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Permit fa OITY OF TIGARD ELECTRICAL PERMIT • PERMIT #: ELC2003 -00340 c � i�n . DEVELOPM SER (503) 639 -4171 DATE ISSUED: 6/10/03 PARCEL: 2S114BA -03100 SITE ADDRESS: 09640 SW SERENA WAY SUBDIVISION: PICKS LANDING NO.2 ZONING: R-4.5 BLOCK: LOT : 108 JURISDICTION: TIG Project Description: Install 2 branch circuits for AC and outlet. • 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: SHAWN SUMERVILLE GRF ELECTRIC 9640 SW SERENA WAY 15460 SE PARADISE LN TIGARD, OR 97224 MULINO, OR 97042 Phone: 506 - 624 -7396 Phone: 503 - 829 -4146 Reg #: LIC 76751 'SUP 1655S FEES ELE 3 -484C Description Date Amount Required Inspections [ELPRMT] ELC Permit 6/10/03 $53.50 [TAX] 8% State Tax 6/10/03 $4 Rough - Elect'I 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 1-800-3 -2344. Issued By: `� .�� _ . /� ` Permit 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 639 -4175 by 7:00pm for an inspection the next business day Jun 09 03 03:18p GRF Electric 5038295747 p.1 ., t • `1 ' - tiL Electrical Permit Apetication y v V Date received: IP 31/0 r }y City of Ti � G � Q3 Petntitao.: �0 b d s••(1 Project/appl.no.: Expire date: City ity.o�gard Address: 13125 SW Haul G , Tigard, �1 � � 3 Date issued Phone: (503) 639 -4171 �\ \ �� BY { Receipt no.: - Fax: (503) 598 - 1960 0 O 6 1\CI S \ � �1 Case file no.: Payment type: Land use approval: r te \ V • . TYPE OF PERMIT 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family 0 Tenant improvement 0 New construction 0 Addition/alteration/replacement 0 Other: 0 Partial JOB SITE INFORMATION lob address: 9 100 S uj 5 k, e ri , i Bldg. no.: Suite no.: Tax map /tax lot/account no.: Lot: I Block: (Subdivision: yJ Project name: 5 0 y v; / / r . I Description and location of work on premises: .. � P.tr Estimated date of completion/inspection: .. . :L_-. . �,JJ CONTRACTOR APPLICATION FEE SCHEDULE ,YVN zo: Max Business name: G (?- G 1 e. mf r t ` c —I Description I Qty. (cc .) l Iota' I no.. map Address: New residential - single or multi farnily per l Ci L(-! v r 5, 1 r G t L/i, dwelling unit. Includes attached garage. City: / r.( / r ;,/ a 5b3 I State: pg., ( ZIP: 47 © c. f-2_ Service included: Phone: 9)3 -VA `Lift fbi Fax: (z % -5-7f 7 I E-mail: 1000 sq. ft. or less 4 , 3 ^ Each additional 500 sq. ft. or portion thereof COB no.: •7 !a7 S I Elec. bus. lic. no: Limited energy, residential 2 City /metro lic. no.: ?i ce Limited energy, non- residential 2 Each manufactured home or modular dwelling Signs ure of upervus ng lectrici (required) I) Service and/or feeder • 2 - Services or feeders - installation, Sup. elect. name (print): � �i u .... N. . Liceoscno: // alteration or relocation: PROPERTY OWNER • 200 amps or less 2 Name (print): 5 r,r7l1 S 0 yyl e ,r-v 7 re, 201 amps to 400 amps 2 401 amps to 600 amps 2 Mailing address: q fe 9-(..-) $ t .c) , 5 (' 1' - e 1 C � 601 amps to 1000 amps 2 City: '`, 44 I State: . IZZI c) •1 L 4 / Over 1000 amps or volts 2 Phone: /4 LL{_ 7 31k, I Fax: I E -mail: Reconnect only t Owner installation: The installation is being made on property I own Temporary services or feeders - which is not intended for sale, lease, rent, or exchange according to tllation, alteration, orrelocation: • ORS 447, 455, 479, 670, 701. 200 amps or less 2 201 amps to 400 amps 2 Owner's signature: Date: 401 to 600 amps 2 • Branch circuits - new, alteration, Name: or extension per panel A. Fee for branch circuits with purchase of Address: service or feeder fee, each branch circuit 2 City: • !State: • ' I ZIP: B. Fee fcr branch erceite v.•itho ut purchase 1 I I of service or feeder fee, first branch circuit: I i e S • 2 Phone: • Fax: E -mail: Each additional branch circuit: J Lt 6. PLAN REVIEW' (Please check all that apply') Misc. (Senice or feeder not included): LAS 0 Service over 215 amps - commercial . 0 Health -care facility Each pump or irrigation circle 2 0 Service over 320 amps rating of 1&2 0 Hazardous location Each sign or outline lighting 2 family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel, 0 System over 600 volts nominal more residential units in one structure alteration• or extension* 2 0 Building over three stories 0 Feeders, 400 amps or more *Description: 0 Occupant load over 99 persons 0 Manufactured structures or RV park Each additional Inspection over the allowable in any of the above: 0 Egress/lightingplan 0 Other- Per inspection I I Submit of plans with any of the above. Investigation fee The above are not applicable to temporary construction service. Other Not all Jurisdictions accept credit cards, please call Jurisdiction for more information. Notice: This permit application Perini[ fee $ S 5 0 0 Visa Cl MasterCard expires if a permit is not obtained Plan review (at ____ %) $ _ If crodi► number: / 1 within 180 days after it has been State surcharge (8%) $ 2--r ' Name of cardholder as shown oo credit card Expires TOTAL as complete. TOTAL $ S Cardholder denature Amount 440 -4615 (600/COM) Case Activity Listing 11/10/2004 1:35 :37P1v1 TIDEMARK Case #: ELC2003 -00340 COMPUTER SYSTEMS, INC. Assigned Done. Updated Activity Description Date 1 Date 2 Date 3 Hold Disp To By By Notes ELCA001 Application received 6/10/2003 None DONE FAX 6/10/2003 BB ELCA003 Permit created 6/10/2003 None DONE BB 6/10/2003 BB ELCA700 Rough -in 8/15/2003 None PASS HFY 8/15/2003 HFY ELCA799 Elect'l Final 8/15/2003 None PASS HFY 8/15/2003 HEY ELCA500 (F) Issue permit 6/10/2003 None DONE BB 6/10/2003 BB ELCA800 . Case Finaled 8/15/2003 None DONE HFY 8/15/2003 HFY Page 1 of 1 CaseActivity..rpt CITY OF TIGARD 24 -Hour • :- 3 BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP Received Date Requested / �AM BUP • Location `i 6 .aJ Suite Contact Person Ph ) 77 — a (fie I PLM Contractor \\ Ph ( ) SWR BUILDING Tenant/Owner J� ° i"-� 3 -0 0 3 4-0-• Footing ELC Foundation 0 g Access: rf� ? ELR Ft Drain Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors - Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final PASS PART FAIL • PLUMBING Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: - Final PASS PART FAIL MECHANICAL Post & Beam Rough -In • Gas Line � �' ' Smoke Dampers PART FAIL ELECTRICAL Service � 1 Rough -In }� Low Vo Low Voltag - - farm Air Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PART FAIL SITE ❑ Please call for reinsp:- tion RE: ❑ Unable to inspect — no access Fire Supply Line -- ADA Approach /Sidewalk Date ' 6 Inspe or ■1�r' - *to Fat Other: Final DO NOT REMOVE this inspection record from the job • ite. PASS PART FAIL