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Permit CITY OF TIGARD ELECTRICAL PERMIT • COMMUNITY DEVELOPMENT Permit #: ELC2012 -00527 T t GA R D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/13/2012 Parcel: 2S114BA16200 Jurisdiction: Tigard Site address: 16225 SW COPPER CREEK DR Project: Martin Subdivision: COPPER CREEK STAGE 4 Lot: 127 Project Description: Reconnect only Contractor: JACOBS HEATING & AIR CONDITIONING Owner: MARTIN, JOHN R JR & JEAN C 4474 SE MILWAUKIE 16225 SW COPPER CREEK DR PORTLAND, OR 97202 TIGARD, OR 97224 PHONE: 503 - 234 -7331 PHONE: 817 - 913 9990 FAX: 503 - 808 -9108 FEES Quantity Description Date Amount 1 ea Reconnect Only 09/13/2012 $67.84 Specifics: 1 ea 12% State Surcharge - 09/13/2012 $8.14 Electrical Type of Use: SF Class of Work: ALT Type of Const: Occupancy Grp: Total $75.98 Required Items and Reports (Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. 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 the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.19887 or 1.800.332.2344. 1 Issued By: � �CLf�1 Permittee Signature: DJ A Pitt 6,0 T kJ 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' Date: LICENSE NO. Call 503.639.4175 by 7:00 a.m, for the next available Inspection date. 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 Pgrmit Aaplicatior e i vE I111.;III 1 il,rr., ;i, la City of Tigard rvo: / 13121 5w 1611 B1vd.,15�rd, OR 97223 S E P 1 3 2012 , EL, e... 010'. -00,,? k- Phone 903.716.2499 Pmt: 503.5981960 Wm Permit .. 1,., ,I:I InspeeaonUnc: 503.639.4173 ! 1 1.11` n� i i'bLD Mato _ net• vfww.r d .s0v ro 1 err t -. . a' B • l ■ ::: �'. : .. ; y. - ' ar 'r' its - Planet: Et New 1a1 : m' 1 ' i n ., elault o3lb jsenorpl whims - ,.. • . , Wilms D ser,llco m foxier 400 mope or mare 13 Builders over throe txor m D Demolition Q Other: w , where the amiable f corm Minim and btaa lards. . : :.' armed{ 1000 amps sr 130 oohs err Cl Fltntia botldip L77- and Zanily dwelling Q Q , building uar re m ant or exceeds 14,000 O c . aorie►daml lar D Muld4niily Q Master builder ❑ Other. OFD as • - . . O D maltim of7S KVA m Jab lro. ./� I V � O Addibpa of Yew mm mr lol al 0. .. " « 1 3 Job site address: I (4 � LL / ,,� (. vL I ODtat m pro`. oowpmey. • City/St 1P:��% lz Q "`" � Pe- p , � ' a which parks i 1 f ter mare than SuiteJbldg /a uo.: Dtawedoos mom,,, 600 writs imo a — Project name: Ciao/vial or kola 600 sofas at mare Cross straeddirectiotts to job sec ',�'`'' "� :,:. ', Werke ariedidi Ca , 1 Subdivision: Lot no.; 1,000 so. It. or less r 160.54 �� Ea. @dell 500 ... fL or portion • Tax map►parccl no.: • .. e •.. . .. Jo r' ., "" :L e _' : I:i - ay. '`M .. J' • _ /.:L i 13 r t t C 1 �,: .. i 75.00 c___ residential with Mows . R. - Services or letekto bialallo ... . antra ..., , wolf or relocation MO amp or ker II 100.70 2 Address: 1 1.0 ��5 `, 1.000 r 301.06 p City/State/ZIP: ' �, Q C•� � r moans d P ltonc: (��) C t �� � q - L7 Fax: ��� � , �q r ( ) = bra alafa Owner installation: This installation is being m ade.on ' ittetauhd for sale, lease, > or t3 ORS that I own which is aw e 401 amp re 599 amps I= 161 14 2 xchange, according to ORS 447, 449, 670, and 401. Owner siguuzur Dam: ..7777.:7 77-7177:At ..,.. Iligg 7.42 Bulb= name: B. A Con J t � act ,. mime: _ - - 1 e Each odd'l branch dumb r l© Cipr/S1atealP: •: Phase: ( ) i Fax:: ( ) � E-mail: as t o 67.84 � Sign ei °Wino liglibay ll 67.84 `{ ' `` .... Vaal ! mugs) of 1mYbd•urtry 16 BusineSs "Me: z••�'L o hS a 0x•1+1 # 'IA cl; C C- onaZ'Fa Ott tilq Pe tel. nllesetlum n . . m "Inma Fach addhigpall . , on ovw allotw6le iD of rite shore Addrost: 6 7 Lf St. )1 ; i atn.04.. y s,v . ..1 laveshpuon II broad 66.2Si hr cny!stacvZaP: ?err+! ( o `17a•01 _ now' ( Z13) 43 Si -733 Fax: (So3) $O$ !Oki Lie.: i t, U eleariad Ldc.: tO pas, 704e..., LLp III 0040111 �� COB 1 T71 � aLio � $a .LIe.: f�F �iY'i�,^!�T�i " .3': Snlay. Electrician signature. required; - ' 1 C�^• Subtotal: f C _. Men review (25% of peal Roh Print same: e. O Li Dm 4 j r! 0.. $IM (12% ofpermit Ike): lg I Authorized signature: TOTAL PERMIT FEE: "1 • Thu pencil opd endues b ta kra fn a permit b sot ... .. - • *bin tac Prim z ; $ r; s n I j Da ctrl I I I I 1 a Nembm of d oiler u has bseo scraped es aoa�ds • karmic= dbwd per paanit. twerasavamierELGPeadarpore 07101/10 46461srtlYAOtlpplr►0/ea t00/00 39dd G9Z6EZ8E09 95 :GZ ZZOZ /ZZ /60 Location: Record Type: Inspection Type: Comments: Inspection Date: Record ID: Result: City of Tigard 13125 SW Hal Blvd. Tigard, OR 97223 Tel: 503.718.2439 16225 SW COPPER CREEK DR, TIGARD, OR, 97224 Residential - Electrical 199 Electrical final 02/28/2013 00:00 ELC2012-00527 PASS - No C of O Violation Summary: Inspector Contractor