Permit 4 �4 C I T' OF T A G A R ® ELECTRICAL PERMIT
PERMIT #: ELC2002 -00301
DEVELOPMENT SERVICES DATE ISSUED: 7/5/02
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S116AD
SITE ADDRESS: 16815 SW 129TH AVE
SUBDIVISION: KING CITY NO. 18 ZONING:
BLOCK: 24 LOT : 001 JURISDICTION: . KIN
Project Description: 2 branch circuits to furnace and heat pump reconnect.
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:
DOROTHEA KAILEY BOB'S ACTION ELECTRIC INC
16815 SW 129TH AVE. 2700 NE BURTON ROAD
KING CITY, OR 97224 STE A
VANCOUVER, WA 98662
Phone: 503 - 639 -4110 Phone: 360- 254 -7200
Reg #: SUP 4322S
LIC 00053136
ELE 37-431C
FEES Required Inspections
Type By Date Amount Receipt Rough -
PRMT CTR 7/5/02 $53.50 2720020000( Wall Cover
Elect'I Final
5PCT CTR 7/5/02 $4.28 2720020000(
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 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -6699 or 1 -800- 332 -2344.
Permit Signature: en"1 ) Issued By: Q l� �.I l/v
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: (Y)f / DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
06/27/01 WED 14:4.x1 ,EA.V. 503 598 1960 CITY OF 'I'ICARD l�jutlz
� ft .. '6 l Y , •
Electrical PermitA∎pplicatioii
r 1 I U N/I Ire D atereceived:1 -5 -o �— Permit n it.: D -40'30 J City of Cl� i llh(1 U V L� Projectiappl. no.: Expire date:
Address: 13125 SW Mill Blvd,I`,rli O.2 .y7,2;20 Date issued: H �ecci tt no.:
City of Tigard JUL I Luu
Phone: (503) 639 -4171
Fax: (503) 598 -1960 : Lk! Y mow' likittiED Case file no.: Payment type:
Land use approval: "U D G DW!SION
TYPE OF •
I,I I & 2 family dwelling or accessory 0 Comsat rcial /industrial 0 Multi- family 0 Tenant improvement
0 New construction 0 Additicn/alteratiou/replacement ❑ Other: 0 Partial
— JOB ,
Job address: 16815 SW 129th Ave . , King City Bldg. no.: Suite no.: Tax map /tax loUaccount no.:
Lot: Block: Subdivision:
Project name: I Descril:tiou and location of work on premises: 2 circuits for furnace & heat
Estimated date of completion /inspection: pump reconnects
CONTRACTOR APPLICATIO ''• IEEE SCIIEDULC
Job no: 02 -570 fee Max
Business name: Bob ' s Action Electric Description Qty. (ea.) Total no. Imp
New rrsidcntial - single or multi - fancily per
Address: 2700. NE Burton Rd. "A" dwelling milt. Includes attached garage.
City: Vancouver State: WA 2• 98662 senice tududed:
Phone360- 254 -7200 Fax: 254-82191E-mail: loons ft. or less t
Each additional 500 sq. fr. or portion thereof ` �
CCB no.: 53136 Elec. bus. lie. no: 37 -431C i
Limited energy, residential
City/lute n I ic. no.: 00003861 Limited energy, non-residential 2
A L _t _ 6/28/07 Each manufactured home or modular dwelling
Signature of supervising electrician (required) Date Service and /or feeder 2
Sup. elect. name (print): Kevin Brose lie Li tense no: 4322S
Services or feeders—Installation,
alteration or relocation:
PROPERTY OWNER 200 snips or less
Name (print): Dorothea Kailey 201 amps to 400 snaps 2
401 amps to 600 amps 2
Mailing address: 16815 SW 129th Ave. 601 amps to 1000 snips _ 2
City: King City State: OR - Zit': 97224 Over 1000 amps or volts 2
Phone: 639 -4110 Fax: E -mail: Reconnect only I
Owner installation: The installation is being made on property I own 'Temporary services or feeders -
whiclr is not intended for sale, lease, rent, or exchanee according to installation, alteration, urrelocation:
200 amps or less 2
ORS 447, 455, 479, 670, 701. -• 201 amps to 400 amps
Owner's signature: - Date: 401 to 600 amps 2
ENGINEER MIMIIIIIMF Branch circuits - new, alteration,
or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
cit State: .,II': 0. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: 1 46. 2
Phone: Fax: E Each additional brunt circuit: 1 6.E5
PLAN REVIEW (Please check all MI apply) • MIsc. (Service or feeder not included):
O Service over225 alnps- commercial 0 I{ealtrcnre facility, Each pump or irtigulion circle 2
O Service over 320 tulips-rating of I &2 Li Hazm'dOus lucatinn Each sign or outline. tightiug 2
family dwellings U Buildine over 10 (10(1 square feet four or Signal circuit(s) or a limited energy panel.
O System over 600 volts nominal more residential mils in one structure alteration, orextension' 2
0 Building raver t stories 0 Feeders. 400 amps or mote 'Description:
❑ Occupant load over 99 persons 0 Manufactured structures or kV park Each additional inspection over the allowable In army of the shove:
O Egress /lighting plan 0 Other: Pei inspection 1 ---- 1 --- 1 — I I
submit sets of plans with any of tht: above. . Investigation fee
The above are not applicable to temporary consr ruction.ser•Ice. Other
Permit fee ,fi 53.50
Not all jurisdictions accept credit cards, please call jurisdiction for more iu 'onnaiiou. Noliee: - Ibis permit application
O Visa 0 MasterCard expires ifa permit is not obtained' Plant review (at _ %)
Credit card number: _ — / / within 180 days after it has been Slate surcharge (8%) .... ,4i 4.28
Ex rinds accepted as complete.
TOTAL $ 57.78 _
Name or cardholder as shown on credit crud
Cardholder signature Aft 01.1111 ` � 44O -4615 (6 /00/CMNI)
CITY OF TI 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
// BUP
Received / Date Requested 7 / AM PM BUP
Location / (? / 5 /(9-9 A - Suite MEC
Contact Person Ph ( 36e ) �.S — 7� �D PLM
Contractor ) 4r -d icryi 'hem Ph ( ) SWR
BUILDING Tenant/Owner ELC _ - (
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing \i
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 �J
PASS PART FAIL
ELECTRICAL i
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
ina El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
Please call for reinspection RE: Unable to inspect – no access
Fire Supply Line //1
ADA Da '�L �/ � Ins actor _ f� „, Ext
Approach/Sidewalk P —
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL