Permit CITY OF TIGARD ELECTRICAL PERMIT
• COMMUNITY DEVELOPMENT Permit#: ELC2013-00608
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/10/2013
.TIGARD 9 Parcel: 2S103CC01300
Jurisdiction: Tigard
Site address: 11925 SW GAARDE ST
Project: Funkhouser Subdivision: COLONIAL VIEW Lot: 8
Project Description: (3)branch circuits for(2)minisplits and outlet.
Contractor: GRF ELECTRIC Owner: FUNKHOUSER,JEFF&JUANITA
15460 S PARADISE LN 11925 SW GAARDE ST
MULINO, OR 97042 TIGARD, OR 97224
PHONE: 503-829-4146 PHONE: 503-352-9907
FAX: 503-829-5747
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo/Purchase 10/10/2013 $71.02
Specifics: Service or Feeder
1 ea 12%State Surcharge- 10/10/2013 $8.52
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $79.54
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. 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 the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OA 52- 90 You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. /
Issued By: • Permittee Signature: #" ,_p,G/C,�o" d
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' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
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.
Oct.09.2013 04 :15 GRF ELECTRICQ 5038295747 PAGE. 1/ 2
Electrical Permit AP_hlication9ECE �y I l t Ile It It t t ti1 ct.,.,Le City of Tigard I-�OCT 9 ' Re a %0 t0 /3 t f,-- Penult No•: eweis',o06ii,'
;71 i 4 13125 SW Hall Blvd.,Tigard,OR 97223 I 7 2 0 1 3 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Pc till:
t.i i,t Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: rte: la Sec Page 2 for
Internet: www.tigard-or.gov fltl I Nutifed/Mcthod: 7-7,;„6-••*"Supplemental
'I1fPE OF WORK—„ �..�' v PLAN REVIEW
❑New construction Addition/alteration/replacetnent Please check all that apply(submit 71 sets of plans w/items checked below):
❑Service or feeder 400 amps or more ❑Building ovor throe stories.
❑Demolition ❑Other:
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Plualitig buildings,
leis to ground,or exceeds 14,000 0 Commercinl-usc agricultural
l-and 2-family dwelling ❑ComtnerCiaUindustrial ❑Accessory building amps for all other installations. buildings.
❑Multi-faintly ❑Master builder ❑Other: ❑Fire pump. ❑installation of 7$KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived system.
❑addition of new motor load of ❑"A" "P""1.2"°1.3"
I Job no.: Job site address: ` f ( a 5 5(.Ai v I Six or or more. Recreational(/l ❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP! "� ❑Health-ore locations.ies. ❑Supply voltage fbr more titan•
1 ( �{ �� L'Z C} 00 wilts nominal.
J 4, . 6 ❑I ealth o r lcations
Suite/bldg./apt.no.: I Project name: I'..� N' h�,��i,.� ❑Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: oacriauoa I oey. I Pa, I Total I -
-'" New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lest no.: 1.000 sq.ft.or less 168.54 4
Ea.add'l 500 sq.R.or portion 33.92 1
Tax map/parcel no.: Limited energy,residential 67.84 2
DESCRIPTION OF WORK (with above sq.ft.)
/ Limited energy,multi-family 67.84 2
b� ' - '�J ' h / 1`r i residential with above sy.R.)
trMr! 5 1 I r s 111 �,/ Services or feeders installation=alteratioo,and/or relocation
0 e„1 ti t°.,.-r 200 amps or leas 100,70 2
Ll PROPERTY OWNER 0 TENANT 201 amps to 400 amps 133.56 2
J 1- 401 amps to 600 amps 200,34 2
Name: +r 1---L, N CL_ {j 601 amps to 1,000 amps 301.04 ' 2
Address: 1 1 c - g S( , (04 CA V- J Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
City/State/ZIP: "r• li/I�'1� G) 1 L 2- ' ' relocation
Phone:( 5,2-g /5-j/ .-C.) U 7 Fix:( ) 200 amps or less 59.36 I-
201 amps to 400 amps 125.08 2
Owner installation:This installation is being made on property that I own which is not 401 amps to 599 amps 168.5 166.54 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. Branch circuits-new,alteration,or extension,per panel
Owner signature: Date: A.Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON service or feeder fee, 7.42 2
each branch circuit
Business name: 13.Fee for branch circuits without
�--- service or feeder fee,first I 56,18 to,I. 2
Contact name: branch circuit C-
Each add'I branch circuit �, 7.42 hill',�r..l
Address: Miscellaneous(service or feeder not included) f
City/State/Z1 ley/State/%I P: Each manufactured or modular 67.84 2
dwelling service and/or feeder
Phone:( )
Fax: :( ) Reconnect only 67,84 2
Pump or irrigation circle 67.84 2
E-mail:
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuits)or limited-energy
Business ntunc: r g • g - tenet,h additional inspection extension. Page 2 - 2
peetion over allowable In any of the above
Address: I S t H`v $ `, i, J Q I 4 Additional inspection(I hr min) 6(1,25/hr
City/State/ZIP: K N
Investigation(1 hr min) 66.25/hr
J r 1 Lit 1 1 Yi G , Qrt- ei 1 0` -L. Industrial plant(I hr min) 78.18/hr
Phone:(t lj) 0 L� - ( -1�I. _ Fax:(- --7 Inspections for which no fee is 90.00/hr
�y specifically listed('4 hr min)
CCFI Lie.: 1 Lei 5 1 Electrical Lic.: 3-414.G Suprv.Lie.: 1 to 5-5-5 ELECTRICAL PERMIT FEES--
Suprv.Electrician signature,required:�`- .�C \ Plan review(25%of pemSuibt
t tu x
Print name: Date: l ' State surcharge(12%of permit fee): ( (,
1 1 /.{ S yy,.'1"1�. / a l I TOTAL PERMIT FEE:`--)G, i A'-1
AUlhUriikd signature: This permit application expires If a permit Is not obtained/elide 180
name: Date: days after it has been accepted as complete.
Print name: Number of inspections allowed per permit.