Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2008 -00025
COMMUNITY DEVELOPMENT DATE ISSUED: 1/11/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S103CA 03000
SITE ADDRESS: 11515 SW TERRACE TRAILS DR ZONING: R -4.5
SUBDIVISION: TERRACE TRAILS LOT : 002 JURISDICTION: TIG
PROJECT: THOMSEN
Project Description: Install (2) branch circuits for AC /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: SIGNAUPANEL:
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:
GEOFF THOMSEN GRF ELECTRIC
11515 SW TERRACE TRAILS DR. 15460 S PARADISE LN
TIGARD, OR 97223 MULINO, OR 97042
Phone: 503 - 577 -0715 Contact #: PRI 503 - 829 - 4146
FAX 503 - 829 -5747
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FEES
Description Date Amount Reg #: ELE 3 -484C
[ELPRMT] ELC Permit 1/11/2008 $53.50 LIC 76751
[TAX] 12% State 1/11/2008 $6.42 SUP 1655S
Total $59.92 REQUIRED ITEMS AND REPORTS
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws.
All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is
suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center.
Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 -001 -0100. You may obtain copies of these rules or direct questions to OUNC at
503.246.6699 •fit= m '.332.2344.
Issued B � � ' Permittee Signature: /a,o C (
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
�` Jam; 10 08 02:31p GRFELECTRIC 5038295747 p.1
Electrical Permit Applicati en ECEIVE City of Tigard , l /I Or S Pat+iNo gi.C, 0fg - 0002$
t 3125 SW Hall 81vd., Tigrind,OR 97223 1 ' pl Review Other Paretic
' � Phone 503,63 Fax 503. 1 0 2008 Daream .
1 t r., ,1•: t• Inspection Line: 503.639.4175 t)we Ready/Br. lW to
' Set bee 1 foe
Internee www.tigwd- rw.gov CITY OF TIGARD . N i ok E7' Supp1cmeneat Inrarrdatiaa
TYPE OF IIMUCUING DW1StON PEA' R&YIEW
❑ Now construction 4ddition/alteration/replacement Nose ebeck all dint sooty (submit 2 NU Of 0anS wMors chcclaed below):
❑ Service a fcoder 400 amps or nor' 0 Building over duo' stories.
❑Demolition 9 Other: where t available fault came DMminssandboatyarda
CATEGORY OF CONS RUCT ION acted' 10.000 amp' rd ISO volts or 0 0 HOP* Indiana.
� lea to pound, or eacxa 14,000 ❑ Coaornocial-oac agricultural ,
:1 and 2- family dwelling ❑ CornmereiaVindusoisl ❑ Accessory building oncr for all ahcriastaniona. Nadine'.
❑ Multi-family ❑ Master builder I Other: ❑ rire O Insinuation of 75 KVA or
Of � "��, "
JOB SITE INFORMATION AND LOCATION I: M n taw s t. o larger E-. "I d". dw: °l -) ". ay'leto,
❑ McMinn ofuew mtor load E'. "1.2", ",
lob Site addre9s f� T n £0018P or mom �P�.7•
Job n0.:
� j • I I J 5 � I J r � S i , ) l f ( . — Ka r .t . p s i . Or mare rola: id airs. o Beamtimal vehicle pasta.
City/Slater/1P: I 1 I ? ! 1! l� , . ` ? or-- ❑ Ham dcro ( cams s. O 600 vain noo ��tce roc WC". am
1 OHasordaua tocaovta 600 vo�aL
Suite/bldg./apt. nor: Projectnamc: Zz3 O ,
1.) �y11 �>2 FEE SCRIM=
• Cross street/directions to job site: De,eviscia, I Q r Tea 1 Tow 1 -
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. R or lave 145.15 4
Ea add'! S00 sq. R or portion 33.40 I
Tax mapfparcel no.: - Limited energy, residential
DESCRIPTION OE WORK Jwith'burr t4 It) ?5,00 2
Limited energy. multi- family 75.00 2
2 - (x(..11 c ti a w • - /4 / 0 (,Ll, -
c residential (with 'bare ems. R) -
Servlas or feeders lafUdhtion and%or relocation
200 amps or less _ 80.30 T 2
ler—YR RYY ❑ TENANT 201 empato400amps 10685 2
H G ,ft 4 `1/1 C P/✓) 401 amps to 600 amps 2
IS 601 amps m 1,000 amps 240.60 2
Address; ) 1 5 S /A) — FP, r rr ,' _ 1 stn S A I Over 1.000 amps or volts 454,65 ' 2
Ciry 1 / G Z3 !
Temporary services or feeders installation, ■ltendon. ■od/er
( l t ��( 7 e- 4J2 I ( ) r' relocation amp
Phone: F 200 00 Amp1 m less 66.85 _ 1
Owner iostaIlatson: This installation is being made on property that 1 own which is not 201 amps to 400 amps 100.30 2
inuaded for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Anna circuits - new. alteration, or extension. (ler patio!
Owns signature: : A. Fee for branch circuits with 1
❑ AYPLICANT 1 ❑ CONTACT PERSON above service or faedcT fee. 645 2
cads branch circuit
Business Aot71e: $, Fee for branch circuits
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Contact name: without service or feeder ter, I 46,85 { sac S 2
first branch circuit _
Address: Each add'1 branch circuit 6.65 le ,fir � 2
At Miscellaneous ( o fee rat In clud e d)
City/Statc21P: Each manufactured or modular I
dwelling. service and/or feeder 90.90 2
Phone: ( ) 1 Fax:: ( ) Reconnect only 66.55 1
C -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting _ i 53.40 T 2
Business name: r Signal circuit(s) or limited-
. C ( e c 1 ci owe, panel, alteration, or •
Address: 1 1i (O 0 J . p(/1 'r 1-4 r- t; L -. , extension. Descrbc Page 1 2
City/Statr/ZIP : f‘,/1 (A A f 6 Up_ G n () (._2_ Each additional lnspccho nover allowable insny, rtheabove
/ T Per inspection 62.50
Phone: (!i ' Lev _ `f) t jLi j Fat: ( 0 --7 l t7 Investigation per hour (1 b rain) 6150
CCB Lie.: 7 , 7 57 Electrical Lic.: Z- 9, ((. ! C Suprv. Lie.: e 55-,S Industrial place per hour - 73.75
�i� i� ELECTRICAL PERMIT FEL&
Suprv. Electrician signature, required: ‘i,.11.�� `e,� Subtotal: l-i , 51)
Print name:: 1 „ 1 ( ` t ', ; fi , j' Date; i // /1i Plan review(LS/.ofperlmitfee):
b/t� ! L v State surcharge (12% of permit fee): fr , ( l-
Authorized signature: TOTAL PERMIT FEE: S , C/
Printname: I Dote: Th6 permit application erpirasIra permit s am arialned within 140
dqa esker it has bon aeaptcd as ovapteta
• Wu tuber of inapcctiona 'Unwed per permit.
IscaIIaiwgernhdQLC.auwiutypaa al1L'a16 ' • 4.
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CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2008.00025
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/11 /200c3
Phone: (503) 639 -4171 Ara,
Inspection Requests (24 Hrs.): (503) 639 -4175 °:_..
INSPECTION WORKSHEET FOR DATE: 1/23/2008 TIME: 7 :00AM PAGE: 37
SITE ADDRESS: 11615 SW TERRACE TRAILS DR CLASS OF WORK:
SUBDIVISION: TERRACE TRAILS LOT #: 002 TYPE OF USE:
PROJECT NAME: THOMSEN
DESCRIPTION: Install (2) branch circuits for AC/outlet.
OWNER: TI-IOMSEN, GEOFF PHONE #: 503 -577 -0715
CONTRACTOR: GRF ELECTRIC PHONE #: 503- 829.4146
Inspection Request Scheduled For: Date: 1/23/2008 Pour Time:
Code # Inspection Description C irm -# Contact # Message
199 Electrical final 063692 -01 503-829-4146 Y
Corrections /Comments /Instructions: f 6 -13C\, \ %Q1;
lb
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11 PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G--i N 641101-- Date: I "7-3 v o Phone #: (503) 718 -7-4> •