Permit - CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00266
i � DEVELOPMENT SERVICES DATE ISSUED: 5/12/03
.' II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S103AB -05100
SITE ADDRESS: 12254 SW 114TH TERR
SUBDIVISION: WALNUT GLEN ZONING: R-4.5
BLOCK: LOT : 009 JURISDICTION: TIG
Project Description: Add (2) branch circuits 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: 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:
AU DIEP BOB'S ACTION ELECTRIC INC
12254 SW 114TH TERRACE 2700 NE BURTON ROAD
TIGARD, OR 97223 STE A
VANCOUVER, WA 98662
Phone: 503 - 709 -7687 Phone: 360- 254 -7200
Reg #: SUP 4322S
LIC 53136
FEES ELE 37 -431C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 5/12/03 $53.50
[TAX] 8% State Tax 5/12/03 $4 Rough -
Elect'I Final
Total $57.78
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 -33 -2344.
Issued By: _ %� L 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: 3 ° ► S
Call 639 -4175 by 7:00pm for an inspection the next business day
06/27/01 WED 14:44 FAA 503 598 1960 CITY OF TIGARD VI 002
e
Electrical Permit A. kpplication
T �l Date received _/a 3 Per nr
mit ,l= f 3 —eu b
, �� • City of ll�ill'd R vED ProjecUappl. Expire date:
Address: 13125 SW 1 hall Blvd,rt irll, Ott ?3 � 2 Z �1
City nfTigard Date issued: By: Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 MAY 0 9 2003 Case file no Payment type:
Land use approval: CITY OF TIGARD 16
It , a •.
TYPE OF PERMIT
3 I & 2 family dwelling or accessory ❑ Comm( rciaUindustrial ❑ Multi- family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Other: 0 Partial
JIOD SITE INFORMATION
Job address: 12254 SW 114th Terrace Bldg. no.: Suite no.: Tax map /tax IoUaccounl no.:
Lot: !Block: Subdivision:
Project name: Descrit;tiou and location of work on premises: 2 circuits for A/C
Estimated date of coot letion/inspection:
CONTRACTOR APPLICATIO ''—''`N,, FEE SCIIEDULE
Job no: 03 -321 Fee Max
Business name: Bob t s Action Electric Description Qty. (ea.) Total no. Imp )
Nov residential-single or multi - family per
Address: 2700 NE Burton Rd. "A" dwelling Wt. Includes attached garage.
City: Vancouver State: WA �.0 *. 98662 Seniceincluded:
13110110 360-254-7 2001 Fax: 254 - 82191E -mail: l000 s Ft or less 1 —
Each additional 500 sq. ft. or portion thereof
CCB no.: 53136 Elec. bus. tic. no: 37 -431C
Limited energy. residential 2
Cityitttetfo c. no.: 00003861 Limited energy, non- residential 2
5 / 8/03 Each manufactured home or rnoth,lsr dwelling
—
Signature of supervising electrician (required) Date Service and /or feeder 2
Sup. elect. name (print): Kevin Bros Li :enseno: 4322S Services artceders— Inslallalinn,
Alteration or relocation:
PROPERTY OWNER 200 amps or less 2
Name (print): Au Diep 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address: 12254 SW 114th Terrace em amps to 1000 amps 2
Ci ty: Tigard IState: OR I;;IP: 97223 Over 1000 amps orvolts 2
Phone: 709 -7687 1 Fax: 1 E-mail: Reconnect only I
Owner installation: The installation is being made on property I own 't'empornry -
which is not intended for sale, lease, rent, or exch;utce according to inslnllnllon, alteration, urrelocation:
ORS 447, 455, 479, 670, 701. -. zoo amps or less 2
201 amps to 400 amps -
Ovvner's signature: Date: — 401 to 600 snips 2
ENGINEER Branch circuits - new, alteration,
or extension per panel:
Name: A. Fee for brunch circuits with purchase. of
Address: service or feeder fee, each branch circuit 2
City: 1 State: 1 .,IP: B. Fee for branch circuits without purchase
n - -- -- of service or feeder fee, first branch circuit: 1 46.85 2
Phone: Fax: E-mail Each additional brunch circuit: 1 6.65
PLAN REVIEW (Please check all th I apply) Misc. (Service or feeder not Included):
O Service over 225 amps- commercial 0 llealtlt -care facility Each pump or inigalion circle 2
U Service over 320 urnps•rating of I &2 ❑ !Hazardous Iocati.,n Each sign or outline lighting 2
family dwellings 0 Building over 10 000 square feet Four or Signal circuil(s) or a limited energy panel,
O System over 600 volts nominal more residential units in one structure alteration, or extension* I 2
O Building over thu re stories 0 Feeders. 400 amts or more *Description:
U Occupant load over 99 persons 0 Manufactured so ucaures or 1 Palk Each addlrionai inspection over the aliownble In :my of the above:
O Egress /lighting plan ❑ Other: _ Pet inspection I I I I
submit _ sets of plans with any of Ow above. Investigation fee
The above are not applicable to temporary construction service. ( Other
Not all jurisdictions accept credit cards, please call jurisdiction for more io brmauiou. Notice: This permit application
Permit fec $ 53.50
0 Visa U MasterCard expires if a permit is riot obtained Plan review Of _ O $
Credit card number: . _ _ / / within 180 days after it has been State surcharge (8%) ., $ 4. 28 _
Ex mires accepted as complete. TOTAL $ 57.78
Name of cardholder as shown on credit cad
$
Cardholder signature Art omit 1t0-4613 (6tt)0/('nAl)
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
IN CTION DIVISION • Business Line: (503) 639 -4171 MST
• BUP
Rec 'ed 7• " / S ' Date Requested / C 'P AM PM BUP
Location �- s lI `y — ce • Suite MEC
Contact Person 1 S 7 ( c..Q Ph ( 3 � 0) c1 S4 ! Z-2 0 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing 3- 00-
Foundation Access: A) v \ G�- o m
Ftg Drain es,. ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall � ✓�
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
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 P RT FAIL
CT�tI
Service
Rough -In
UG /Slab /
Low Voltage 11/
Fire Alarm
,, Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
�7 PART FAIL
SIT Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach /Sidewalk Date .3 r / `�� Inspe ' Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL