Permit CITY OF TIGARD ELECTRICAL PERMIT
4.�
PERMIT #: ELC2006 -00085
DEVELOPMENT SERVICES DATE ISSUED: 2/6/2006
°7f I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1 S 134CC - 03700
SITE ADDRESS: 12436 SW WINTER LAKE DR ZONING: R - 4.5
SUBDIVISION: CAPSTONE LOT : 004 JURISDICTION: TIG
Project Description: (2) branch circuits for furnace & NC.
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:
BONNIE DEAHL JACOBS HEATING AND NC
12436 SW WINTERLAKE DR 4474 SE MILWAUKIE
TIGARD, OR 97223 PORTLAND, OR 97202
Phone: 503 - 524 -4177 Contact #: PRI 503 - 234 -7331
FAX 503 - 808 -9108
FEES
Description Date Amount Reg #: SUP 704LHR
[ELPRMT] ELC Permit 2/6/2006 $53.50 LIE 1441
[TAX] 8% State Surcharge 2/6/2006 $4.28 ELE 26 807CRE
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: � �-� LC� Permittee Signature: t'�f (
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 : FAX NO. Feb. 01 2006 11:29AM P2
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Electrical Permit Application _
�������® Datereceived� Q( rmitno. -(�( g
-,_- , i _ City of Tigard Project/opt :no.: Expiredatc:
City of Tigard Address: 13125 SW Hall Blvd;rT�gar6, �R2QZ�,23 Date issued: Byf/� Receiptno.:
Phone: (503) 639 -4171 f�CC[[33 [��JJ�Jbb !!
Fax: (503) 598 -1960 Case file nn -: Payment typo:
CITY OF TIGARD
Land use approval: BUILDING DMISION
TYPE OF Pt:Iln71T
0 1 & 2 family dwelling or accessory 0 Commercial /industrial ❑ Multi- family ❑ Tenant improvement
U New construction %Addition/alteration/replacemcnt ❑ Other. U Partial
.1011 SUIT] 1NI.OltNIA'l'l0N
Job address: A ,, - I 1 s _S S1dg. no.: Suite no.: Tax map/tax lot/account no.:
Lot: Block: Subdivision:
Project name: I Description and location of work on promises:
Estimated date of completion/inspection:
CON I ItACI Olt APPLICATION l I I; S(:Il1;I)l l.i:
Job no: Fee Max
Business name: , ,1ng �. n , pes on Oty. (ea.) Total no. (asp
C _ ( � 1 Now :Addenda' - & Omer mid-family per
Address:u\. U `f\( \ \ �a dwelling unit. Includes attached garage.
City: . Qt--t - \ is ZIP:ei Service Included: •
Phone: rr�� Fax "° • - mail: 1000 sq, ft, or less 4
rJ' I w Each additional 500 sq. It. or portion thereof
CCB no.: L Elec. bus. lic. no • .Y C - 1.imitedenergy, residential 2
City /t - tro lie. 1o.: ,,,, ,, Limitedener€y, non- residential 2
7 R� 1 Is 1l I / Q J() Each manufactured home or modular dwelling
: TS! .1i i o ` suupe er rvising lectrician (require . Dale Service and/er 2
Sup. elect. name (prin License no: Services or feeders Installation,
alteration or relocation:
200 Amps or leas 2
Name (print): �C7K1��� �o dA 201 amps to 400 amps 2
— 401 amps to 600 amps 2
Mailing address: sot amps to 1000 amps 2 _
City: I State: IMP _ Ova 1000 a mps err volts 2
Phone: I Fax: 1E-mail: Reconnect only 1
Owner Installation: The installation is being made on property I own lemporxty services or feedera -
which is not intended for sale, lease, rent, or exchange according to hleWlAdoa, alteration, orreloeadon:
200 amps or Ices 2
ORS 447, 455, 479, 670, 701. 201 amps to 400 amps 2
Owner's si nature: Date: 401 to 600 am s 2
Branch dreutts - new, alteration,
• or extension per panel:
Name: A. Pee for branch circuits with purchase of
Address: service or feeder fcc, each branch circuit 2
City: I State: I ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: 1 2
Phone: Fax: E-mail: Gich additional branch circuit: I
PLAN Kl:Vll W (I'lc.tse checic :ill ilia( rtppIV) Misc. (Service or feeder not included):
CI . Service over 225 amps-commercial 0 Haalrh- care facility Hach pump or Irrigation circle 2
CI Service over 320 amps- rating of 1&.2 0 Hazardous location Hach sign or outline lighting _ 2
fnntilydwellings ❑ Building ova 10.000 square feet four or Signal circuit(s) or a limited energy panel,
U System over 600 volts nominal more residential units in one structure alteration, or extension* , . 2
O Building over three stories U Feeders, 400 amps or mere *Description:
I7 Occupant load over 99 petsnns 0 Manufactured structures or RV past E additional Inspection over the allowable In any of the above:
0 Egress/lighting plan 0 Other. Per inspection F I I I
Submit _ sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. _ Other
Permit fee $ .
N ot nil ppriidlcUonr accept Credit cools. pteate call.Iorlsdlc rhr more infumuaion. N o t ice: 'Phis permit application o
o visa D MasterCard expires if a permit is not obtained' Plan review (at ,__ %)
Credit card number; _ / / within 180 days after it has been State surcharge (8%) .... $
E a accepted as complete. TOTAL $
Name-of cardholder as Chown on credit cunt •
$
cardholder si>taature Anwaa " 440-4615 (tyooWCOM)
•
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC200&.00Q05
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/0!2006
Phone: (503) 639 -4171 k
Inspection Requests (24 Hrs.): (503) 639 - 4175 !!+1 eh
INSPECTION WORKSHEET FOR DATE: 11/29/2007 TIME: 7 :00AM PAGE: 26
SITE ADDRESS: 12436 SW WINTER LAKE DR CLASS OF WORK:
SUBDIVISION: CAPSTONE LOT #: 004 TYPE OF USE:
PROJECT NAME: DEAHL
DESCRIPTION: (2) branch circuits for furnace & NC.
OWNER: DEAHL, BONNIE PHONE #: 503.524 -4177
CONTRACTOR: JACOBS HEATING AND NC PHONE #: 503 -234 -7331
Inspection Request Scheduled For: Date: 11/29/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 060484 -01 603-234 -7331 Y
VY� CA c L
Corrections /Comments /Instructions:
UL-L '. S 2 IA 4111 ' N o n-
r PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
L ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: I4t6 Date: III *slog Phone #: (503) 718- Vi
i r
CITY Of TIGARD - m�
BUILDING DIVISION PERMIT #: a O D - 10 Q5-6
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED:
Phone: (503) 639 -4171 l
Inspection Requests (24 Hrs.): (503) 639 -4175 �_ & ^ 'I L . eE 6.2 AO S -OooR5
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: 0. C,� ? / � �� = I "" CLASS OF WORK:
SUBDIVISION: ` J LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 3 - " /U " a (° Pour Time: 1 i / ' '
Code # Inspection Description Confirm # Contact # Message
/ 9 (0 ? a3q -7.33(
Correctio ructions:
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The electrical installation defoots noted
on this report shall be corrected and
---1 an inspar:tinn requast made within 20
calendar days per OAR 918-271 -0030
---,,_>...
CS
C6. PASS 11 PARTIAL APPROVAL 1 ❑ CANCEL ❑ NO ACCESS
O ZAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
/ Z , / °
Inspector: _ Date: ✓ ` P hone #: (503) 718- ,. -
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