Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00455
I" DEVELOPMENT SERVICES DATE ISSUED: 7/23/2004
r � l II 13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171
PARCEL: 2 S 102A B -00501
SITE ADDRESS: 12115 SW LINCOLN AVE
SUBDIVISION: NO. TIGARDVILLE ADDITION AMEND ZONING: R-4.5
BLOCK: LOT : 063 JURISDICTION: TIG
Project Description: Install (2) 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: 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:
CAROL D. SCOGIN GRF ELECTRIC
12115 SW LINCOLN 15460 SE PARADISE LN
TIGARD, OR 97223 MULINO, OR 97042
Phone: 503 - 888 -4510 Phone: 503 - 829 -4146
Reg #: LIC 76751
SUP 1655S
FEES ELE 3 -484C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 7/23/2004 $53.50
[TAX] 8% State Surcharge 7/23/2004 $4.28 Elect'l Final
Total $57.78
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 / L� Permit Signature: `�G -� Qs\) e •
OWNER INSTALLATION ONLY r
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
Jul 23 04 06:55a GRF Electric 5038295747 p.1
- -
Electrical Permit � , : 1 cation . FOR OFFICE USE ONLY
Received �j U f Electrical / ,/
G �• Date/By: / i � C
/ / , Permit d0'1SS
City of Tigard c 0 Planning Approval Sign
Cl J O1 Plan Review : Permit No.:
13125' SW Hall Blvd. fr ,` \ (� \ �\ Plan Re Other '
. Tigard, Oregon 97223 " ' ( O \ , Date/By: Permit No.:
Phone: 503 -639 -4171 Fax: 503- 6,,r; /4M. Post - Review • Land Use
Internet: www.ci.figard.or.us 0 . 49 _ j'�` e • T i i Contact Case No.:
g --i•„i ` ntact Juri .: 18:1 See Page 2 for
24-hour Inspection Request: 503-W-4175 '" Name/Method:
Supplemental Information. ,
i. N.s TYP.V0FVORIC , _'';:' :: -..•,: .•••:.,' ; .. . , N`
; PLAREVIEW clieck all'tliat aPP 0Y) '- ,' •
New construction [] Demolition ❑ Service over 225 amps- ❑ Health -care facility
i Addition/alteration/replacement 1=1 Other: commercial ❑ Bu s on
❑ SeSerrvvice ice o ov l ver 320 amps - rating of ❑ Buildinlding g oveer r 1 100,000 square feet,
:.::;'::';'' CATTEGORY'.OF:CONSTRUCTIOIV .. I & 2 family dwellings four or more residential units in
l & 2- Family dwelling ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
❑ Accessory Building ❑ Multi- Family
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
. .. •`.':I.OB SITE NFORMATION and :LOCATION.:' ' :.. . Submit _ sets of plans with any of the above.
The above are not applicable
' FE * to temporary .....:.:.':::!...1.-'::!':;;;;.:t
construction
L .1, S c J L r- , , In service.
Job site address: /
Suite #: I Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: S cmq i . :raacriptittn 1 Qty Fee (es.) Total
Cross street/Directions td job site: New residential - single or multi - family per
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
Subdivision: LOt #: Limited energy, residential 75.00 2
Limited energy, non residential 75.00 r 2
Tax map /parcel #: Each manufactured home or modular dwelling
•.
•' :.• I ••:• •. tRIPtI service and/or feeder 90.90 2
Services or feeders - installation,
, . C, / , y i 4 r /Z Al f / 1 :.;''rr e'r4 alteration or relocation:
200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
ROVF,RTY:'OWDTM. _ Tp1A,NP. " .....; '' :" 601 amps to 1000 amps 240.60 2
Over 1000 amps or volts 454.65 2
Name: L. r1.� , 1 S -o fi 1 eir Reconnect only 66.85 2
•
Address: I Z t t` -5 t • J L / - 1 _t) I" pr.) Temporary services or feeders - Installation,
City/State/Zip: J alteration, or relocation:
p 0 X i z 2 - 3 200 amps or less 66.85 1
Phone: S> i - i b / U Fax: 201 amps to 400 amps 100.30 2
I a ,Ap.pIICAiltin ? "::•.: .. ... ,,...
401 to 600 amps • 133.75 2
CONTACT.,�'�R$ON' :' +.: Branch circuits - new, alteration, or
Name: extension per panel:
Address: A Fee for branch circuits with purchase of 6.65 2
service or feeder fee, each branch circuit
• City/State/Zip: B. Fee fot branch circuits without purchase of
service or feeder fee, first branch circuit . 46.65 q 1• 7 ,--2
Phone: I Fax: Each additional branch circuit t 6.65 L' t' 7 2
E -mail: Misc.(Service or feeder not included):
;Rv :'i >;`;:'`';;;':: : ` "'' °I i r` ;^ :;, . Each pump or irrigation circle • 53.40 2
,... i.. - :. r . ,... 1CQ1Y �t+'� C'I..... ' .. v;:,.`' „ +. ;' Each sign or outline lighting 53.40 2
Job No: Signal circuit(s) or a limited energy panel,
. alteration, or extension Page 2 2
Business Name: G R-•F . 0 eC -l r. Description: •
Address: 1 -Lo S, Pik YO t1d2.P 1 --/'1 , •
City/State /Zip: M i , I . Each additional inspection over the allowable in an of the above:
� � 1�-- '7 12 t Per inspection per hour (min. 1 hour) 62.50
Phone: •Sp 3 Qvi c/ / f p Fax: 5D 3 - 8 al - S 7.1-7 Investigation fee:
CCB Lic. #: 7 1 c Lie. #: 3 - `_ C• t+ Other: . . •
Su 9 Supervising electrician • ' •: " ::::. . ;: : :' : , • , Elictrlcal..PermifFees . .
P Subtotal $ 3, S .
signature required:�'`1 Plan Review (25% of Permit Fee) S • ; - : -,
Print Name: w,7 ), A.,.1 5.-v, I Lic. #: / j , 5 c $ State Surcharge (8% of Permit Fee) S '
;711 TOTAL PERMIT FEE $ S” 7 .7 S
Authorized Notice: This permit application expires If a permit is not obtrtlned within
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\Permit Forms\ElcPemtitApp.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested AM PM BUP
Location f a I . (i02 �/yf Suite MEC
Contact Person /7) a Ph ( ) 2, 7 — 00 7 7 PLM
Contractor Ph ( ) SWR
_
BUILDING Tenant/Owner -- --- ELC
Footing ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: /! c SIT
Post & Beam v
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
(/-
Other: (--1‘
Final
PS T FAIL
PLUMBING 1
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer •
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
Service
Rough -In
UG /Slab
Low Voltage
Fir: arm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
• PART FAIL
SITE Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line /
ADA
Approach/Sidewalk
Other: Date . 16 / 42 ' . 1"z `/ Inspector ; ��. Ext
Final DO NOT REMOVE this inspection record from t = ob site.
PASS PART FAIL