Permit A. CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00841
DEVELOPMENT SERVICES DATE ISSUED: 10/28/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 - 4171
PARCEL: 2 S 104AA -06200
SITE ADDRESS: 12735 SW WILLS PL ZONING: R -4.5
SUBDIVISION: BELLWOOD NO. 2 LOT : 083 JURISDICTION: TIG
Project Description: 1 branch circuit.
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: 0 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:
TRINA JEPPSON JACOBS HEATING AND A/C
12735 SW WILLS PLACE 1421 SE HOLGATE
TIGARD, OR 97223 PORTLAND, OR 97202
Phone: 503- 579 -4198 Phone: 234 -7331
FEES Reg #: SUP 704LHR
LIC 1441
tion Date Amount ELE 6-8
Description ELE 26- 807CRE
[ELPRMT] ELC Permit 10/28/200' $46.85
[TAX] 8% State Surcharge 10/28/200' $3.74 REQUIRED ITEMS AND REPORTS
Total $50.59
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
Issued By: j f j Permittee 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 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.
FROM , : Ja .. sHeating FAX NO. : Oct. 27 2005 01:49PM P2
>a} _I /
:
Electrical permit Application -
A � Dakroceived: / , D Permitno. _ i
rll L t r ED) � Ou .,
City of ; ; Pr Uappl.no.. Bxpi date:
City ofTigard Address: 1312: ....: pp �
y , OR 97223
Phone: (503) 639.4171
Date issued: �� ' Recaptno.:
Fax: (503) 598 - 1960 1 2 a 2005 Case file no.: Payment type:
Land use approval: AMU
gill& 2 family dwelling or a Cl Commercial /industrial LI Multi- family • Cl Tenant improvement
0 New construction a' Addition/alteration/replacement Cl Other: Cl Partial
Job address: 3 5 As ') \ Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: I Block: 'Subdivision:
Project name: I Description and location of work on protniaca: •
Estimated date of completion/ins 'an: • .—
.Yob no: 1 Th■c•37. 1
r1 JXt ._n Pee Max
Business name: DItlon Qty. (ea.) Total no. Imp Address:(,ll -n(4 ' Nci ,� dWllbi aldeatlal -stttgkortmtltttaea(�p
dwelling tmt41 nchides attached garage. .
City: +., . Statet� ZiP: , •a ServImIncluderb
Phone. �,L .. r. s ''1 ;i E -mail: 1000 sq. f. or less 4
o to Elec. bus. lic. no•� =1`j' • ► Bach mtdttimtnl soo �. R o nlon thereof CCB no.: 14, \ ii I7
Cif.
metre li . n0.: `a�`J .l 1 0 - Limited energy, residential 2
1 .i mi ted ettergy, non-residential 2
1 tr 1 , Each manufactured home or modular dwelling
ignat of su • - wising el clan ired) Date • (p Service and/or feeder 2
Sup. elect name (print): * . , _ . Iicenseno. q t serrleevorfeeders— Installation,
l'Itt)1'I:It l l' t)11'n'4:It aiterntlouorrolocattoe:
200am sonless 2
Name (print): t* 4 t , �. . ► 11 , I .. L , 201 amps to 400 amps 2
Mailing address. • 401 amps m 600 amps 2
City: . 601 amps to 1000 (ip0 amps 2 .
Y: State: ZIP: Over 1000 amps or volts 2
Phone: - 1..U') V IFax: Email: Reconnttcton _ 1
Owner installation: The installation is being made on property I own Temporary services orfeedera
which is not intended for sale, lease, rent, or exchange according to lrtrmlleiton ,allerstton,orreloeogea:
ORS 447, 455, 479, 670, 701. 200 amps or les 2
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 am 2
Brunch clrculla - new, alteration,
Name: or extension per panel:
A. Pco for branch circuits with purchase of
Address: service or feeder fee, each branch circuit
City: State: ZIP: R. Poo for branch circuits without purchase
Phone: Pax: E-mail: service or feeder fee, first branch circuit: V ii�'• �✓ 2
•
Each additional hranclt circuit
PLAN 1(1.,V 11'11' (Please cltcrlt all [Intl apply) Me. (Service or feeder notIneludod)t - -'
O Service over 225 amps commercial 0 Heyhh - care facility Each pump or irrigation circle 2
L"1 Service over 320 amps - rating of 1 &2 O Harmdriva Lam sign oroutlinelighting 2
family dwellings 0 Building over 10,000 equare foot four or Signal circuits) or a limited cnorgy panel,
O System over 600 volts nominal more residential units in one structure alteration, or extension* 2
O Building over three stories O Feeders. 400 amps or MOre *Description:
O Occupant load over 99 persons 0 Manufactured structures or RV park Each additional
O tigresa/lightingplmt O Other Inspection over the allowable In any of the ahem
Spbmdt _ sets of platys with any of the above. POT In lnvostigati n I I I 1
gntio fee
The above aro not applicable to temporary construction service. Other
Not alt Juriatot an. aocerg credit cords, Wrote cot Ju tadteuon Tor moue iofonnnlon Notice: Thin permit application Kermit fee $ /7014a 0 visa O MasterCard expires if a permit is not obtained' review (at %) $
Candid Cant rmmlwr, / / Within 180 days after it has been
State surcharge (8%) $ �:;
tvmoe•w cardholder as ahovm an credit sand Expires as complete. TOTAL $ .. . S
cardholder alfaataro E3Bc4 Amount
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2005 -00841
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/28/2005
Phone: (503) 639 -4171 Avd°II
Inspection Requests (24 Hrs.): (503) 639 -4175 . �!
INSPECTION WORKSHEET FOR DATE: 9/21/2006 TIME: 7 : 02AM PAGE: 72
SITE ADDRESS: 12735 SW WILLS PL CLASS OF WORK:
SUBDIVISION: BELLWOOD NO. 2 LOT #: 463 TYPE OF USE:
PROJECT NAME: JEPPSON
DESCRIPTION: 1 branch circuit.
OWNER: JEPPSON, TRINA PHONE #: 503 -579 -4198
CONTRACTOR: JACOBS HEATING AND NC PHONE #: 234 - 7331
Inspection Request Scheduled For: Date: 9/21/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical Final ' 036789-01 503-234 -7331 Y
Corrections/Comments/Instructions:
0
A PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 61/i r Date: q Z/ ° Phone #: (503) 718- 2 V
CITY OF TIGARD , .. ,„
BUILDING DIVISION PERMIT #:g4C_,- 00S —oeg4
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639- 4171Jhooli
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: I '27 I/4 I) 5 P i CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION: r J p p
OWNER: PHONE 4 6 7 / ) S 75 T[ Lp -
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: L/_ 1- 0,6 Pour Time:
Code # Inspection Description Confirm # Contact # Message
f (1q 6 c j
Corrections/Comments/Instructions:
• c
44/1114 l ;.r I / , i� J /, / ! /. ii / • / I 1 AL_!
i i / c prutie � � r 3
/ rte' 1)- ))O.J2(c)
. ,
.4.via.s .; .L .. , t. :„. •
The electrical installation defects noted
on this report shall be corrected and
an Inspection request made within 20
calendar days per OAR 918- 271 -0030
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: r /' 4 7 .- 1. 6 Phone #: (503) 718- "WO