Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2000 -00412
Alyt ji�^ DEVELOPMENT SERVICES DATE ISSUED: 7/24/00
� "" 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S 114AC -01000
SITE ADDRESS: 09080 SW WAVERLY DR
SUBDIVISION: WAVERLY ESTATES ZONING: R -12
BLOCK: LOT : 043 JURISDICTION: TIG
Project Description: Installation of one branch circuit for new a/c unit.
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:
JOHN CHANG GRF ELECTRIC
9080 SW WAVERLY DR 15460 SE PARADISE LN
TIGARD, OR 97224 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 DEB 7/24/00 $37.50 003902 Elect'l Final
5PCT DEB 7/24/00 $3.00 003902
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 ,1 OfLeI /' .r0 0,, ISSUED B •
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: Q ..- DATE:
LICENSE NO: (&5
Call 639 -4175 by 7:00pm for an inspection the next business day
07/19/2000 08:31 5038295747 GRF ELECTRIC _ _ PAGE 01
r,..
ClTV''OF TIGARD Electrical Permit Application Plan Che
13125 SW HALL BLVD. Recd By
TIGARD OR 97223 _ Date Rec'd - 7 /? .
Phone (503) 6394171, x304 / P Date to P.E.
Data to DST
Inspection (503) 639 -4175 Print of Type p zGCa -4, 02//s.2
Fax (503) 598 -1960 Incomplete or Illegible will not be accepted Called
•
•
1. Job Address: 4. ,Complete Fee Schedule Below: •
J
Name of Development dd I'1 kl ct it _ Number of Inspections par perrnit allowed
Name (or name of business) Service included: Items Cost Sum l
Address O g0 S (.t) ) i fGi I/ 'Art !.( D r, sa. Resldemial - per unit
City /State/Zlp Tr G ,L Q f2-- 9 7 2:12- 1000 sq. ft. or less $ 117.75 4
J �' Each additional 500 pi. R or
Commercial ❑ Re sldent1a p°^I thereof S 26.25 1
��l� \\\\\ i �,✓ '_ Limited Energy 5 80.00
Each Manufd Home or Modular
2a. Contractor Installation only: /VCS Dwelling Service or Feeder s 72.76 2
(Prior to permit Issuanoa, applicants must provide • rltractorr license 4b. Services or Feeders
Information for COT daft bee). I Installation, aeration, or relocation
Electrical Contractor '1'Y G 200 amps or less 5 84.26 2
Address 154 .5. a r s.4 ;se_ ti,.. 201 amps to 400 amps 5 85.50 2
401 amps to 600 amps 128,60 2
City Se �� � _ 5 te � 601 amps to 1000 amps S 192.50 2
Phone No. k2-el ` Y-rG FA K gZei ^ 5 7sq Over 1000 amps or wens $ 363.75 2
Job No. ' L Reconnect only _ $ 63.50 2
Elec. Cont. Lice. No. 3 - - g "T C. Exp.Date / 0 v 4c. Temporary services or Feeders
OR State CCB Rog. No. '1 to '7 Exp. )ate q z7 ! Installation, alteration. or relocation
COT Business Tax or Metro No. 72- Exp.Date 4/1/ 11.9 200 amps or less s 63.60 2
201 amps to 400 amps $ 80.26 2
Signature of Supr. Elec'n 401 amps to 800 amps t 107.00 2
Over 600 amps to 1000 volts, 1
see "b" above.
Ucense No. ss s Exp.Date I Cs^ () - 4d. Branch Circuit,
No. g "41 New, alteration or extension per panel
a) The fee for branch circuits
2b. For owner Installations: mai purchase of *wales or
feeder fee.
Print Owners Name Each branch drawn $ 5 -35 2
Address b) The fee for branch circuits
without punehast of wwlca ^`
City State Zp or feeder rye. Z 5 y
Phone No. First brandy circuit 1 S 37.50 ✓ '
Each additional branch circuit $ 5.35
The installation is being made on property I own which is not 4s.. Miscellaneous
intended for sate, lease or rent. (Service or feeder not included)
Each pump or irrigation circle 5 42.76
Owners Signature Each sign or outline lighting 8 42.75
Signal clrcult(s) or a limited energy
(if required):* e panel, alteration or extension S 60.00
3. Plan Review section
(. r q / Minor Labels (10) 5 107.00
Please check appropriate item and enter fee In section 5B. 4f. Each additional Inspection over
4 or more residential units in one structure Ow allowable In any of the above
Service and feeder 225 amp) or More Per inspection S 50.00
Per hour S 50.00
System over 800 volts nominal In Plant __- $ .-____ S 69.00
Classified area or structure containing sped hl occupancy as
described N N.E.C. Chapter 5 5. Fees: SV
6s. ter total of above fees $ 3 � -
" Submit 2 east of plans with application where any of the above apply. (r % Surcharge (.05 X total fees) S _ S .
Not required for temporary construction services. 0 Subtotal $
Ms. Enter 25% of tine 8e for .
NOTICE Plan Review if requited (Sec. 3) 5
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED Subfofa! / / $
IS NOT COMMENCED WITHIN 160 DAYS, OR IF CONSTRUCTION OR /0 / 51
WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS Trust Amount a l / �/°o
AT ANY TIME AFTER WORK IS COMMENCED. Tofu/ balance Due $ T 0 .
i•\dsts \forms \electric.doc 000 39 ---
CITY OF TIGARD BUILDING INSPECTION DIVISION • MST
244-lour Inspection Line: 639 -4175 Business Line: 639- 4171-
Date Requested -� AM PM BUP BLD
Location qo 8° S w 6.141 v.f - 17 P Y Suite MEC
Contact Person Ph 251 - 7e/ v 0 PLM
Contractor Ph SWR �/
BUILDING Tenant/Owner ELC c2.1.00 Ov �f / L
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
Drywall on /� r
Drywall Nailing !O
Firewall
Fire Sprinkler -
Fire Alarm
Susp'd Ceiling
Roof
X a 6 z
Misc:
Final
PASS PART FAIL
PLUMBING -
Post & Beam •
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In •
Gas Line -
Smoke Dampers
Final
PASS PART • FAIL
CTRL
" ice
Rough In
UG /Slab
Low Voltage 4 C.-
• Fire Alarm
agr RT FAIL
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 � e
Other Date f Ins a rg fir _ Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.