Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2007 -00516
COMMUNITY DEVELOPMENT DATE ISSUED 7/26/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S114AB-02800
SITE ADDRESS: 09260 SW MILLEN DR ZONING: R -4.5
SUBDIVISION: KNEELAND ESTATES LOT : 015 JURISDICTION: TIG
PROJECT: CLARK
Project Description: (2) branch circuits for heat pump and condensate pump.
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: 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:
AMBER CLARK BOB'S ACTION ELECTRIC INC
9260 SW MILLEN DR 2700 NE BURTON ROAD #A
TIGARD, OR 97224 VANCOUVER, WA 98662
Phone: 503 - 708 -8953 Contact #: PRI 360- 254 -7200
FAX 360- 254 -8219
FEES
Description Date Amount Reg #: ELE 37 -431C
[ELPRMT] ELC Permit 7/26/2007 $53.50 LIC 53136
[TAX] 8% State Surcharge 7/26/2007 $4.28 SUP 43225
Total $57.78 REQUIRED ITEMS AND REPORTS
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 1.800.332.2344.
Issued By: Ads // Permittee Signature: # ) / I / a !
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 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
. . . . ..
' Electrical Permit Application .
. - - '. .., . ::-.. FOR OFFICE USE ONLY
,... . ,
City of Tigard RECEIV17,...; Received .m_ L .., i AO ..
Date/By. / 0 SL Permit No : L • 0
1 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 14 1 111 050114\ Date/B : Other Permit: HE Z „ _ , /4
Inspection Line: 503.639.4175
r 4 - 1 1._ L %-alloo -11., - Date Ready/By - - El -See Page 2 for - . .
Internet: www.ci.tigard.or.us Notified/IVIethod: IBMI Supplemental Information
el .,..- . - , -. , , .- ...-.,. -- -,,, .• . - . , _
-
E New construction E AddilTo ar eration/rep acement Please check all that apply
El Service over 225 amps, comm'l 0 Hazardous location
E Demolition El Other:
i ffo'&°t EService over 320 amps - rating OBuildng over 10,000 sq. ft.,
"- - 2. 1 1 C' : ' -' 'i'.l : ''' j--r- *-"Z . ''''':'I-`-' : - " l . '' ' tk:'f-ed'&i ; (';rd' ' I.R'aIC1 ' SfiZ -- ife'''.' . ''' ' '' .: ' '/;l, ";-"''..'- : '' - '''' ' ':'.;---;;- `‘: ' r of 1- and 2-family dwellings 4 or more new residential
nl- and 2 dwelling 0 Commercial/industrial E Accessory building l=l System over 600 volts nominal units in one structure
['Building over three stories EFeeders, 400 amps or more
El Multi E Master builder El Other:
['Occupant load over 99 persons ['Manufactured structures or
, 3wk 3 fi nNavix"' , .'" - --' . 13 ,, - ,,, z .- - , - ,, gtto. ,.0,
'030: 719N 0 Egress/lighting plan RV park
EHealth-care facility ['Other:
Job no.: 07 Job site address:
9260 SW Millen Dr. Submit 2 sets of plans with any of the above.
City/State/ZIP: Tigard, OR 97224 The above are not applicable to temporary construction service.
-j.":" 1-' : .. .
Suite/bldg./apt. no.: Project name:
Description Qty. Fee. Total **
Cross street/directions to job site: New residential single- or multi-family dwelling unit.
includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map/parcel no .
Limited energy, non-residential 75.00 2
4}"F.§...-,.:RI1 ,.„;; .. ,r:z0r4t.-;''* Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Heat pump & plug for condensate pump Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
ii
, . 2 .-, :s 201 amps 10 400 amps 106 85 2
160.60 2
Name: Amber Clark 601 amps to 1,000 amps 240.60 2
Address: 9260 SW Millen Dr. Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/Stae/ZM: Tigard, OR 97224 Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( 503 ) 708-8 9 5 3 Fax: ( ) ; 200 amps or less 66.85. - 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps - 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
4fitte17 iA'AI:14.';.;.*: A!'n*6, *i5Nia°14,1,4ptRSoNAk`,-. ,;!:_-'e.,:-A A. Fee for branch circuits with
service or feeder fee, each
6.65 2
Business name: branch circuit
B. Fee for branch circuits .
Contact name: without service or feeder fee 1 46.85 46.85 2
each branch circuit
Address:
Each add'l branch circuit 1 6.65 6.65 1 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) Fax: : ( ) -
Sign or outline lighting 53.40 2 .
E 'Signal circuit(s) or limited-
R:Vr-4-r244.41V-";!:a414;fil,01*W*10ik;-ge,4-,U,,str,.:-W11;plAi‘g:7,7,.n enli energy panel, alteration, or
extension. Describe: Page 2 2
Business name: Bob's Action Electric
Each additional inspection over allowable in any of the above
Address: 2700 NE Burton Rd. "A" Per inspection 62.50
City/State/ZIP: Vancouver, WA 98662 Investigation per hour (1 hr min) 62.50
- Industrial plant per hour 73.75
Phone: ( 360) 254-7200 Fax: ( 3 60 ) 254-8219
;'''IYi3OIV(. WkEITWOM. :'-'--, 7.
CCB Lie.: 53136. Electrical Lie.: 7 _ 1C Suprv. Lie : 4322S Subtotal 5 3 .5 0
.
Suprv. Electrician signature, require - _,-.1..c_____ Plan review (25% of permit fee)
' State surcharge (8% of permit fee) 4.28
Print name: Kevin Broselle Date: 7/20/07 TOTAL PERMIT FEE 57
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: * Fee methodology set by Tri-County Building Industry Service Board
** Number of inspections per permit allowed.
i \BuildIng \Permits \ELC-PermitApp.cloc 12/03 440-461ST(10/02/COM/WEB
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CITY OF TIGARD c
BUILDING DIVISION Ae PERMIT #: FL,C.-200 16
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1126,
Phone: (503) 639-4171 i Mqrp
Inspection Requests (24 Hit.): (503)-639=4175 m
INSPECTION WORKSHEET FOR DATE: 8/2212007 TIME: 7:01AM PAGE: *14
SITE ADDRESS: 09260 SW MILLEN DR CLASS OF WORK:
SUBDIVISION: KNEELAND ESTATES LOT #: 015 TYPE OF USE:
PROJECT NAME: CLARK
DESCRIPTION: (2) branch circuits for heat pump and condensate pump. •
OWNER: CLARK, AMBER PHONE #: 503-708-8953
CONTRACTOR: BOB'S ACTION ELECTRIC INC PHONE #: 360-254-7200
Inspection Request Scheduled For: Date: 8/22/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 054467-01 360-254-7200 Y km/
Corrections/Comments/Instructions:
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V i PASS PARTIAL APPROVAL El CANCEL I I NO ACCESS
l I FAIL fl CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
lo
Inspector: Date: 472-ial Phone #: (503) 718