Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2006 -00212
1111 DEVELOPMENT SERVICES DATE ISSUED: 4/19/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S112CC - 03100
SITE ADDRESS: 08080 SW CHURCHILL CT ZONING: R -12
SUBDIVISION: BOND PARK NO. 3 LOT : 059 JURISDICTION: TIG
Project Description: 2 BRANCH CIRCUITS. AC 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: 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:
BICKFORD, GARY J AND GRF ELECTRIC
HELENE M 15460 SE PARADISE LN
8080 SW CHURCHILL CT MULINO, OR 97042
TIGARD, OR 97224
Phone: 503 - 620 - 4814 Contact #: PRI 503- 829 -4146
FAX 503- 829 -5747
FEES
Description Date Amount Reg #: ELE 3 -484C
[ELPRMT] ELC Permit 4/19/2006 $53.50 LIC 76751
[TAX] 8% State Surcharge 4/19/2006 $4.28 SUP 1655S
Total $57.78 • 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: ` row � t L� Permittee Signature:
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.
•
Apr 19 06 11:50a • p.1
t FOR OFFICE USE ONI 1' -.
Electrical Permit Application
Received . 60-00 0 Planni ` o v rf O/ ) E Pem Electrical vtNo.:
PlanningAp oval Sign
City of Tigard Date /By: Permit No.:
- • 13125 SW Hall Blvd. APR 1 9 2006 Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503 -639 -4171 Fax: 503-598-19,60 A Post-Review Land Use
CITY of TibARD Aar�r'�¢v Jli Date/By: Case No.:
Internet: www.ci.tigard.or. Bt t a nth ISIO' t� ~'
1 J Contact s.� ® Sec Page 2 for
24 -hour Inspection Request: 5•05= 11
5 "`""" NameiMethod: Supplemental Information.
. ' :TYPE OF WORK'. . . . ' : PLAN REVIEW (Pleasectieck all that apply) '
❑ New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
No-Addition/alteration/replacement ❑ Other: ❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet,
' ' ' ` •CATEGORY OF.:CONSTRUCTION • : 1 & 2 family dwellings four or more residential units in
i & 2- Family dwelling ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
[1] Accessory Building 11] Multi - Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
r
Pi Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
' JOB SITE INFORMATION and'LOCATION :' Submit sets of plans with any of the above.
The above are not applicable to temporary construction service.
Job site address: I0 to S LA) c...k cA .v. �k a7 I. C't ' ... SCHEDULE :'
Suite #: Bldg. /Apt. : Number of inspections per permit allowed
Project Name: 1 5 , L p�l.r , ;vc,„riptiou t Qty I Fee (ca.) Tots! I !
l'� j Y 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
service and/or feeder 90.90 2
DESCRIPTION :OFWORK =. Services or feeders - installation,
c.--t'r G L. 4,- --- f 0 �-/-- f . _1 ' alteration or relocation:
I 200 amps or less 80.30 2
—
201 amps to 400 amps 1 06.85 2
401 amps to 600 amps 160.60 2
PROPERTY OWNER El :TENANT " 601 amps to 1000 amps _ 240.60 2
Over 1000 amps or volts 454.65 , 2
Name: 1.1 r e Q t. g r Z j rot-- Reconnect only 66.85 2
Address: ( - o fro S t.J Gh Ur. ✓c ;1 / Ct - Temporary services or feeders - installation,
alteration, or relocation:
City /State /Zip: T 4 « c) c) Z- 2—`11" 200 amps or less 66.85 I
201 amps to 400 amps 100.30 2
Phone: ( �j , te-kt ef-' Fax: 401 to 6 00 amps 133.75 2
[ .APPLICANT:':' El CONTACI'PERSON, 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. FCC for branch circuits without purchase of ` {'
service or feeder fee, first branch circuit 1 46.85 L ite •a C..-a
Phone: I Fax: ' Each additional branch circuit 6.65 4` �� 2
E-mail- Misc.(Service or feeder not included):
, Each pump or irrigation circle 53.40 2
CONTElA CTOIt ' . • • Each sign or outline li 5 3.40 2 -
Job No: Signal circuit(s) or a limited energy panel, .
alteration, or extension Page 2 2
Business Name: G II-f El e.e. -> f'. / '_ Description:
Address: 1 5'ki-(p o S, PA r ci->' i I n ' Each additional inspection over the allowable in any of the above: '
City /State /Zip: /1/� Le'r s - 0 lt-- C -7 I' L--1 -- Per inspection per hour (min. 1 hour) 62.50
Phone: .9)3 3 ' q7„,(1, `it 11+-( _, Other:
Fax: 3 - 8e-9- S - 7 , -1--7
Investigation fee:
l c. #: er:
CCB Lic. #: - J (�( ; 3 - � fl 4 C. ,
;, •� `, `� Electticai Pi:rmit Fees *': -'
Supervising electrician c - f 41 � r Subtotal $ .3 ...4
signature required: v s.��1�1 s till 0 r Plan Review (25% of Permit Fee) $
\ f
Print Name: ,) ) i Gti,., <w Li c. #: J s State Surcharge (8% of Permit Fee) $ q z? all to j — TOTAL PERMIT FEE _ 5 c.-"`�
Authorized Notice: This permit application expires if a permit is not obtained With
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\Pcrrnit Forms \ElcPermitApp.doc 01/03
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2006-00212
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4110/2006
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 4/21/2006 TIME: 7:02AM PAGE: 68
buciWi
SITE ADDRESS: 08080 SW CHURCHILL CT CLASS OF WORK:
SUBDIVISION: BOND PARK NO. 3 LOT #: 059 TYPE OF USE:
PROJECT NAME: BICKFORD
DESCRIPTION: 2 BRANCH CIRCUITS. AC AND OUTLET
OWNER: BICKFORD, GARY J AND, PHONE #: 503-6204114
CONTRACTOR: GRF ELECTRIC PHONE #: 5034829-4146
Inspection Request Scheduled For: Date: 4/21/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 028463 503
Corrections/Comments/Instructions:
A--PASS PARTIAL APPROVAL fl CANCEL NO ACCESS
FAIL El CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: Date: I- 1 .2 / Phone #: (503) 718-