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Permit C ITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC2004- 0016 1� DEVELOPMENT SERVICES DATE ISSUED: 4/6/04 ��' 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S103CA 04900 SITE ADDRESS: 11550 SW TERRACE TRAILS DR SUBDIVISION: TERRACE TRAILS ZONING: R BLOCK: LOT : 003 JURISDICTION: TIG Project Description: NC, FURNACE 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: 2 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: BLACK, GAROLD R NANCY E GRF ELECTRIC 11550 SW TERRACE TRAILS DR 15460 SE PARADISE LN TIGARD, OR 97223 MULINO, OR 97042 Phone: 503 -639 -0294 Phone: 503 - 829 -4146 Reg #: LIC 76751 SUP 1655S FEES ELE 3-484C Description Date Amount Required Inspections [ELPRMT] ELC Permit 4/6/04 $60.15 [TAX] 8% State Surcharge 4/6/04 $4.81 Elect'I Final Total $64.96 This Permit is issued subject to the regulations contained in the Tigard Munidpal 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 - 332 -2344. Issued By. . Permit Signature: _Ap/ ' ` / 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 Apr 02 04 03:30p GRF Electric _ 5038295747 p.1 w . FO R OFHICE USE ONLY E tectrrcal Permit A Pon C G1Ved Electrical /�� ( � O Date/By: Permit NoECG aon (tee /4 ? City of Ti and 1 t: LO )k Planning Approval Sign \ `J g y P Date/By: rm Date/By: Permit No.: \ • 13125 SW Hall Blvd. , �= � P+ S Plan Review Other • . Tigard, Oregon 97223 p` 1 \G ON Date/By: Permit No.(nie 7 4 1 --'d 0i Phone: 503- 639 -4171 Fax: 503697831 N O \v k�: Post- Review Land Use \ : Contac Case No.: Internet: www.ci.tigard.or.us \ \,O ■ i4.. t - i I Contact y: El Sec Page 2 for • 24 -hour Inspection Request: 503 - 9 -417 Name/Method: Supplemental Information. • .. ' - E: OF WORK ,' : ,;- >= . : :... . . •PLAN:!REYIEW (Please check all:that aji )h ❑ New construction . ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility commercial ❑ Hazardous [ Addition/alteration/replacement ❑ Other: location ❑ Service over 320 amps - rating of 0 Building over over er 10 10,000 square feet, '.." ';'?S;CATEGORY:OF CONSTRUCT,ION'':::.:. ..' , .::'' . 1 & 2 family dwellings four or more residential units in I 1 & 2- Family dwelling ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure ❑ Building over three stories ❑ Feeders, 400 amps or more !Accessory Building — Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park Master Builder _ „, Other: ❑ Egress/lighting plan ❑ Other: .. JOB. -SI.T INFORMATION:aad:LOCATION :.: +.' ' Submit sets of plans with any of the above. The above are not applicable to temporary construction service. Job site address: 1` 1 5 S p 5 c,) 1e- v e , „..::..:: _ . � .FEE *sSCHT;DiIL . Suite #: Bldg. /Apt. #: Tr S pt'-, Number of inspections per permit allowed Project Name: 6e v-r t . ,ti 1 :,.i� . 1 - ;,- �� Description . t Qty Fee (ea.) Total Cross street/Directions to job site: Z 3 New residential-single Incl or multi-family per 7 L dwelling unit. Includes attached garage. Service included: 1000 sq. ft. or less 145.15 4 Each additional 500 sq. ft. or portion thereof 33.40 1 Subdivision: I Lot #: _ Limited energy, residential 75.00 2 Limited energy, non residential 75.00 2 Tax map /parcel #: Each manufactured home or modular dwelling �, '. service and/or feeder 90.90 2 . - .... •:�: ..•.. �'. ��DF :S.G`'$IPTION,:OF�1,'VORIC ;;...: : r, ... ,.,a /� ,/ Services or feeders - installation, • 5 C .+Y C.�, a /A-e. /t / ,h ,..,,,,we alteration or relocation: / 200 amps or less 80.30 2 b r 4 *lit— 201 amps to 400 amps 106.85 2 401 amps to 600 amps 160.60 2 C]:PROURTY- APANER;IV:'-. ∎I;D!IENANT;':i ': ;.:. :.;is` :�! 601 amps to 1000 amps 240.60 2 / Over 1000 amps or volts 454.65 2 ( Name: ,e )/, o f t / A r }2-_ " Reconnect only 66.85 2 • Address: l i cc-0 - w -re r lr6 G Z TrA, j e _ Temporary services or feeders - installation, alteration, or relocation: City /State/Zip: r a 7 2 -Z- 3 f /, - 200 amps or less 66.85 I 3 °f - ej 201 amps to 400 amps 100.30 2 Phone: �, J- 401 to 600 amps 133.75 2 ID APP T.::;a . , LICAN . CONTACT.PER,SOO'`• . Branch circuits - new, alteration, or Name: extension per panel: A. Fee for branch circuits with purchase of Address: service or feeder fee, each branch circuit 6.65 2 City /State /Zip: B. Fee for branch circuits without purchase of f . , .— service or feeder fee, first branch circuit / I 46.85 I N , b 2 • Phone: I Fax: Each additional branch circuit (A 6.65 1 3, 5o • E- mail: , Misc.(Service or feeder not included): 7 ,,..,: .:-...:.!.....'.:t.:!;!;;:..'1..: , :, ,; ; i, Each pump or irrigation circle e �.� (�t�ft�t�� { D{..�,�.e,4�.. 53.40 - 2 53.40 ��' :ii ��,���. ,.f�Y, �', r. ..�yfu' AD:h��. �.F'.... .: ,;: i 's , •,� �'.,��. i ' ` ,.,; � Each sign or outline lighting 2 Job No: Signal circuit(s) or a limited energy panel, • alteration, or extension Page 2 2 Business Na G 1- . P_e, - { - r' I r . Description: Address: 1 51-Le (' S, " rlr C 4_,/ /-r) • - - Cl City/State/Zip: /� Each additional inspection over the allowable in any of the above: ty p: M u / r �2 I c_ q '7 /9 ` Per inspection per hour (min. 1 hour) 62.50 Phone: sz3 0,4 .- Lt / , t-i, Fax: 5b3 - tI zi - 5 '79-7 Investigation fee: Other. CCB Lic. #: (� � .Si Lic. #: 3 — y .' :;;" , :', i;! . ^ ;` Electi-ical:Peri :Fees ,.. . ' ; =. ' Supervising electrician � °iii ='? "° Subtotal $ ,,:, i y i C signature required: - .,r., � Plan Review (25% of Permit Fee) $ Print Name: AV r7 j; G,,., K 2 I Lic. #: / l c $ State Surcharge (8% of Permit Fee) S / _____7-- If i TOTAL PERMIT FEE S / n g_.• Cj 0 Authorized Notice: This permit application expires if a permit is not obfncd within Signature: Date: 180 days after it.has been accepted as complete. *Fee methodology set.by Tri- County Building Industry Service Board. (Please print name) i :\Dsts\Permit Forms\ElcPermitApp.doc 01/03 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP Received a 5 2'f' Date Requested Y l 0` 7' / AM PM BUP Location 1/ n SD 24, O-C's2<- .Q,SaitIL MEC Contact Person Ph (_. 20C) r 72 PLM Contractor Ph ( ) SWR BUILDING Tena Own I L, / c l Footing Foundation ELC Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall V P4� V v�J , C j � I 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 - RT FAIL ECHANIC Roh-In Beam Rout ryi� _ � G I'� ugh /' l /! Gas Line oke Dampers G �► PART FAIL Service Rough -In UG/Slab r 149 Low Voltage Alarm ® Reinspection fee of $ _ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PAS P. RT FAIL SI ❑ Please call for reinspection RE: J Unable to inspect — no access Fire Supply Line ADA Dat /� (' / Inspector Ext Other: Final DO NOT REMOVE this Inspection record from the Job site. PASS PART FAIL r