Permit A. CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00321
..,.i� DEVELOPMENT SERVICES DATE ISSUED: 6/8/2004
rlll 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 PARCEL: 1S136CD -00101
SITE ADDRESS: 11675 SW PACIFIC HWY
SUBDIVISION: ZONING. C -G
BLOCK: LOT : JURISDICTION: TIG
Project Description: Job No 04 -491 Roof top HVAC
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:
MILLAR, TED LTRUSTEE BOB'S ACTION ELECTRIC INC
BY WILLIAM C FLOBERG 2700 NE BURTON ROAD
834 SW ST CLAIR STE A
PORTLAND, OR 97205 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 6/8/2004 $60.15
[TAX] 8% State Surcharge 6/8/2004 $4.81 Ceiling Cover
Wall Cover
Total $64.96 Elect'I Final
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: Permit Signature:
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
•• 06/2'`7/01 WED 14:44 FAX 503 598 1960 CITY OF TIGARI) VI0(12
j
.. • fZ. oo -.4
A 11 Electrical Permit Application
T Date received: Pcr nil nn.
CIE of Tigard s`ll�� Fro ecUa i I. nu.: Expire date:
y F� C1VED _ I I I
Cis nj Ti ,lcad Address: 13125 SW Hall Blvd Ualeissued: B): Receipt no.:
Phone: (503) 639 -
Fax: (503) 598 -1960 JUN UN ' 2004 Case file no.: Payment type:
Land use approval: v PUG vW / VZ °134: g P
e a
.. - - -- = -- - - - -- -- . -- - -- ___.. -_,.. i _ _ - T_Y..01?_PERMI'r...
J I & 2 family dwelling or accessory 0 Comm( rcial/uldustrial 0 Multi- family 0 Tenant improvement
0 New constntction 0 Additicn/alteratiou/•eplacement 0 Other: 0 Partial
JOB SITE INFORMATION
Job address: 11675 SW Pacific Hwy. Bldg. no.: Suite no.: Tai map/tax lot/account Ito.:
—
Lot: Block: Subdivision:
Project name: 1Descril:tiou and location of work on premises: Rooftop HVAC
Estimated date of corn rletion/inspection:
CONTRACTOR APPLICATIO ''-`'' FEE SCIIEDIILE
Job no: 04 -491 lee Max
Business name: Bob' s Action Electric Description Qty. (ea.) Total no. lisp
2700 NE Burton Rd. "A" Ncsrresidential - singleormnlli- fantilyper
,
Address: dnelthrgnnU. Includes attached garage. •
City: Vancouver 'State: WA l•1P: 98662 Seniceltscluded:
Phoite360- 254 -7 200 Fax: 254-82191E-mail: 1000 ft. orless 4 --
CCB no.;
53136 j Elec. bus. lie. n o: 37-431C Each additional 500 sq. ft. or portion thereof
_ Limited energy, residential 2
City /me o ' •. no.: 0003861 Limitedeneigy,non- residential 2
�,...." —.....e 5/28/04 Each manufactured home or modular dwelling
Sign store of supervising electrician (required) Date Service and /or feeder 2
Sup. elect. name (print): Kevin Broselle Li:enseno: 4322S Senicesorfceules— Inslnllallan,
alteration or relocation:
PROPERTY OWNER 200 amps or less 2
Name (print): West Coast Bank 201 amps to400amps 2
Mailing address: 11675 SW Pacific Hwy 401 a,pstoGOOamps 2
601 amps to 1000 amps 2
City: Tigard 1State: %,IP: 97223 over 1000 amps or volts 2
Phone: 539 - 5484 I Fax: 1 E -mail: _ ttecouncuonly � I
Owner installation: The installation is being made on property I own 't'empararyservlcesorfeeders -
which is not intended for sale, lease, rent, or exch;u)ce according to installation, alteration, orrelocation:
ORS 447, 455, 479, 670, 701. -- according 200 snips or less 2
201 ;nips to 400 amps _
Owner's signature: D:tte: 401 to 600 snips j 2
ENGINEER Branch circuits - new, alteration,
or extension per panel:
Name.: A. Fee for branch circuits with purchase of
Address: service or feeder fee., each branch cbcuit 2
City: 1 State: 1 .,fP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: 1 46.85 2
Phone: Fax: E -mail
Each additional branch circuit: 2 6.65
PLAN REVIEW (Please check all tits apply) • Misc . (Service or feeder not included): '
0 Service over 225 apps- corumercial 0 Health-care facility Each pump or litigation circle 2
O Service over 320 urnps- rating of I &2 0 liaearddus location Each sit' or outline lighting 2
family dwellings 0 Building over 10 000 square feet four or Signal cireuit(s) or a limited energy panel.
O System over 600 volts nominal more residential inks in one structure alteration, or extension. 2
.0 Building over three stories 0 Feeders. 400 aim is or more *Description:
O Occupant load over 99 persons 0 Manufactured souctures or kV pail; Each additional inspection over the allowable hi guy of the above:
0 Egress/lightingplan 0 Other: Per inspection I I l
Subunit sets of plans with any of ( above. . Investigation fee
The above are not applicable to temporary construction service. Other
Nur all jurisdictions accept credit cards, please call jtuisdiction for more Ill brtnatioo. Notice: This permit application
Permit fee $ 60.15
0 visa 0 MasterCard expires ifs permit is not obtained' Plan review (at _ %) $
Credit card number _ _ I / within 180 dnys after it has been Slate surcharge (8%) .... $ 4.81 _
Ex tires accepted as complete. TOTAL $ 64.96
Name of cardholder as shown on credit rind
$ _
Cardholder signature Au ouur , .1.10.1615 W)0 /:MO
CITY OF TIGARD 24 -Hour
BUILDING Inspection Lien: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
/
Received Date Requested _ C ' --a a AM PM BUP
Location / I . 7 s / � L -G , _ Suite MEC
Contact Person (4A Ph (3') aS d PLM
Contractor I Ph ( ) SWR
BUILDING Tenant/Owner c,L -� ELC o7 4 0 3.
Footing ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: A SIT
Post & Beam Q`C�/1
zi
Shear Anchors �, O O ((/� /
Ext Sheath/Shear �1�
Int Sheath/Shear / e—iet7
Framing
Insulation
Drywall Nailing
Firewall fl-PP 6� Ft nt/e'(r
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof (TThT Vet i?/�- 1/11G� Neroks (AI/TP/ etrr v &
Other:
Final B N R6x 0 � 0 r/16/ZS)
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
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
PART FAIL 111 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA / (,! Ext
Approach/Sidewalk Dat �Z v V Inspector l�
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL