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Permit i CITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC2000 -00339 lii DEVELOPMENT SERVICES DATE ISSUED: 6/19100 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S102CB -01600 SITE ADDRESS: 10395 SW PARK ST SUBDIVISION: NORTH TIGARDVILLE ADDITION ZONING: R -4.5 BLOCK: LOT : 032 JURISDICTION: TIG Project Description: Install two (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: EASTERLY, JOSEPH H G + TONIA GRF ELECTRIC 10395 SW PARK ST 15460 SE PARADISE LN TIGARD, OR 97223 MULINO, OR 97042 Phone: Phone: 503 - 829 -4146 Reg #: LIC 76751 SUP 1655S ELE 3 -484C FEES Required Inspections • Type By Date Amount Receipt Elect'l Service \ \ N �` PRMT DEB 6/19/00 $42.85 0003084 Elect'I Final C 5PCT DEB 6/19/00 $3.43 0003084 vQ1'S Total $46.28 ` 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 -0080. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -1987. PERMITTEE'S SIGNATURE C �/ � : ISSUED B ,C , Y 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: .J9J - .JO/ 1 -- DATE: LICENSE NO: I t0 5 S S Call 639 -4175 by 7:00pm for an inspection the next business day 06/16/2000 08:32 5038295747 GRF ELECTRIC PAGE 01 CITY OF TIGARD ' Electrical Permit Application Plan Check s " 13125 SW HALL BLVD.. � , ' Read By TIGARD OR 97223 Date Recd • Phone (503) 839-4171, x3041UN 16 20(!O Dale to P.E. R Data to DST Inspection (503) 639-4175 Print of Type Permit 001 Z' � - 0033 Fax (503) 598 - 1880 Incomplete or Illegible will not be accepted . 1. Job Address: 4. .Complete Fee Schedule Below: • • Name of Development OJ e. _it _ e r l Number of Inspections Per permit allowed Name (or name of business) k. Service Included: Items Cost Sum l Address T. ( q elk, -1 7 T.17 fi 4a. • Residential - per unit . City /State/Zip ;J 1000 ay. R. or less $ 117.75 4 . Each additional 500 sq, ft, or portion thereof a 28.26 1 Commercial ❑ Residential Limited Energy $ 80.00 Each Manufd Home or Modular 2a. Contr 7nsta 8 On O l y: ning Service or Feeder S 72.75 2 (Prior to pemtlt Issuance, applicants must provide contractor license 4b. Services or Feeder* Intonation for COT data bass). Installation, alteration. or relocation Electrical Contractor G g.p a F.G.4I..i 200 amps or less $ 64.25 2 201 amps to 400 amps S 85.60 2 Address 5 110 5r G rAd r SP !� _ 401 amps to 600 amps s 126.50 2 City _A/i4 G .7 it State D 2._ Zip , 9 7D tf 601 amps to 1000 amps $ 192.50 2 J'Z Phone No. . / � I r aI t2Q ,- 5,41 over 1000 amps or vons $ 363.75 2 Job No. Reconnect only $ 53.50 2 Elec. Cont. Lice. No. 3-4- g 1 C Exp.Date - /0 I J I d 0 •4c. Temporary Services or Feeders OR State CCB Reg. No. I is ? Si Exp.Date 9 /2 Installation, alteration. or relocation COT Business Tax or Metro No. 342j, Exp.Date or COT 200 amps or less $ 53.50 2 201 amps to 400 amps 5 80.25 2 Signature of Supt. Elec'n . I �' 401 amps m 800 am i 107.00 2 Over 800 amps to 1000 volts, 1 see -b" above. License No. • 114 C Exp.Datte I (?, 4d. Branch Circuits Phone No. g " 4"1 New, alteration or extension per panel a) The fee for branch circuits 2b. For owner installations: with p rchose ofs*rwice or feeder lee. Print Owner's Name Each branch circuit $ 5.35 2 Address b) The fee for branch comas City State Zi p without purchase of sandal �Tt Phone No. First branch circuit rcAit S 37.50 3i. gV _ Each additional branch dreult I $ 5.35 3 The installation is being made on property I own which is not b. slorican•nooue 5 ' intended for sale. lease or rent. (Service or feeder not Induded) Each pump or lmgation circle $ 42.76 Owner's Signature • Each sign or outline lighting 5 42.76 Signal arcuit(s) or a limited energy 3. Plan Review section (if required):* panLa Labels (1 or extension 6 80.00 Minor Labels (10) S 107.00 Please check appropriate Item and enter tel In section SB. 4f. Each additional Inspection over 4 or more residential units In one structure the allowable In any of the above Service and feeder 225 amps or more Per Inspection $ 50.00 _ Per hour $ 50.00 System over 800 volts nominal In Plant 5 58.00 Classified area or structure containing specie! occupancy as described in N.E.C. Chapter 5 5. Fees: S. Enter total of above fees $ r_ * Submit 2 sets of plans with application where any of t he abov* apply. 5% Surcharge (.05 X total fees) $ Not required for temporary construction senlcesx Subtotal S 6d. Enter 26% of line le for NOTICE Plan Review if reauir, l (Sec. 3) S PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED Subtotal S IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS Trust Account e G AT ANY TIME AFTER WORK IS COMMENCED. rota balance Due $ &j Z is \dsts \forms \eleetric.doc /0(5C/3 �Q oY CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 6394175 Business Line: 639 -4171 BUP Date Requested 7 /7 0-z7 AM PM BLD Location /19 3 p:r Suite MEC 2gairp ^ d 82349 Contact Person -1�- J I f Ph U ZZ 1 © 3 0 PLM Contractor . f /e-/,9 W Ph SWR BUILDING Tenant/Owner < - 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 Drywall Nailing Firewall Fire Sprinkler 4111111.� Adolo.. Fire Alarm �`� �' �T4' (Cr � Susp'd Ceiling +, - � �� - Roof `r,-- Misc: Final PASS PART FAIL PLUMBING • • "b / \ Post & Beam Under Slab Top Out Water Service /10 6-4-5 V&& 4CQ' /s., ,r Sanitary Sewer 6 Rain Drains Q it A.4 Cl5 9 773 6 �Gt c O Final PASS PART FAIL r MLICAANIC P•s Beam Rough In Gas Line - Smoke Dampers 41t i,-_• RT FAIL Service Rough In UG /Slab Low Voltage F" - larm - PART FAIL %ITE Backfill /Grading Sanitary Sewer Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access ADA — Other och /Sidewalk Date /// !J" Inspector ( (741 Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.