Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2002 -00310
I DEVELOPMENT SERVICES DATE ISSUED: 7/11/02
- 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
PARCEL: 2 S 103 BA -00129
SITE ADDRESS: 12085 SW 116TH AVE
SUBDIVISION: LERON HEIGHTS NO. 2 ZONING: R -4.5
BLOCK: LOT : 043 JURISDICTION: TIG
Project Description: Install 3 branch circuits for A/C and 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: 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:
DUTTON, DELOS M MARLENE BOB'S ACTION ELECTRIC INC
12085 SW 116TH AVE 2700 NE BURTON ROAD
TIGARD, OR 97223 STE A
VANCOUVER, WA 98662
Phone: 503 - 590 -3506 Phone: 360- 254 -7200
Reg #: SUP 4322S
LIC 00053136
ELE 37 -431C
FEES Required Inspections
Type By Date Amount Receipt Rough -in
PRMT CTR 7/11/02 $60.15 2720020000( Wall Cover
Elect'I Final
5PCT CTR 7/11/02 $4.81 2720020000(
Total $64.96
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Spedalty 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: C't A ).fr ) 11041 - 1 Issued By: 4 4 11 ....ef.4 _ 0L
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. ELE CN: dY ( DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
06/2(/01 WED 14,:44 FAX 503 598 196 CITY C OF 11 6181) ca 002 •
Electrical • Permit
Application
���� / ' � Date received : — iU —p Z Permit nn.• a.Fj -03/
,r li City of Tigard R �` , 223 D Project/appl. no.: Expire date:
Address: 13125 S W Hall lv tart , 7 Date issued: 13)/23/3 l:ecei ,t no.:
City r, Tigard 1
Phone: (503) 639 -4171
-
Fax: (503) 598 -1960 • JUL 9 2002 Case file no.: Payment type:
Land use approval: CH Y OF IiUAKL)
It Ilk III I 4.1 .
TYPE OF PERMIT
11 i & 2 family dwelling or accessory ❑ Comm( trial/industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction ❑ Additicn/alteration/i•eplacement ❑ Other: 0 Partial
,t011 SITE INFOiLMATION
Job address: 12085 SW 116th Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: Block: Subdivision:
Project name: I Descril:tiou and location of work on premises; 3 circuits for A/C & furnace
Estimated date of cons. letion/inspection:
CONTRACTOR APPLICATIO s `- - •'" s 'N FEE SCiIEDI LE
Job no: 02 -596 Fee Max.
Business name: Bob' s Action Electric Description Qty. (en.) Total no. Imp
New residential - single or multi - family per
Address: 2700 NE Burton Rd. "A" dwelling unit. Includes attached gat -age.
City: Vancouver State:WA 2•I-F: Service included:
1110 =360-254 - 7 200 Fax: 2 4 -8219 E -mail: 100059 ft. or less ,t --
37 -431 C Each additional 500 sq. ft. or portion thereof
53136
CCB no.: Elec. bus. lic. no: Limited energy, residential 2
City /metro 1' ..
no 003861 _ Limited energy, non-residential 2
7/8/09 Each manufactured home or modular dwelling
Signature of supervising electrician (re(' _ ' Date Service and /or feeder 2
Sup. elect. name (prinQ: Kevin Broselle Li :enge no: 4322S
Services or feeders—Installation,
aherallou or relocation:
PROPERTY OWNER 200 amps or less 2
Name (print): Marlene Dutton 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address: 12085 SW 116th 601 amps to 1000 amps 2
City: Tigard State:OR :' 97223 over 1000 amps or volts 2
Phone: 590 -3506 Fax: E -mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary servicccor feeders -
which is not intended for sale, lease, rent, or exchanfe according to installation, alteratlan,urrelocation:
200 amps or less 2
ORS 447, 455, 479, 670, 701. -• I
201 turps to 400 amps _
Owner's si nature: Date: 401 to 600 imps
IIIIIIIIIIIIII circuits - new, alteration.
or extension per panel:
Name: A. Fee for branch c with purchase of
Address: service or feeder fee, each branch circuit 2
City: State: .71P: B. Fee for branch circuits without purchase
h' of service or feeder fee, first branch circuit: 1 46. 8_ c 2
Phone: Fax: E-mail Each additional branch circuit: 2 6.65 .3.3C
PLAN REVIEW (Please cheek all Hu apply) • Misc. (Service or feeder not Included):
O Service over 225 amps-commercial 0 ire :lth- care faciliry Each pump or iniguf ion circle 2 •
O Service over 320 imps- rating of I&2 0 Hazardouslocati,m Each sign or outline lightiog 2
family dwellings U Building over 10 000 square feet four or Signal circuits) or a limited energy panel.
O System over 600 volts nominal more residential mirs in one structure alteration, or extension* 2
D Building over three stories Cl Feeders, 400 amps ormore *Description:
O Occupant oad over99 persons 0 Manufactured sit mores or RV park Each additional inspection over the allowable In any of the above:
O Egress /lighting plan 0 Other: Per inspection i I I
Submit sets of plans with any of Ilya above. . Investigation fee
The above are not applicable to temporary construction service. Other
'No, all Jurisdictions accept credit cards, please call jurisdiction for more iuonmaiw. Notice: This permit application
Permit fee $ 60.15
ns
O Visa ❑ MasterCard expires i a permit is not obtained Plan review (at _ To) $
• 81
Credit card number: _
_ / / within l80 days after it has been State surcharge (8%) ... 9i _
Cx tires accepted as complete. TOTAL $ 64.96
Name of cardholder as shown on credit raid
$ _
Cardholder signatiu Art Oatll ■ s- 4o•4(i15 (6B0VCt)Ar)
CITY OF TIGARD 24 -Hour
BUILDING - � Inspection Line: (503) 639 -4175 w
MST
INSPECTION DIVISION Business Line: (503) 639 -4171
-7 BUP
Received Date Requested // . ' AM PM BUP
Location / o $-S / l f Suite MEC
Contact Person Ph ( :366 ) , • 7o- as PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC p 3 ) e
Footing (5 3,5
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: —%rye tJ , SIT Ira.
Post & Beam / l�
Shear Anchors f
Ext Sheath/Shear /� 15
`
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof \S\kA) 1 S S b
Other: 1
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
Po� ugh -In'
Gas Line
Smoke Dampers
`Vi_ PART FAIL
EL TRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fir Alarm
PASS PART FAIL El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE ri Please call for reinspection RE: ❑ Unable to inspect - no access
Fire Supply Line
ADA
Approach/Sidewalk Date ,7 � �' Inspecto ' / ' — Ext
Other:
Final DO NOT REMOVE this inspection record from th = ob site.
PASS PART FAIL
•