Permit r... CITY,.OF
TIGARD ELECTRICAL PERMIT
r , PERMIT #: ELC2004 -00261
I n DEVELOPMENT SERVICES DATE ISSUED: 5/14/2004
�� I � 13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171
PARCEL: 1 S133AD -13800
SITE ADDRESS: 12687 SW SORREL DOCK CT
SUBDIVISION: SUMMER LAKE ZONING: R -7
BLOCK: LOT : 019 JURISDICTION: TIG
Project Description: . ,1 branch circuit for 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:
401 - 600 amp: EA ADD'L BRNCH CIRC: 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:
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BAITINGER, GEORGE F + LOIS M BOB'S ACTION ELECTRIC INC
12687 SW SORREL DOCK CT 2700 NE BURTON ROAD
TIGARD, OR 97223 STE A
VANCOUVER, WA 98662
Phone: 503- 524 -8587 Phone: 360 - 254 -7200
Reg #: SUP 4322S
LIC 53136
FEES ELE 37 -431C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 5/14/2004 $46.85
[TAX] 8% State Surcharge 5/14/2004 $3.75 Rough -in
Elect'I Final
Total $50.60
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 2- 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 . -2344.
Issued By: GO �jlf.L Permit Signature: ( 7') alp"(( 1(
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
c r
o6i�/ol. WED 14:44 ,FAX ;03 598 1960 CITY OF 'rJC(viu [ap(,2
Electrical Permit Applicat
T Dale re �/ _ � ..
A City of J11�i1I�(� `, ProjecUappl.I .: Gxpirctlatc:
City ofTi,r;a(.d Address: 13125 SW Hall : :�t 9 Date issued: B) Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 MAN 1 .6 2004 Case file no.: Payment type:
Land use approval: Y �F IteARD �I�
TYPE OF PERMIT ,
. f2§ 1 & 2 family dwelling or accessory ❑ Comm( rcialuldustrial 0 Multi- family ❑ Tenant improvement
❑ New construction ❑ Addilicn /altcrat.iou/replacement 0 Other: 0 Partial
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JOIl SITE INFORMATION
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Job address: 12687 Sorrel Dock Ct. Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: Block: Subdivision:
Project name: . I Description and location of work on premises: A/C connection
Estimated date of con letion/inspection:
CONTRACTOR APPLICATIO \ ,, FEE SCHEDULE
Job no: 04 -433 Fee Max
Business nante: Bob's Action Electric Description Qty. (ea.) Total no. Map
New residential - single or multi-family per
Address: 2700 NE Burton Rd. "A" dwellhngnnft. Includes ntachedpine. •
City: Vancouver 'State: WA 2.LP: 98662 Senicclucltrdr.d:
Phone360- 2 54- 7200IFax :254- 82191E-mail: woo sq.ti. Urless •1 _—
5 3136 Each additional 500 sq. ft. or portion thereof
Elec. bus. lic. no: 37 -431 C
CCB no.:
Limited energy, residential 2
City/me o `c. no.: AC1003861 Lintitedenergy, ion- residential 2
/�� _ 5/11/04 Each manufactured home or modulo' dwelling
Signature of supervising electrician (required) Date Service and/or feeder 2
Sup. elect. utante (print): Kevin Broselle Li :ease no: 4322S Services arfccllers- Install :lllnlh,
tilleration or relocation:
PROPERTY OWNER . . 200 amps or less • 2
Name (print): Lois & George Baitinger 201 amps to400amps 2
401 amps to 600 amps 2
Mailing address: 12687 Sorrel Dock Ct. 601 amps to 100U amps 2
City: Tigard JState:OR I : ;EP: 97223 Over 1000 amps or volts 2
Phone: 524 -8587 I Fax: I E-mail: Reconnect only 1
Owner installation: The installation is being inade•on property I own Temporary services or feeders - -
which is not intended for sale, lease, rent, or exch:unre according to
200 amps or less 2
installndon,nueratIon , orrelocation:
ORS 447, 455, 479. 670, 701. - • according
201 amps to 400 amps -
Owner's signature: Dade: 401 to 600 amps 2
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ENGINEER Branch circuits - new, alteration,
or extension per pnttcl:
Name.: • A. Fee for branch circuits with purchase of
Address: service or feeder fee., each branch circuit 2
City: I State: I .?,lP: 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:
PLAN REVIEW (Please elleck.all MI apply) • Misc. (Service or feeder not included):
O Service over 225 traps- commercial 0 Health-cure facility Each pump or irrigation circle 2
O Service over 320 amps-rating of I &2 0 Hazardous locatimm Each sign or outline lighting 2
family dwellings U Building over 10 UUO square feet four or Signal s.ircuit(s) or a limited energy pancl.
O System over 600 volts nominal more residential •units in one structure alteration, or extensions 2
.0 Building over Ihi centuries 0 Feeders. 400 aunt's or mote 'Description: -
O Occupant load over 99 persons 0 tulanufactured sit uctures or RV punk Each nddlllnnal inspection over the allowable in any of the above:
0 GttresaJlightingplmt 0 Other: Per inspection F--7---T
.. Subunit , sets of with any of flu: above. . Investigation fee .
The above are not applicable to temporary construction service. Other .
'Nut all jurisdictions accept credit cards, please call jurisdiction for more in brmatioo. Notice: This permit application Permit fee 46.85
0 Visa 0 MasterCard expires if a permit is not obtained' Plan review (at _ To) 4 _•_
Credit card number: _ _ / . / within 180 days after it has been State surcharge (8%) .... 9i 3.75 _
Ex lives accepted as complete. TOTAL $ 50.60
Name of cardholder as shown on credit c•md
$
` Cardholder signature A \rrouut 140.4615 (C!U(VCr)AI)