Permit CITY OF TIGARD ELECTRICAL PERMIT
- COMMUNITY DEVELOPMENT Permit #: ELC2011 00494
Date Issued: 09/08/2011
TI GAR D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 parcel: 2S102CCO5800
Jurisdiction: Tigard
Site address: 13665 SW GARRETT CT
Project: BROWNING Subdivision: BEREA Lot: 19
Project Description: (2) branch circuits for NC and outlet.
Contractor: GRF ELECTRIC Owner: BROWNING, STEPHEN D & LINDA M
15460 S PARADISE LN 13665 SW GARRETT CT
MULINO, OR 97042 TIGARD, OR 97223
PHONE:
PHONE: 503 - 829 -4146
FAX: 503 - 829 -5747
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 09/08/2011 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 09/08/2011 $7.63
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law, 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 the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through. A 9 -001- 090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 11,8000.332.2344.
Issued By: Permittee Signature: o c/ MA G/6 77pA/
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' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
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.
2011 -09 -07 13:44 GRF ELECTRIC 5038295747» 5035981960 P 1/2
Electrical Permit Application t*
City of Tigard ', RDeact f 17 / Permit No.FC L 99r
r ' 13125 SW Hall Blvd.. Tigard 97223- Q�\ /
Plan RC: m �. /� 3�O / l� a1 Phone; 503,639,4171 Fax: 503.598196
Date By Other Per
1 1(i.# 14D
Inspection Line: J 503.639,4175 C� {� ^t Ante Ready/By: wi � BJ See Page 2 for
Internet: www,ti ard•or.gov � ~t !!y�,''.\ � Notified/Method: I v SupplemenmI Information
TYPE OF WO1 h „�^, VOI”- PLAN REVIEW
❑ New construction Addition/altc a[ ,ian /, =ep('acement Please check all that apply (submit 2 sers of plans wlitems checked below): 1
"'"
El pDemolition ❑ Other: ❑ Serv,ue or feeder 400 amps or more ❑Buildin over three stones. '
where the available fault current ❑ Mannaa and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial•use agricuhural
Il- and 2- family dwelling ❑ Commercial industrial [❑ Accessory building amps for all other installations buildings.
❑ Multi - family ❑ Master builder Other: 1`1 Fire pump. ❑ installation of 75 KVA or
_
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system
0 Addition of new motor load of
Job no.: Job site address: 3 , — s 1001-1P or more. occupancy.
❑ Six or more residential units ❑ Recreational vehicle parks,
N City /State/ZIP' I (4..4.. VIA-- CI -7 x ❑ Healrh•care facilities. 0 Supply voltage for more than
�J IM s ❑ Hazardous locations, 600 volts nominal
Suite/bldg. /apt. no.: Project name: . ❑ Service or feeder 600 amps or mare.
FEE SCHEDULE
Cross street/directions to job site: - Detcri'.don LT= MOT= r ant -
New residential single- Or multi•famity dwelling unit.
•. Includes attached garage.
Subdivision: Lot no,; 1,000 sq. ft. orless 168.54 �
Ea. add'I 500 sq. ft. or portion _ 33.92 III
fax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 67'$4 2
— Limited energy, multi - family m
G '1 residential (with above s.. ft.) 67.84
• II
Services Or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
0 PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 El
Name: C 401 amps to 600 amps 20D.
- ' "t • 601 amps to 1,000 amps 301.
Address' r
�I� Over 1,000 amps or volts 552.26 2
City/State/ZIP: '''' 'temporary services or feeders installation, alteration, and /or
•
Z relocation
Phone: ( .sls 3 MI a Fax: ( ) 200 amps or less IM 59.36
201 amps to 400 amps I. 125.08 2
Owner installation: This installation is being made on property that I own which is not
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 70I. 401 amps to 594 amps 166.54
Branch circuits - new, alteration or extension i er . aael
Owner signature: p ate
_ ,. A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee, 7 42
- each branch circuit 2
Business name: 13. Fee for branch circuits without
service or feeder fee, first
Contact name; branch circuit 5618 1 ;
Each add') branch circuit Inri 7.42 '
Address;
Miscellaneous (service or feeder not eluded
•
City /State /ZIP: Each manufactured or modular
dwelling, service and/or feeder 67.84 2
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
' E - mail: Pump or irrigation circle 67.84
' ' /
Sign or outline lighting 67 84
CONTRACTOR MI
Signal circuit(s) or limited - energy
Business name; / / -anel alteration, or extension. Pale 2
•
�1 Each additional ins'ection over allowable in any of the above _
Address; j S tg. s Additional inspection (1 hr min) 1 M 66.25/hr
City /State /ZIP: C - 7 C. . Investigation (I hr min) 66.25/hr ■
• •
Industrial plant (1 hr mm) 111111 7$.18/ hr
' / Phone: ( g �i ' Fax: ( • - 3 S " ZA -• C t nspecnons for which no fee is
NMI
S. •cificall listed ('/•_ hr min 90.00 / hr
CCB Lic.: 1 ti Suprv. Lic.: ' s ^ - ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: 4,Q�� Subtotal: WAXIER
+�/- c.,_ - ^'- : . t ♦ Plan review (25% of permit ice):
Print name: . V i i ' _• " Date: • State surcharge (12% of permit fee): 1 '
Autr,.riscd alanntur., TOTAL p r t r+' :!;�
This permit application expires it permit It net obtained it in Igo
Print name: hate: days after It has been accepted as complete.
' Number of inspections allowed per permit.