240.60
d�.. .•.±..•'..,.. ��' Over 1000 amps or volts 454.65
Name: AA& Alt AI ' . -r Reconnect only 66.85
•
Address' 3 5 S t� Z' Temporary services or feeders - installation,
1 alteration, or relocation:
:. r w` 200 amps or less 66.85
201 amps to 400 amps 100.30
Phone: • i — �� . • m 133.75
t,� 401 to 600 amps
wE ; t} 1;1te f l;.kj �. l ; i k H; ''CO T' ' ` ;' ' Y r } Branch circuits - new alteration, or
Name' • • extension per panel:
• A. Fee for branch circuits with purchase of 6.65
Address: service or feeder fee, each branch circuit
CI /State/Zi • ' B. Fee for branch circuits without purchase of ` t � tt .�
• service or feeder fee, first branch circuit 1 46.85 `t w. -
Phone: . Fax: Each additional branch circuit t 6.65 p �Q'0 • E-mail: Misc.(Service or feeder not included): I ?
r r r r , p R. Each pump or irrigation circle 53.40
err': a i ;. .' f �. • Py i1 ;4:; ; 6 ' - +S 41 Each signor outline lighting 53.40
• Job No: - Signal circuit(s) or a limited energy panel,
r alteration, or extension Page 2
Business Name: (O -_ .■ Descri
• Address: / • Each additional inspection over the allowable in an) of the above:
• U _ Per inspection per hour (min. 1 hour) 62.50
Fax: 5b 3 - $
Phone: Is ... Investigation fee:
CCB Lie: #: 1321311MILIMMIII '„ it- (r ; = e `s -1;aEl'ectii k :; ` . ;sK ,;'
Supervising electrician- Subtotal $ (p() i I J
si � r :lure re. uired: -,r44, Plan Review (25% of Permit Fee) 5, { "1 �'
>�
Print Name: A r i .. .... - State Surcharge (8% of Permi! Fee) $ '
TOTAL PERMIT FEE $ (91141 4
Authorized Notice: This permit application expires if a permit is not obtained within
' Si tatluo: Date: 180 days after it.has been accepted as complete.
*Fee methodology set.by Tri- County Building Industry Service Board.
;v7.7!.' • • • ' (Please print name)
1 :\Bats \Permit Fotms\ElcPetmitApp•doc 01J03
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2005- 00388
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/8/2006
Phone: (503) 639- 4171INpud�iiq° +
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 6/29/2005 TIME: 7:08AM PAGE: 72
SITE ADDRESS: 12375 SW 128TH AVE CLASS OF WORK:
SUBDIVISION: BELLWOOD NO. 3 LOT #: 132 TYPE OF USE:
PROJECT NAME: GOODHART
DESCRIPTION: (3) branch circuits.
OWNER: GOODHART, SUSAN PHONE #: 503 - 590.0978
CONTRACTOR: GRF ELECTRIC PHONE #: 503-829-4146
Inspection Request Scheduled For: Date: 6/29 /2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Eledtrical final 010403 -02 503-260 -0077 Y
Corrections /Comments / Instructions:
0/
X PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED •
Inspector: // 9 Date: 027'"() Phone #: (503) 718 -