Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2000 -00318
, k DEVELOPMENT SERVICES DATE ISSUED: 06/09/2000
c� l 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S133DA-02000
SITE ADDRESS: 11045 SW SUMMER LAKE DR
SUBDIVISION: AMART SUMMERLAKE ZONING: R -7
BLOCK: LOT : 042 JURISDICTION: TIG
Project Description: Installation of one branch circuit
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:
WAYNE MCCROSKEY GRF ELECTRIC
11045 SW SUMMER LAKE DR 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
PRMT JMT 06/09/200C $37.50 00002843
5PCT JMT 06/09/200C $3.00 00002843
Total $40.50
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 CK.I rY ISSUED BY: s
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
06/07/2000 19:26 5038295747 GRF ELECTRIC PAGE 01
v.
-CITY OF TIGARD i Electrical Permit Application Plan check tf
13125 SW HALL BLVD. Reed By Orr lie
TIGARD OR 97223 Date Rec'd
• Phone (503) 6394171, x304 ■ Date to P.E.
Date to DST
Inspection (503) 639 -4175 Print of Type Permit* F,Q,(i .vw
Fax (503) 598 -1960 incomplete or Illegible will not be accepted Called
1. Job Address: t Complete Fee Schedule Below: •
Name of Development Number of InspectIons_erpermtt allowed
Name (or name of business) , VU y H e , A . "415 Service included: Items Cost Sum •r
Address / / 0 if- s s S 1.4....k e,-. LAfrii 4a. Residential - per unit
City/State/Zip P/7 )C -/ 2-z-3 b f 1000 sq, ft. or Tess $ 117.75 4
Each additional 500 sq. ft. or
portion thereof 3 28.26 1
Commercial 0 Residential 45 Limited Energy S 60.00
i Cit*C2� 09141'' 09141'' Each Manufd Home or Modular
2a. Contractor installation on y: • Dwelling Service or Feeder S 72.75 2
(Prior to permit issuance, applicants must provide contractor Ilcenee 4b. Services or Feeders .
information for COT date base). C, . Installation, alteration, or relocation
Electrical Contractor ,� r t 1 t`.- - -- Yt C� 200 amps or less 5 54.25 2
Address (5 ft ( I) 3, pi ra (14e (,r, 201 amps 10 400 amps 5 85.50 2
mi l " 7 401 amps to 600 amps S 128.50 2
City /0,4i r o State Oa_ Zip 011.2_ 801 amps to 1000 amps S 192.50 2
Phone No. - 4 4 - 1 4 Over 1000 amps or volts 5 363.75 2
Job No. Reconnect only 5 53.50 2
Elec. Cont. Lice. No. S '"'t k + G Exp.Datb it ) . 4c. Temporary Services or Feeders
OR State CCB Reg. No. '1 to '7 5 I Exp.Date s( 00 Installation, alteration, or relocation
COT Business Tax or Metro No. 34 72- Exp.Date ri J l icic 200 amps or less 1 53.50 2
201 amps to 400 amps 5 80.26 2
Signature of Supr. Elec'n � 401 amps to 600 amps $ 107.00 2
Over 600 amps to 1000 voile, •
see °b" above.
License No. ) I,, 5) Exp.Datla It - D'L
Phone No. e Z 9 - 4 1, 4d. Branch Circuits
New, alteration or extension per panel
FAX in- 5 7 4-7 a) The fee for branch dreuits
2b. For owner installations: with purchase of service or
feeder fee.
Print Owners Name Each branch circuit S • 5.35 2
Address b) The fee for branch circuits
without purchase of swvlce
City State Zip or leaser tae. n C13 Phone No. First branch circuit 1 S 37.50 , •
Eacn additional Branch circuit $ 5.35
The installation is being made on property I own which is not . w. Miscellaneous
intended for sale, lease or rent. (Service or feeder not included)
Each pump or irrigation circle $ 42.75
Owners Signature Each sign or outline lighting $ 42.75
Signal circuit(s) or a limited energy
3. Plan Review section (If ulred : `
panel, Labels or extension $ 07.00
Minor Labels (10) $ 107.00
Please check appropriate item and enter fee in section 5B. 41. Each additional Inspection over
4 or more residential units in one structure the allowable to any of the above
Service and feeder 225 amps or more Per inspection $ 50.00
Per hour 5 50.00
System over 800 volts nominal in Plant
$ 59.00
Classified area or structure containing special occupancy as
described in N.E.C. Chapter 5 5. Fees:
6a. Enter total of above fees $ 37.
Submit 2 sets of plans with application where any of the above apply. 5% Surcharge (.05 X total fees) 5 2 -.-
Not required for temporary construction services. Subrotal $ -7 �' - "
6b. Enter 25% of line 6a for
NOTICE Plan Review if requited (Sec. 3) S
$
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED Subtotal
IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR / / � �/ �2
WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS runt Account 0 / 7
AT ANY TIME AFTER WORK IS COMMENCED. Total balance Due $ To ( L-
is \dst4\ forms \c lcctric. doc
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Li e: 39 -4171
2; BUP
Date / R ' equested 67/ —I ) v A 1 M / PM BLD
Location / 10 `l; 5747114 or suite / MEC 9L - 00121
Contact Person (,(� 14 /r Ph 211'1- r '1- WS `7 PLM
Contractor Ph SWR rr
BUILDING Tenant/Owner ELC e & 1 p
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 V /
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final •
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS P FAIL
aII ECHA
Post & Beam
Rough In
Gas Line
Sm•. - Dampers
S PART FAIL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
PART FAIL
S
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
Approach /Sidewalk Date I Q Inspector "1 Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.