Permit CITY O F T I O A R D ELECTRICAL PERMIT
P ERMIT #: ELC1999 -00536
DEVELOPMENT SERVICES DATE ISSUED: 09/02/1999
..�� 13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171
PARCEL: 2S110CC -19300
SITE ADDRESS: 12416 SW KING GEORGE DR
SUBDIVISION: KING CITY NO. 5 ZONING:
BLOCK: LOT : 070 JURISDICTION: KIN
Project Description: Add two (2) branch circuits to an existing dwelling.
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:
TURNER, WILTON T + JEAN E GRF ELECTRIC •
12416 SW KING GEORGE DR 15460 SE PARADISE LN
KING CITY, OR 97224 MULINO, OR 97042
Phone: Phone: 503 - 829 -4146 •
Reg #: LIC 001015
SUP 3003S.
ELE 26 -878C
FEES Required Inspections
Type By Date Amount Receipt Wall Cover
PRMT GEO 09/02/199E $42.85 99- 318080 Elect'l Final
5PCT GEO 09/02/199 $3.00 99- 318080
Total $45.85 I
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This Permit is issued subject to the regulations contained in the Tigard Munidpal Code, State of OR. Spedalty 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.
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PERMITTEE'S SIGNATUREP ISSUED BY:
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: (9 ' DATE: ' ' `7
• LICENSE NO: d 3 -- Sr •
Call 639 -4175 by 7:00pm for an inspection the next business day
i.
081'L611999 10:32 5038295747 GRF ELECTRIC PAGE 01
CITY OF- 11GARD Electrical Permit Application PlanC.hicc
13125 SW HALL, BLVD. Recd By
TIGARD OR 97223 Date Recd
Phone (503) 639 -4171, X304 Date to P.E.
inspection (503) 639 -4175 Print or Type Oats to DST
incomplete or Illegible will not be accepted Perms[ " Et�i - tb33�
Fax (503) 684 -7297 P g Called,
1. Job Address: �'
4. Complete Fee Schedule Below:
Name of Development 4GTT,t) V,IFA /E • ►'i1� Number of Inspections per permit allowed
Name (or name of business) y f /TO jai . I
J to n ec Service included: items Cost Sum
Address J Z a < . ail. ; e , 4. Residential - per unfit
City/State/Zip l sly _ f 4 2.-1-' tt 1000 K. h. or lass 11 10.00 •
f Each additional 500 sq. ft or
Commercial 0 Residential portion try Limited 1
Limited gnergy x.00
2. 'Lt -/ Each Marlurd Horn. or Modular
2a. Contractor installation only Dwelling Service or Feeder $08.00 2
r (Attach copy of all current licenses .., Roden; . Services or Roden;
Electrical CQn Ctor ^ � Installation. alteration, or nHocation
Address ! (J Q GI p-, ' 4' 200 amps or less „` $80.00 2
� 201 amps to 400 amps - 580.00 2
Ciy State b iz. Zip ' 9 -70 9 C 401 amps to 900 amps $120.00 2
Phone No. r 1.. q ' i Lf (p 801 amps to 1000 amps - $180.00 2
Job No, Over 1000 amps or volts 1310.00
Reconnect only $50.00 2
Elec. Cont. Uce. No. 2- Klf(Z. Exp,Cate 2
OR State CCB Reg. No. /t1 t 5 14- p.Date. Ex 4c. Temporary Services or Pescara
COT Business Tax or Metro No j Exp.Date installation, alteration, or relocation
4 ,
/ 200 amps or less 150.00
Signature of Supra Elec'n l 201 amps to 400 amp. $76.00 2 -
-
401 amps to 800 amps 5100.00 2
BOO License No. 3 OD _5 Exp.Date over above. too° volts,
Phone No.
ad. Brooch Circuits
New, alteration or extension per panel
2b. For owner installations: a) The fee for branch circuits elm
pvrcM.* Of avivtoe or
Print Owner's Name loottor /ao.
Address Each branch circuit 35.00 2
City State Zip b) The fee for branch circuits
without purchase of Z� � D
Phone No. wryly* or to der too. 3) .
First branch circuit 2
The installation is being made on property I own which is not Each additional branch circuit Lead
intended for sale, lease or rent. die. 4ltaositattaous S. 3
Owner's Si nature (Smoke or feeder not kxkrdsd)
g Each pump or Irrigation clrzle $40.00 2
Each sign or outline lighting $40.00 2
3. Plan Review section (if required):* Signal clrcult(s) or a limited energy
penal, alteration or extension 1140.00 2
Minor labels (10) $100.00
Please check appropriste Item and enter fee in section 58.
4 or more residential unite In one structure 41. Each additional Inspection over
SeMce and feeder 715 amps or more the allowable In any of the above
System over 600 volts nominal Per Inspection $35.00
-
Classified area or structure contalnirng special occupancy,, Per hour $
as described in N.E.C. Chapter 5 In Plant $55.00
R Submit 2 sets of plans with appticatlon where any of the above apply. 5. Fees: . Q
ry
Not required for tempora construction s.Mces. Si. Enter total of above tees $ Z U
- - - - - - - - - / a4, Surcharge (.05 X total fees) • I
t calms ' . Suatatal 3
. Enter 25% of line Se for
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review I1 roau (Sec.3) S
NOT COMMENCED WITHIN 180 DAYS. OR IF CONSTRUCTION OR WORK Sub ! $
IS. SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY / � cL S r
TIME AFTER WORK IS COMMENCED. _ rust Ac c ou nt ���! a 3 T -
i
Total balance Due .
r
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
c�1 c� c� BUP
Date Requested e '/ 1 — l ! AM PM BLD
-- Location 1 rA (- ( Suite MEC 11q� 7
Contact Person O1 '' JJ Ph 2S — 7O c? 3 PLM
Contractor Ph SWR
Tenant/Owner ELC / 9 q -COS S ,3(:3
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation f n�
Drywall Nailing . w Cth
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
c HANI C L)
Post & Beam
Rough In
Gas Line
Smoke Dampers
PASS PART FAIL
Service I S' i, j
Rough In - r L
UG/Slab
Low Voltage
Fire Alarm "l )
PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
Fire Supply Line
Approach /Sidewalk
Date - /V` 9? Inspector C �' Ext
Other • 9
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site