Permit CITY TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00626
I
DEVELOPMENT SERVICES DATE ISSUED: 9/30/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S114BA -05800
SITE ADDRESS: 16530 SW GREENLAND DR
SUBDIVISION: PICKS LANDING NO.2 ZONING: R-4.5
BLOCK: LOT : 082 JURISDICTION: TIG
Project Description: Furnace & A/C connection corrections as per inspector.
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:
DICK, JACK EAND JUDY L BOB'S ACTION ELECTRIC INC
16530 SW GREENLAND DR 2700 NE BURTON ROAD
TIGARD, OR 97223 STE A
VANCOUVER, WA 98662
Phone: 503 - 449 -0766 Phone: 360- 254 -7200
Reg #: SUP 4322S
LIC 53136
FEES ELE 37 -431C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 9/30/2004 $53.50
[TAX] 8% State Surcharge 9/30/2004 $4.28 Rough -in
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- 332 -2344.
Issued By: � � ..Ls( (.GC Permit Signature: � (z
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 639 -4175 by 7:00pm for an inspection the next business day
Elects ical Permit Ap ' FOR ^OFFICE USE ; ONLY.
City of Tigard EGIV Jam
ED D Received __ l' / / �j PernritNo.:� X ,,,e) l
13125 SW Hall Blvd., Tigard, OR 9722 9 Es Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 i � � ;di l , ��G'�I'�� DateB : Other Permit:
Inspection Line: 503.639.4175 SEP 21 20 t e Date Ready/By: El See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
� z t' � "t'^ r .x : , a f • fi. :,rc ,i... {.wltE r .•^ i.. , .q_ 'iiPI.t1N •."I2E5!`IE.. W..
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❑ New construction El AdtitiffeelMailaWIWAtlent Please check all that apply:
['Service over 225 amps, comm'l ['Hazardous location
❑ Demolition Ill Other:
..,, _ . , • 9 , , ax.,ri wi; rr-r, .^,.1 6. - _ , - „4. x -, . , _ . •.� , ❑Service over 320 amps rating ❑ Buildng over 10,000 sq ft.,
,-
'i:`z 4CA. Q.ORX OF COt STR:L IC�^alfzi „r� r ; i ,i 1A - 4
�?'" M '` " �+ ' °- ^' "� ,: of 1 -and 2-family dwellings or more new residential
Esp =��P�� w�"r,x�,et*: �.^• snxaoar. �:: x�es' t�x�- ?�-.: crrFvauS^ a�z:: i" m' 4::. M+"`,'. t� :Ed:�u��.:i��.- >,._:i�.la,8 ° .sa Y g
® 1- and 2- family dwelling ❑ CommerciaUindustrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
['Building over three stories ❑Feeders, 400 amps or more
❑ -,;
Multi family ❑ Master builder ❑ Other:
�§ 1kY - . , ['Occupant load over 99 persons EManufactured structures or
'- ¢� -. �+€. ; z :<, °4 wa �a.rtx..• . ^edv. xn <r �"
,p , �� ;` " § J ORIVI T IL LOO ,..,,GTt�': F a � @' z ' ' t " ; ; ❑E /li plan RV park
b$
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, A , 171 1a$ r .«;NS..4&,, a.:.e ^ ' m`_ .w:,= +.:n. -e k.i. - ,,°"f,3.ui:.rat e:.. ,; ,, '»,z t.`" *.=. .�c, :citv '.A
❑Health -care facility ❑Other:
Job no.: 04 - 817 Job site address: 16530 SW Greenland
Submit 2 sets of plans with any of the above.
Tigard, OR 97224
City/State/ZIP: The above are not applicable to temporary construction service.
w ,,.
Suite/bldg. /apt. no.: Project name: *. a (`!s" . i '=:;SEE *„`S HEDUEE'ir;':`'' ; . • f -
Description Qty. Fee. 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'l 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no.: Limited energy, non - residential 75.00 2
E ARS =fax 4 `"s .�. {, .- r.`k 1 a€';ab
'f: ; ., krf UES a TIOIY IP WO RK`.. rkitt< i1,_ fi
°' , t r t; Each manufactured or modular
'J$6��D!h n.."f". .@.".'�.:%�;''�_- • 6t+ziR : aasa:..a .r„:.o-�J . ': lir;.�ana_n :,� #a : 1 +k�.�:..,5 e�.. � $Sa,lu.�`�,,,•.i:3z'� =.
dwelling, service and /or feeder 90.90 2
Furnace & A/C connection corrections as per Services or feeders installation, alteration, and /or relocation
(ZF. MkC-004- OCISY1 200 amps or less 80.30 2
mechanical inspector for Bell Heating
- s s d, a» , -w k..'r r..a� es. a, r 201 amps to 400 amps 106.85 2
1110� X" OWN R a ,� ®TEIVAN t ,
.rw';��,,..a�;�w..,r � tz a, "�' �'w,.� �.,.�r�..;v,�i °' ?�'.',�'� , a4 . 401 amps to 600 amps 160.60 2
Name: Judy & Jack Dick 601 amps to 1,000 amps 240.60 2
Address: 16530 SW Greenland Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City /State /ZIP: Tigard,-OR 97224 Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( 503 )
6 2 0 7 6 6 6 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
;''a. :r "'• u '" °. ` / »,,"'; V ' l' . stole ., .' '`irh' "m ` , '.: rF V'' ,' ""H ;A A. Fee for branch circuits with
UP A �
,. ._ a , ,i t.s.`;'.tiCT Y aa�
� k:. i- ,. :4 «:zr"�*s.:- x. (wx *5 eu. 2vn as2..sAC rx�§ + x�� m*'aa'»' t•d';�:t
service or feeder fee, each 6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee,
each branch circuit 1 46.85 46.85 2
Address:
Each add'l branch circuit 1 6.65 6.65 2
City /State /ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) Fax:: ( )
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
s -ct H,y-a, . ,s; n^ • 3 ^- rs --•-v: 3 n n '.: -: t °s3-'x s`^ `€tr`r : -� energy
€ 3t. " -" -, , ; -{ m^1 .' w 't. je panel alteration ' or
��i�� � ;xF ,,y. �,. r� ���'°TR�h,,;C�OEt'�� -° ,�z.�'� .�. �ti �i..; a,�...
extension. Describe: Page 2 2
Business name: Bob's Action Electric
Address: „ tt Each additional inspection over allowable in any of the above
2700 NE Burton Rd. A Per inspection 62.50
City /State /ZIP: Vancouver. WA 98662 Investigation per hour (1 hr nun) 62.50
Industrial plant per hour 73.75
Phone: ( 360) 254 -7200 Fax: ( 360) 254 -8219 t:=
..
" �'��ELE'( sTRICAL %,PERiVIIT= : !
CCB Lie.: 53136 Electrical Lic.: 7'431C Suprv. Lic.: 4322S Subtotal 53.50
Suprv. Electrician signature, required: • Plan review (25% of permit fee)
State surcharge (8% of permit fee) 4.28
Print name: Kevin Broselle Date: 9/28/04
TOTAL PERMIT FEE 57.78
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: • Fee methodology set by Tri- County Building Industry Service Board
** Number of inspections per permit allowed.
i:\ Building \Permits\ELC- PermitApp doe 12103 440 -461 ST(IO /02 /COM/WEB
1 ,
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2004 -00626
13125 SW Hall Blvd., Tigard, OR 97223 / DATE ISSUED: 9/30/2004
Phone: (503) 639 -4171 Jailir: Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 3/23/2005 TIME: 7:08AM PAGE: 94
SITE ADDRESS: 16530 SW GREENLAND DR CLASS OF WORK:
SUBDIVISION: PICKS LANDING NO.2 L OT #: 082 TYPE OF USE:
PROJECT NAME: DICK
DESCRIPTION: Furnace & A/C connection corrections as per inspector.
OWNER: DICK, JACK E AND JUDY L, PHONE #: 603- 449-0766
CONTRACTOR: BOB'S ACTION ELECTRIC INC PHONE #: 360 - 254 -7200
Inspection Request Scheduled For: Date: 3/23/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 002530 -02 503- 449-0766 N
Corrections /Comments /Instructions:
_____
6 ( r
,ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
/ _ _, , __—
Inspector: Date: 3 Z3 bne #: (503) 718-