Permit .,CITY OF TIGARD ELECTRICAL PERMIT
•
PERMIT #: ELC2003 -00114
k �l 1l . DEVELOPMENT - SERVICES DATE ISSUED: 3/7/03
---' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S 103DB -06300
SITE ADDRESS: 11345 SW AMBIANCE PL
SUBDIVISION: GENESIS NO. 2 ZONING: R-4.5
BLOCK: LOT : 023 JURISDICTION: TIG
Project Description: Install 2 branch circuits for furnace and AC.
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: k"
401 - 600 amp: EA ADD'L BRNCH CIRC: 1 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:
SCHWAB, JOHN E + BOB'S ACTION ELECTRIC INC
BRINK - SCHWAB, K R 2700 NE BURTON ROAD
11345 SW AMBIANCE STE A
TIGARD, OR 97223 VANCOUVER, WA 98662
Phone: Phone: 360 - 254 -7200
Reg #: SUP 4322S
LIC 53136
FEES ELE 37 -431C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 3/7/03 $53.50
[TAX] 8% State Tax 3/7/03 $4.28 Rough -
Elect'l Final
Total $57.78
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 -0100. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -6699 or 1 -800 -3• • -23 _
Issued By: ; �� / 1 S � � . � � � Permit Signature: / • S r�
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
^..06/27/01 , WED 14:44 FAX 503 598 1960 CITY OF 'I'IGARD (lu0
� ; � � / �� n C , 8V®
YV rf/�lc -. .
Electrical Permit Applicatio
�ci i y pate�cccived: j� ,_ permit nn. €_ �
City of Tigard r► `�`� I rl "}
a 3' NI.NG /EN lift/ -in.Va i1;1 Expire date:
City n/7i,t and Address: 13125 SW 1-(all Blvd Ti OR 97223 Date issued : 1-3 Receipt no.:
Phone: (503) 639 -
Fax: (503) 598 - 1960 Case flit no. Payment type:
Land use approval:
' TYPE On PERMIT .
El I & 2 family dwelling or accessory ❑ Commr rcial /industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction O Additicn/alteratiou/replacement 0 (filler: 0 Partial
JOB SITE INFORMATION . •
Job address: 11345 SW Ambiance Pl . , Tigard Bldg. no.: Suite no.: Tax map /tax loUaccount no.:
Lot: Block: Subdivision:
Project name: Descril:tiou and location of work on premises: 2 circuits for furnace & A/C
Estimated date of completion/inspection:
• CONTRACTOI1 APPLiCATIO '' - • FEE SCiIEDULE . •
Job no: 03 - 194 Fee Max
Business name: Bob' s Action Electric
Description Qty. (en.) Total no.Insp
New residential - single or multi - family per
Address: 2700 NE Burton Rd. ''A" dtretlingtmlf . Includes attached garage. •
City: Vancouver State: WA 2•0': 98662 Serviceinclude.d:
•
Plrone. Fax: E -mail sq. t. ur l ess 4
3 60 - 254 -7 200 254 -8219 1000 I
__
531 36 Elec. bus. tic. no: 37 -431 C Each additional 500 sq. ft. or portion thereof
CCB no.:
Limited energy, residential 2
City/metro lie. 10. : Q 003861 Limited energy, non- residential 2
\ / 2/27/03 Each manufactured home or modular dwelling
Signature of supervising electrician (required Date Service arrdlor feeder 2
Sup. elect. name (print): Kevin Broselle Li :ease no: 4322S .Services or-feeders—installation,
alteration or relocation:
• PROPERTY OWNER 200 amps or less 2
Name (print): Jack Schwab 201 amps to 400 snips . 2
401 amps to 600 amps _ 2 • Mailing address: 11345 SW Ambiance P1. 601
amps to 1000 amps 2
City:. ; Tigard ,., State: -OR ' ; :IP: -97223 • -Over 1000 rumps or volts - . 2
Phone: 624- 6199 , Fax: .-1 I.E- mail :. • • , . .12econnccrol4 : • • . . , • -' I. r • •• • ,
Owner' installation: The installation is being made on property i own •i'emparitryscrvlcesor feeders -
which is not intended for sale, lease, rent, or exchanre•accordin; to installnllon ,alteratton,nrrelocritiou:
ORS 447:4155, 479, 670, 701. -• .. . 200 amps or less. . . . . 2
201 strips to 400 amps _
Owner's signature: .. . . Date: 401 to,600amps 2
ENGINEER 11111111.11111 Branch circuits - new, alteration,
or extension per panel: '
Name: A. Fee for brunch circuits with purchase. of
Address: service or feeder fee, each branch circuit 1 46.E5 2
City: State: I .UP: B. Fee for branch circuits without purchase
' of service or feeder fee, first branch circuit: 1 6 . E 5 2
Phone: Fax: E Each additional branch circuit:
'' PLAN REVIEW (Please check all tilt apply) • Misc. (Service. or feeder not Included):
0 Service over 225 anps•commcrcial 0 Health•enrefacili Each pump or irrigation circle 2
0 Service over 320 umps•rating of I &2 0 I- aza,dous location Each sign or outline.lightiug 2
family cIwellings U lluilditrg over tO (tOt) square feet tour or Signal circuits) or a limited energy panel.
O System over 600 volts nominal ' more residential' nuts in one structure : alteration, or extension* t 2
.0 Building over three Stories : U Feeders. 400amps or more °Description: _ •
U Occupant load over 99 persons • 0 Manufactured sir uctures on tiv p in k , Each additional inspection over the allowable In :my of the above:
O Egresslligihtingplai ❑Other: pet inspection I
Submit sets of plans nitli any of thti above. . Investigation fee
The above arc not applicable to I emporary construction service. Other
4 Nor all jurisdictions accept credit cards, please call jurisdiction for more iu ormatinu. Notice: This permit application
Permit fee '1; 53.50
❑ Visa 0 MasterCard expires if a permit is not obtained' Plan review (at %) s
credit card number: _ . _ _ / / within 180 days after it has been State surcharge (8%) .... $ 4.28 _
Ex "ref TOTAL $ 57.78
accepted as complete.
Name of cardholder as shown on credit clad
$
-_ -_-
Cardholder signalise An oust f rot -4615 (6 /Solt.'' )r.t)
CITY OF TIGARD 24 -Hour
BUILDING ' Inspection Line: (503) 639 -4175
INSPECTION DIVISION .' �, Business Line: (503) 639 -4171 MST
BUP
Received Date Requested /? PP' PM BUP
Location / 1 .3 cis P_ Suite MEC
Contact Person C,A Q Ph ( 36,0) c9-54- 7a bcD PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC 3 - 06 // lIt
Footing
Foundation ELC
Access: ELR
Ftg Crawl Drain 0 r F 3 ' Iv 1 �,d b
Cr Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation N Ntv P, L.
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
R
14
ough -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
Fire Alarm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
' PART FAIL
SITE ❑ Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA / 6 c5
Approach /Sidewalk Date 3 U 3 Inspector / Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL