Permit t `
CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2007 -00452
COMMUNITY DEVELOPMENT DATE ISSUED: 7/3/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S103BD -03800
SITE ADDRESS: 11865 SW FONNER ST ZONING: R -4.5
SUBDIVISION: LOT : JURISDICTION: TIG
PROJECT: ADAMS
Project Description: (3) branch circuits for new heat pump. Job NO. 07 - 758
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: 2 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:
ADAMS, PAUL T /PATRICIA BOB'S ACTION ELECTRIC INC
11865 SW FONNER 2700 NE BURTON ROAD #A
TIGARD, OR 97223 VANCOUVER, WA 98662
Phone: Contact #: PRI 360- 254 -7200
FAX 360- 254 -8219
FEES
Description Date Amount Reg #: ELE 37-431C
[ELPRMT] ELC Permit 7/3/2007 $60.15 LTC 53136
[TAX] 8% Statc Surcharge 7/3/2007 $4.81 SUP 43225
Total $64.96 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 : � // / Permittee Signature: P 4-idi / •
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.
Electrical Permit Application � FOR O FFICE U SE -ONLY �` t ' u +_ a+ f
CI of Tigard • - (:,, '2D I E iew Pernut No 131 SW Hall Blvd. Tigard, OR 97223 r 0 6 S �i'. E?L Zoo - /5Z
CITY O F TIG (' ' Other Permit
Phone 503 639 4171 Fax 503 598.1960 a6 ■
v' �1 Datey
Inspection Line 503 639.4175 BUILDING DI 1 , -.: � . , P --' Date B d/ Ready/By Ju is � See Page 2 for
Internet www ci tigard or us NonfieMethod ) 1 0 Supplemental Information
,: .. T1' P E,f- :OF -, WORK r ;r': ` - PLAN REV E
❑ New construction ❑ Addition/alteration /replacement Please check all that apply
I] Demolition ❑Other: ❑ Service over 225 amps, comm'l ['Hazardous location
['Service over 320 amps - rating ❑ Buildng over 10,000 sq ft ,
`` '' 0 H-- - is . ":C ATEGORYI , OF: CONSTRUCTION 't' of I- and 2-family dwellings 4 or more new residential
® 1 and 2 dwelling ❑ Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi family ❑ Master builder ❑Other ❑Building over three stories EFeeders, 400 amps or more
3T _ _, M _, 4„ - „ „y g iy y Occupant load over 99 persons EManufactured structures or
) ; * >. --snE. ,.,..,;,. ..- ,:,,` RV
' ,JQ$HISIT'E rgF- MATION>.yANA LOCATION ' i =°>° ",.i ' ❑E ess /It hi plan ark P
Job no • J site address ❑Health -care facility ['Other
07 -758 11865 SW Fonner St. Submit 2 sets of plans with any of the above
City /State /ZIP: Tigard, OR 97223 The above are not applicable to temporary construction service
` / EE CII
F *' < ,SEDULE
Suite/bldg /apt no • Project name } d -`°` ° `
rik .m5 Description Qty Fee. 1 Total
Cross street/directions to job site: New residential single -or multi - family dwelling unit.
Includes attached garage.
1,000 sq ft or less 145 15 4
Subdivision Lot no Ea add'1 500 sq ft or portion 33 40 1
•
Tax map /parcel no. Limited energy, residential 75 00 2
4, ;,,.. 4 ,, vt tg;° :- _ «'<:;?.::.f SCRIP'TION3` "OF {'WORK: ' 'f ,..; . p ,,, ay
Limited energy, non - residential 75 00 2
= '�,f,_.����;,i�i�;r::` _ „ z.�,t,,..�...n,.,.,,.,,� ..e.� „r ,_�,.,. .�.•��.t,�. >'a�`� ;.1' ' „, Each manufactured or modular
dwelling, service and /or feeder 90 90 2
Heat pump Services or feeders installation, alteration, and /or relocation
200 amps or less 80 30 2
,„ "1'1-1'1' ,.,; ,':!:W< • - . a3; rail:, - -' .. - 201 amps to 400 amps 106 85 2
"
t 0; ''FPIi QPERT. ..4j N = z °
' F- > rr IN ; ` T EI V AN 'T -'- - , _
` _ .. 3_ v . - -' " - ''- - ' a:� '' '" - ' ' ' ...�,.. -- '- - _ 401 amps to 600 amps 160 60 2
Name. Paul & Pat Adams 601 amps to 1,000 amps 240 60 2
Address Over 1,000 amps or volts 454 65 2
11865 SW Former St . Reconnect only 66 85 2
City /State /ZIP: Tigard, OR 97223 Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( 503 590 -8090 Fax. ( ) 200 amps or less 66 85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100 30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133 75 2
Owner signature: Date Branch circuits - new, alteration, or extension, per panel
'''' ;— art, =:', .''�.3 "'`�" `:" ' ' A Fee for branch circuits with
i i' „
° 2._ :4-1*,:, ® ".APPLICANT s 5 " } ®rC 'n. '; -.
service or feeder fee, each 6 65 2
Business name: branch circuit
B Fee for branch circuits
Contact name without service or feeder fee,
Address: each branch circuit / 46 85 , ` J 2
Each add'l branch circuit „' 6 65 /5 5d 2
City /State /ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) Fax:: ( ) Pump or irrigation circle 53 40 2
Sign of outline lighting 53 40 2
E • Signal circuit(s) or limited -
'x-° ' I r ;r` -CONTRA'CTOR' f=' "t` ° t 'i ').' - ->= 't energy panel, alteration, or
extension Describe Page 2 2
Business name Bob's Action Electric
Address. tt �t Each additional inspection over allowable in any of the above
2700 NE Burton Rd. A Per inspection 62.50
Cit /State /ZIP • Vancouver . WA 98662 Investigation per hour (I hr nun) 62 50
Phone:( 360) 254 -7200 Fax ( 360 ) 254 -8219 Industnalplant per hour 7375
° , :; °' :3ELECTRLCAL:;PE RMIT,;FEES*
CCB Lie.• 53136 Electrical Lic 37 431 Supry Lic 4322S Subtotal 6,p./ ,°
Suprv. Electrician signature, require / Plan review (25% of permit fee)
State surcharge (8% of permit fee) .;!X/
Prmtname: Kevin Broselle Date 6/27/07
TOTAL PERMIT FEE ,05i
Authorized signature: This permit application expires it a permit is not obtained within ISO
days atter it has been accepted as complete
Print name Date. * Fee methodology set by Tn- County Building Industry Service Board
** Number of inspections per pemut allowed
,\Buiidmg\Permits\ELC- PermitApp doc 12/03 440 4615T( /02 /COivi/WEB
CITY OF TIGARD a A - .
BUILDING DIVISION"' PERMIT #: ELC2007- 00452
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/3/2007
Phone: (503) 639 -4171 �u ,
Inspection Requests (24 Hrs.): (503) 639 - 4175'__..
INSPECTION WORKSHEET FOR DATE: 7/23/2007 TIME: 7 :06AIV6 PAGE: 39
SITE ADDRESS: 11865 SW FONNER ST CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: ADAMS
DESCRIPTION: (3) branch circuits for new heat pump. Job NO. 07-758
OWNER: ADAMS, PAUL T /PATRICIA, PHONE #:
CONTRACTOR: BOS'S ACTION ELECTRIC INC PHONE #: 360 -254 -7200
Inspection Request Scheduled For: Date: 7/23/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 052438-01 360-254-7200 1°
r
Corrections /Comments /Instructions: 0/\ 1
476._ v 'V7 T c_2 m'(, W_
3-.0 (1--0 ? )S(-.c / 6K/C P_ 1.) ic_._,,,-,//1.)-
7
r PASS • PARTIAL APPROVAL CANCEL ' NO ACCESS
I I FAIL El CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
Inspector: 1 ► ls 10 "_ Date: 1 2i31'o9 Phone #: (503) 7 18 :2 *(7 4