Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00846
DEVELOPMENT SERVICES DATE ISSUED: 10/31/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 - 4171
PARCEL: 2 S 102 B D -01503
SITE ADDRESS: 12750 SW PACIFIC HWY 123 ZONING: C -G
SUBDIVISION: VILLAGE SQUARE LOT : 001 JURISDICTION: TIG
Project Description: 1 circuit to furnace.
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: 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:
GOSPODINOVIC, ROSE GRF ELECTRIC
12770 SW PACIFIC HWY 15460 SE PARADISE LN
TIGARD, OR 97223 MULINO, OR 97042
Phone: Phone: 503 - 829 -4146
FEES Reg #: LIC 76751
SUP
Description Date Amount 3-484
ELE 3 -484C
[ELPRMT] ELC Permit 10/31/200' $46.85
[TAX] 8% State Surcharge 10/31/200' $3.75 REQUIRED ITEMS AND REPORTS
Total $50.60
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 -8 }, —
Issued By: Permittee Signature: l / G/' � ?.
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.
Sep_ 12 05 03:33p GRF Electric 5038295747 p.1
t :AritTiEleetrical Per ' ' n ..„...- FOR OFI.10E USG. ONLY
• Received 503 -639 -4175 -- / 0 5 A A Electrical Electrical it�l Q
g ':',•,e!•. ,,,. ti, .4 u . - Datc/By: X / Permit No.: / Y C�0�7S• p S `it •
�. Planning Approv l Sig.
Qf
• �, g'd SEP 12 2005 Date/By: Permit No.:
.WW: Blvd. Plan Review Other
' F t Date/BY: Permit No.: •-•
9,.7223
x :r _ ,�- R O Post - Review Land Use
h : .Ph 9.4171 'Fa SIO
' I:c4.1141 r� .• c, Date/By: Case No.:
'4 ' ' Q> ' :W WW.cI.tlgaTd.OT.t1S l Contact J / Set Page 2 for
"'' ".`', r I spectiaa Request Name/Method: LI Supplemental Information.
6, 'ii; 2ciCi ' .:it • PUANREVIEW ; etka`I1t6itaPPlY)•'r; . ' •
' +�. iris I. • - • ^cofstruction II Demolition CI Service over 225 amps- ❑ Health -can facility
�+ commercial ❑ Hazardous location •
•.,': `1 i i : . •
•• ; • • ;literati . • . dement ,I Other: ❑ Service over 320 amps -rating of ❑ Building over 10,000 square feet, .
•. :; . ,, :::_. ',; ?: , `? 4 1.l1-11 L'-‘:117.T01. � I 1 & 2 family dwellings four or more residential units in
" f ii l ? ig. . • amil dwellin : li ommercial/Industrial ❑ System over 600 volts nominal one structure
S _ ❑ Building over three stories ❑ Feeders, 400 amps or more
`i i'fi; lltii Billidln: �� ❑ Occupaot•load over 99 persons ❑ Manufactured structures or RV park
' I, ;I : _ �\ Other: ❑ Egress/lighting plan ❑ Other - _
- t • •�J�/( /` TI N r ,_ • :,., i •, Submit sets of plans with Bay of thS above.
: ! ` . p �S : - 4. .. • !:1.•.!! " - t ll�,:l•�: O:: :1.• P;.\itJlll.�.. *: ' ION. '.' . i - ... l: ,:e tl� I.
� i , - - The above are not a • livable t0 tam � ora eoostruetioa service.
a • ' site address: • GI Gr 9 ' • : ie ,' .. " . 4' ... .'' ,....,....
� ' k'EE'7 SCHED.U.IEw � � � , ::: : 1,, , ...,...F.:: .
'1:4'''''44 ,i Bld: JA • t. #: ' r■a • •''' i _ Number of inspections per permit allowed ■
. o - Name: • j
1 .. , � 1 Lia Qty Fee (ea) ' Total
:Ill 1 , V, ) j A 1 e, .S vl t
' ` • u'ections t0 ob site: el ( /' Q • New residential -single or multi- family per _
dwelling gall. includes attached enrage.
• ; ,F `i t kr " ' {' •t: • • .: i; Service included:
' ' ' .H Y' !
t r' :::.. : .'t `� : . • :! 1000 sq. ft. or less 145.15
r I Each additional 500 sq. f . or portion thereof 33.40
. :'
'f-;- !r .` _ R LOt #: Limited energy, residential 75.00
R' Subd ivision: ' Limited energy, non residential 75.00 •
r t 4 `' 1' • ma . • 4 #: Each manufactured home or modular dwelling
"t'#'3 J 90.90 0
10. -'‘'''''''•. + ' '' .e �:, 'I: l��' rl ! 0 • 0�.,.�,p ',;'� °'jv} '���r ^ service and/or feeder �
nyt • • .`'i'' a -.t. i �$ Se rvices or feeders - Iostallaeloty
It 1' ' " . " l rel r'.r 4.0 Gl Fit S pet c ,r alteration or relocation:
;�W 200 amps or less 80.30 • r . ' "� 201 amps to 400 amps 106.85 . • `
C :`:*? " .:r 401 amps to 600 amps 160.60 •
'I.; .',• ! I - , � q : - m`•:'',, L: . r .. • " :i ` 1 4i. amps to 1000 240.60 ' ir k,^ ::7.71-Y. - �: > ... r , ,, }' "Ova 1000ais • . � ', •- or v olts 454.65
s e 4 3 =Cy �/ 0 l /.; r• e' .
S J • it Reconnect only 66.85
jl1 .. "- ;F �•' i" ;,;. Temporary services or ✓ ► t� feeders - Install
' L • . .. Sl t, C' ■ •• alteration, or relocation:
• 66.85
X81+.`.: = . 20 amps or less 6685
.
i.; 201 amps to 400 amps 100.30
Yi 1' . •.. •, t.
401 to 600 amps 133.75
• -' .r1'' .; ,• _• ..(c ‘• 1' 1' ,_t '' o -1 , • ?.' �E'It$ 0 1 � .� :'+t �� . /b Branchclrcuita - new, alteration, or
l t I :.µ•., Li : extension per panel:
! t .:. t A. Fee for branch circuits with purchase of
i ° ;)Z' �'' r 6.65
f �. � ` . � e•$S. � ' ' � �. I � . �� service or feeder fee, each branch circuit
„�
, i : : •, . , . 4L.21..) r g. Fes for branch circuits
without purchase of • Lit f j ;4 . service or feeder fee, first branch circuit ( 46.85 .
;3 51, ; , : , • -'f„. , " • ,.•• I Fax: Eacb additional branch circuit 6.65
t ' *. ( .!ti r'. :+??' '..w . • • • Misc.(Service or feeder not included):
r. .. 53.40 -
"• „:1144. „ Each t►tunP or irrigatio evele
_0s N., •.' au i ili: u ': 81 - 71tP a �W 1i j y;':; .1r 53.40 • Each sign or outline lig
,. r '
" i'' , I .` s . 4 ,.• ?.. ` Signal circuit(s) or a limited energy panel,
• , • ♦ alteration, or extension Page 2
' Business:Name: ar-F -7 e r'j r. Description: • • Address• ! �� i� -n . �' Pk rtr 1"44 ` s • Each additional inspection over the allowable In an of the above:
IBS ' - / _ L Z Per inspection per hour (min. 1 how) 62.50
;713 .40 41 , Fax: 5 )3 - 8 5 79-7 Investigation fee:
F . "r I O
L'�C6 : #:. Lic. #: 3 - ,,> :,:� .. 4rNti. z 3 ,:4 „ ::�' ` --
• ; �I• x���+ �; ��; �� !:...�lescrtt:xl.2+eicmttjFeesx . , ��� � - _-
+ ' 1 • Subtotal S - (/ .
r i �a5 Plan Review (25% of Permit Fee) S '
s' w: - State Surcharge (8% of Permit Fee) S .____
Lie. #: , .
. y Y I i, , • - •. ., r - - - TOTAL PERMIT FEE _ S
Notice: This permit application expires if a permit is not ob
S Date: 180 days after lt.has been accepted as complete.
"l'•' . . •F methodology set. by T11- County Building Industry Service Board. / •' • ,r ".1..f". ..: ,::: *Fee (/ ,
M
1 lmdi FormaTlePeteni1App.doc 01/03
CITY QF TIGARD , .
BUILDING DIVISION PERMIT #: ELC2005 -00846
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/31/2005
Phone: (503) 639 -4171 A Inspection Requests (24 Hrs.): (503) 639 -4175 '� ..
INSPECTION WORKSHEET FOR DATE: 11/4/2005 TIME: .7:08AM PAGE: 59
SITE ADDRESS: 12750 SW PACIFIC HWY 123 CLASS OF WORK:
SUBDIVISION: VILLAGE SQUARE LOT #: 001 TYPE OF USE:
PROJECT NAME: VILLAGE SQUARE
DESCRIPTION: 1 circuit to furnace.
OWNER: GOSPODINOVIC, ROSE, PHONE #:
CONTRACTOR: GRF ELECTRIC PHONE #: 503829 -4146
Inspection Request Scheduled For: Date: 11/4/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 020364 -01 503-235.9083 Y
Corrections /Comments /Instructions:
, ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ' ..,� 4 Date: / 1 — i f " Phone #: (503) 718-