Permit ` CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00671
_AV
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 122 ZONING: C -G
SUBDIVISION: VILLAGE SQUARE LOT : 001 JURISDICTION: TIG
Project Description: 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:
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 1655S
Description Date Amount ELE 3 -484C
[ELPRMT] ELC Permit 10/31/200' • $53.50
[TAX] 8% State Surcharge 10/31/200' $4.28 REQUIRED ITEMS AND REPORTS
•
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 .
Issued By: �' Vii �� 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.
•
Sep 12 05 03:34p GRF Electric 5038295747 p.3
t ..
USE
, E lee' FOR OFFICE: ()Nil'
i � l:;, l teal •Per on Received q /� Electrical ` . " " 4 ` . . • : S ,t•: Date/By: /3/05 A& . Permit No. & --- 06 /Q G/ • 1=..",'',,i'; V `{ � 2 2t/t/5 Da g Appro al SSim.. ��' � . SEP 1 y: Pem it No.:
P ' f 41Vd• Plan Review Other -
l e. i. t Date/By: PermitNo.:
`'' ,� $ � I �� G �� A //,�� F ., � D ON Post- Review land Use
'',..1:11 t F t g1 ,,,.,: +: . ; L Date/By: '' ' • ; 'Iviwl�l.ei.tlgaid.or. Case No.:
�' .; ' JW. C.1 Contac Juris.: El See Page 2 for
' ' • '! `' 21 thSprect Request: 503 -639 -4175 Name/Method: Supplemental information.
•
.• .,: n0 , •
�7 , t ri . q .. ' �• r 7''r F r', i't <f II I. .,.A %___I ' � � : PL N REVIEW .lease' cbeck'alf ttiat a t l .:
,: ': =, ,,; .,•o ate`' mitt
•t -- --
' l i la Service over 225 amps- Health-care facility
•tlst<iictiun' �r D
r # commercial ❑ Hazardous location •
i :.,' 1 .-fV: •...,i altera • ilacemen t I. Other: ❑ Service over 320 amps -rating of ❑ Building over 10,000 square feet,
i'' ..':.: • - ,: • •': \ __Iii.P• t' e a:W 0 1 & 2 family dwellings four or more residential units in
or. ',...qiiiiii, .: :& dwellm _ P.► .. } t r : / t • n • ❑ System over 600 volts nominal one structure
S'• '4 ,' • ❑ Building over three stories ❑ Feeders, 400 amps or more
'`I' - 61 tug • -. • BIlildin_ 11111 Multi- Farnil ❑ Occupant-load over 99 persons ❑ Manufactured structures or RV park
ti:F 'awl , , N Other: ❑ Egress/
lighting plan ❑ Other:
i �' ' ll�.l�'C�i T ` t' 1a1Ur iT u ri ^ TICI N•' :. r, �� • Submit _ sets of plans with any of the above. - •
i9 I W. . v.
tY "�� ( � � - • e(,l ^t�`i l� �� `- • ' i •� li' � ::r7: � The above are not a placable to leraporary construction service.
0`., ' 1 --/- - 540 C 1,12 PAr.I " /i �:. wt� . : :, ..:• .lk'.EF:R�'SCIIED.Li.LEIr i ' ,.
r h t " '°F "r'' f '' � f{ v N umber of in permit allowed
inspections per tntQ,#r. ^ ".. " ' BId: JA � t. #: ,,, • : �� p P P
• t " ! Fee (m.) Total
` amC : J � � Dcacr u Qtr
. New ge
`:;; Service Included:
I. '..3%,..:,!,,,,4,z ; 1
` .;'..: 41. 1000 s4• it or less 145.5 4
• ter �{,�, Each additional 500 sq. f . or portion thereof 33.40 1
- A l Limited energy, residential 75.00 2
' f "' '- :-i. I' • Lot #: Limited energy, non residential 75.00 2
L.S ;y, i. 1 1, , • . , tj , , 1 # : Each manufactured home or modular dwelling
r : ' .'; 90.90 '2
. I -
-.' ' j -�., i't: � C�' '' ' Q il u ' - -- . T � : a ,; : 1 ? ±' %';,I�c� ,� 3 ' serv icesorfee feeder ' . � i , .. - . _ - Services or feeders - installation,
q �C'r?;.:. " •: 's: ' alteration or relocation:
�;; 200 amps or less 80.30 2
S ;+i p l :. - - •• d J 201 amps to 400 amps 106.85 2
;r" `;�" - 401 amps to 600 amps 160.60 2
• i y � 601 amps to 1000 amps 240.60 2
.;, . • .t' . I 1 1 . `i S t-1'i,t- `' : t• EiII , _ ' y2� .. it ,'i •' : , i 4 4..q` 454.65 2
^ + Over 1000 amps or volts
41 ii ''�" ' -: '
..:p•'; 1 i ,) 1 . e (e- L •1' C._ Reconnect only 66.85 2
. ` :' j t ����'���s.a��,,,,�,,.` ` - J �� / • - � . } � Temporary services or feeders- Installation,
" ' . -.. � f t ! �l / r " �`� alteration, or relocation:
� .. % / ''
- 4"' : L.`u .: - gy pp: 1 1 y/Yr ,/f. 1 7 7 7-- yk' I L 2 200 amps or less 66.85 ►
;
' l!� . 201 snips to 400 amps 100.30 2
• .: :' Ir. r . , .; . J, .'s - 1 � Fax: 133.75 2
, 401 to 60o a s
' � � :I;;� L l' � \1_' ". r. I f ' . -il ? ., :;t re � . 't , O r � t /T:,.::/ m p 1
I • :c ? :. 'h - I i i • :. .r i e. . -...
.. ; a.' - i- 1 nU Branch circuits - new, alteration, or
1 iy : , . -" - . ', :;, t : , ,i'• extension per pane
{� i: ' n „ , A. Fee for branch circuits with purchase of
' . 6.65 2
• - , : service or feeder fee, each branch circuit - - . • .
;3 � , ,, r • . •.� Fee far • B . en at branch circuits without purchase of ti . 2
•.r 1' ,. 1 46.85 y( ,
; . . s, Z service or feeder lee, lust branch c
.4..,-..,„! : - • ) ..:' f! '' -r' ,t: Fax: Each additional branch circuit 6.65 2
• :At ;`;, e 15
vwj �.- r ti w r,: orurngetwnCUCle Misc.(Service or feeder not included): ( ( 53.40 2
S
�f; . . .• .,S,��n ~r�e,t u. ; tri _ ;i tl is :�.6•.n` •. •'� Eacltr p 53.40 2
r� . , . Each sign or outline lighting
1 ; °q:',,- . jsr.'.'1 = t • : •' . . • I ' S ignal circuit(s) or a limited energy panel, 2
^ . ,,.- Page 2
♦ alteration, or extension
Busuiess Na1ne: (3 -•f is e if. Desc iption:
T . R :, I n p
.I 68r:.'` : -I l 1 n S . ` e rt' d 441 • Each additional inspection over the allowable In an of the above:
, - 6 •+ ' iSt ater i . . 44 _ / L. Z Per inspection per hour (min. 1 hour) [ 62.50 I, i
• '..1, ! Fax: 5b 3 - . • • - Investigation fee:
- _'_moo' Other
- r Lic. #: 3- . fig �' >; Vii:; :tl Pe tt Fees ' k'; �* � • - t•
�c1au• / Subtotal S c -< 5
':: ' _ . •' ' `-* \ l 1 Plan Review (25% of Permit Fee) $ • 2 3"
u ' a r • " - �'" • Lic. #: , . State Surcharge (8% of Permit Fee) $
a Y , . .. . .
, -;•:, TOTAL PERMIT FEE $ �7 _ + J
.,_I :_::•. '::,' = ' '' • Notice: This permit application expires If a permit is not ob ed within
: - . , • •. Date: 180 days after it. has been accepted as complete.
" * • i , , , • ! + , •
*Fee methodology set.by Trl- County Building Industry Service Board.
1 v , ' 1 ; r1 'I i :'' ' Pllat. lf) .
• • . t pamistElcPernutApp.doc
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELG2005 -00671
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 10/31/2005
Phone: (503) 639 - 4171'
Inspection Requests (24 Hrs.): (503) 639 -4175 "�
INSPECTION WORKSHEET FOR DATE: 11/4/2005 TIME: 7:08AM PAGE: 62
SITE ADDRESS: 12750 SW PACIFIC HWY 122 CLASS OF WORK:
SUBDIVISION: VILLAGE SQUARE LOT #: 001 TYPE OF USE:
PROJECT NAME: VILLAGE SQUARE
DESCRIPTION: 2 branch circuits.
OWNER: GOSPODINOVIC, ROSE, PHONE #:
CONTRACTOR: GRF ELECTRIC PHONE #: 603-829-4146
Inspection Request Scheduled For: Date: 11/4/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 020360-01 503- 235.9083 V
Corrections /Comments/ Instructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
1 1 0 FAIL El CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
Inspector: _ Date: 1 I —L i Phone #: (503) 718-