Permit a CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2002 -00075
A 6" DEVELOPMENT SERVICES DATE ISSUED: 2/22/02
13125 SW Hall Blvd.. Ticiard. OR 97223 (503) 639 -4171 PARCEL: 1S134DC -09100
SITE ADDRESS: 11454 SW TWIN PARK PL
SUBDIVISION: TIGARD PARK ZONING: R -4.5
BLOCK: LOT : 007 JURISDICTION: TIG
Project Description: Installation of 1 branch circuit to furnace.
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:
KATHY STROM GRF ELECTRIC
11454 SW TWIN PARK PL 15460 SE PARADISE LN
TIGARD, OR 97223 MULINO, OR 97042
Phone: 503 - 670 -0162 Phone: 503 - 829 -4146
Reg #: LIC 76751
SUP 1655S
ELE 3 -484C
FEES Required Inspections
Type By Date Amount Receipt Wall Cover
PRMT CTR 2/22/02 $46.85 2720020000( Elect'I Final
5PCT CTR 2/22/02 $3.75 2720020000(
Total $50.60
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 -6699 or 1 -800- 332 -2344.
Permit Signature: le...,e, 0 -PI Issued By: 44.1:La,t- lc ,t5a1-(-/L
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: rte- 6 7#2,40 • DATE:
LICENSE NO: / 655 s
Call 639 -4175 by 7:00pm for an inspection the next business day
Electrical Permit Application
Date received: ) 4 / 2- ' Permit no.: r , y), l _ OOO S
A „ Cl of Ti ardA EC E I V E D Pro ect/a 1 no.: Expire date:
•: _„ � g J PP • P�
City ofTigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By` l Receiptno.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 FEB 1 207 Case file no.: Payment type:
Land use approval: CITY OF IRAd”
LJr_ 'Ilan ) : rail M
TYPE OF PERMIT
}C1 I & 2 family dwelling or accessory 0 Commercial/industrial ❑ Multi- family ❑ Tenant improvement
0 New construction ❑ Addition/alteration/replacement O Other: 0 Partial
JOB SITE INFORMATION
Job address: / I 4 5Lr- s T, pg,,I -1, 1 '7(. Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: I Block: Subdivision: f ; f j Project name: ...+,,,-. vv J Description a�d location of work on premises:
Estimated date of completion/inspection: , 4 4 L
. CONTRACTOR APPLICATI • N FEE SCIIEDULE
J V :-. •iv:
Fee Max
Business name: 5g_F Cie. c-÷ t.- i• G Description Qty. (ea j soon l no. insp
New residential - single or multi - family per
Address'
f e i 4-I P 0 5. P ei b — a I f P. L dwelling unit Includes attached garage.
City: /11 4, 1 ( rr o 5b3 State: Pg., ZIP: 4 d:
pc�-z_ Service include
Phone: 51)3-en — `+p4 j Fax: g'z l - $ -`f 7I E -mail: 1000 sq. ft. or less 4
CCB no.: '? ta7 C / I Elec. bus. lic. no: 3- t{' 8- + c__ Each additional 500 sq. ft. or portion thereof
, _Limited energy, residential 2
City /metro tier. no 1 e{ 7 Z Limited energy, non - residential 2
; ) / o Z Each manufactured home or modular dwelling
Signature of •upervisrng�lectric3tt (required) / / /// Date' Service and/or feeder 2
Sup. elect. name (print): , i7 /' A _ .... - r. . License no: ft. _ Services or feeders— installation,
alteration or relocation:
PROPERTY OWNER : 200 amps or less 2
Name (print): iCeCT S')YD 1/1•/1 • 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address: 1 1 Li r,"'LL $ u )_. T,,�rM Pz .ylZ r I. , 601 amps to 1000 amps 2
f I
City: 1 t i � I. Z , j Over 1000 amps or volts 2
Phone: l D7 � � State: ZIP: r7 ^ 0 / (o 7 I Fax: I E-mail: Reconnect onl 1
Owner installation: The installation is being made on property 1 own Temporary services or feeders -
which is not intended for sale, lease, rent, or exchange according to installation, slterat ion, 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 am s 2
Branch circuits - new, alteration,
or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: I State: • I ZIP: P.. Fee far branch ei coite witheut r_rc'3_ I
Phone: Fax: E - mail' of service or feeder fee, first branch circuit: I I 2
Each additional branch circuit: l I
PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included):
O Service over 225 amps - commercial 0 Health -care facility Each pump or irrigation circle 2
O Service over 320 amps - rating of 1&2 0 Hazardous location Each signor outline lighting 2
family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
O System over 600 volts nominal more residential units in one structure alteration, or extension` 2
O Building over three stories Cl Feeders, 400 amps or more *Description:
❑ Occupant load over 99 persons O Manufactured structures or RV park Each additional Inspection over the allowable in any of the above:
O Egress/lighung plan ❑ Other. Per inspection I I I I
Submit _ sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Permit fee $ CO- k- 5
Not all jurisdictions accept credit cants. please call Jurisdiction for more information Notice: This permit application Plan review (at %) $ 4r�
_
O Visa O MasterCard expires if a permit is not obtained sr
Credit card number: / I within 180 days after it has been State surcharge (8%) $ �, —
Expires TOTAL as complete. TOTAL i l�
Name of cardholder as shown on credit card
$
Cardholder signature Amount j v 440-4615 (6Vo/COM)
1 'd LirLS628EOS 3C -J'3al3 3x9 dBG :90 20 02 qa3
CITY OF TIGARD 24 -Hour •
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received 11 Date Requested 3 AM PM BUP
Location 1 / `t 5 ) W-1.41 l' Pt_ Suite MEC
Contact Person 7-.,e Ph ( ) '77/ 6 St PLM i ti( Contractor Ph ( ) SWR
BUILDING Tenant/Owner 7%J8 7; AM ELC 96 - 2- 66
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam 5
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear S
Framing
Insulation \NCLOIV c '
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
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
're Alarm
antil
SS PART FAIL 111 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
• SITE ❑ Please call for reinspection RE: 7 Unable to inspect — no access
Fire Supply Line
ADA Aor
Approach/Sidewalk Date , G ^ Z Insp or . __ Ext
Other:
Final DO NOT REMOVE this Inspection record from the jo s = ite.
PASS PART FAIL