Permit CITY OF T I GA R D ELECTRICAL PERMIT
PERMIT #: ELC2001 -00401
I
1 DEVELOPMENT SERVICES DATE ISSUED: 08/06/2001
13125 SW Hall Blvd., Tigard. OR 97223 (503) 639 -4171
PARCEL: 2S 110CA -00200
SITE ADDRESS: 12120 SW IMPERIAL AVE LAUNDRY
SUBDIVISION: KING CITY ZONING: ?
BLOCK: LOT : JURISDICTION: KIN
Proiect Description: Remove hot water heater from dedicated meter and reconneact to building meter.
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: 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:
WESTEN HOLDING GEORGE + SONS ELECTRIC CORP
2154 SW BROADAY PO BOX 339
PORTLAND, OR 97212 CLACKAMAS, OR 97015
Phone: 503 - 284 -2147 Phone: 654 -8634
Reg #: LIC 35600
ELE 3 -117C
SUP 3185S
FEES Required Inspections
Type By Date Amount Receipt Rough -in
PRMT CTR 08/06/2001 $46.85 2720010000( Wall Cover
Elect'I Final
5PCT CTR 08/06/2001 $3.75 2720010000(
Total $50.60
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: Issued By: ' A
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: 3L
Call 639 -4175 by 7:00pm for an inspection the next business day
Electrical Permit Application
• : Date receive 7 0 .. All Permit no.: g , ) 7..= Q
alj ` �'1 City of Tigard :
. �� ty P rojecdappl.no.: ,. . - Expire date: -
City Address: 13125 SW Hall Blvd, Tigard, OR 9722 •
tY o f Tigard Phone: (503) 639 4171 Date issued: By: 6P? Receipt no.: ,---.
Fax: (503) 598 -1960 Case file no.: Payment type: _
Land use approval:
- TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial al Multi - family ❑ Tenant improvement '
❑ New construction la Addition/alteration /replacement ❑ Other: ❑ Partial
- JOB SITEINFORMATION
Job address: 1,...2./uZ p s)d C l r / $/ • y Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: (Block: ' ISubdivision: , /y2/ i �iivG C.ry �P77.S / r � 1 /
Project name: 'Description and locatio work on premises: Re o u� 40'16....$ . - ,ier 4a yta
Estimated date of completion/inspection: �c c3 7`cd one t° coti>7 ec" 1 4 40 . 14 v wt v
CONTRACTOR APPLICATION ': . - - : FEE SCIIEDLLE •
Job no: /Z. ) Fee Max •
Business name: Ce m r f .e Sc�ls (ec 2 Description Qty. (ea.) Total no. insp
J New residential -single or multi- family per
Address: Po 13r, x d 33 y dwelling unit. Includes attached garage. • .
City: C LkMs I State: oyz I ZIP: ?70/S Service included
Phone: 5 Y g6 3 r I Fax: 6s 3- gQ61 E -mail: 1000 sq. ft. or less • 4
CCB no.: 3,5600 I Elec. bus. lic. no: // 7 C. Each additional 500 sq. ft. or portion thereof
Limited energy, residential 2
City /metr lic. n0.: 2 p Limited energy, non- residential - 2
Each manufactured home or modular dwelling
Signal supervi • g elee clan (required) • Date - 7-14-i 14 -/ Service and/or feeder 2
elect, name (print): 7� License no: Services or feeders — installation,
Sup. (P ) �� /t o / S n N �� S alteration or relocation:
PROPERTY OWNER 200 amps or less 2
Name (print): e r •A/ p , /ii p 201 amps to 400 amps 2
g address: . s + � � ) r my y 401 amps to 600 amps 2
Mailin address• r v
601 amps to 1000 amps 2
City: p h • I State: PR I ZIP: 7 72 / Over 1000 amps or volts • 2' ■
Phone:, - I Fax: I E -mail: Reconnect only 1 ._. .
Owner installation: The installation is being made on property I own Temporary services or feeders - .
which is not intended for sale, lease, rent, or exchange according to installation, alteration,orrelocation:
ORS 447, 455, 479, 670, 701. 200 amps or less 2
20,1 amps to 400 amps 2 ' '
Owner's signature: Date: 401 to 600 amps 2
• ENGINEER - • - 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
City: I State: I ZIP: B. Fee for branch circuits without purchase '//
Phone: Fax: E -mail: of service or feeder fee, first branch circuit: / k r 2 .
Each additional branch circuit:
• PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included): • -•
❑. Service over 225 amps - commercial ❑ Health -care facility Each pump or irrigation circle 2
❑ Service over 320 amps - rating of I &2 ❑ Hazardous location Each sign or outline lighting 2
family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel, .
❑ System over 600 volts nominal more residential units in one structure alteration, or extension* - 2
❑ Building over three stories ❑ Feeders, 400 amps or more *Description: -
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
❑ Egress/lightingplan ❑ Other: Per inspection I I
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other /� a
t credit cards, please call jurisdiction for more information. Permit fee $ ]' �� .e3 -c
Not all jurisdictions accept P Notice: This permit application
❑ Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: I / within 180 days after it has been State surcharge (8 %) .... $ �, - 25 — S
Expires accepted as complete. TOTAL $ ,CO 6 0
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440 -4615 (6/00/COM)
•
07/30/2001 15 :12 5036393771 CITY OF KING CITY PAGE 05
• eL-C J O-° i f D (
ZING CITY
1,3O0 S.W. 116th Avenue, King City Oregon 97224-2693
PhonE: (503) 639 -40$2 • FAN (503) 639.3771
•
Notice To Contractors Workin In King City
Due to an intergovernmental agreement with the City of Tigard, many building related permits
for projects in King City are issued and inspected by the ,City of Tigard.
•
If your permit application DOES NOT REQUIRE PLAN REVIEW, simply complete the
appropriate application legibly and submit it to the King City staff. The King City staff will
collect all fees and fax the application to the City of Tigard.. City of Tigard staff will then create
the permit issue the permit, and perform inspections. Please indicate on the permit application
whether you would like the Tigard staff to ,call you when the permit is ready for issuance or
.. whether you prefer it to be mailed without any notification. Any incomplete or illegible
application will be returned to King City staff for correction and nb processing will occur until a
complete, legible application is received.
If your permit application DOES REQUIRE PLAN REVIEW, this form must be signed by a
King City staff person. King City staff will simply sign this form indicating land use approval.
Take this signed form to the City of Tigard Development Services Counter located at 13125 SW
Hall Blvd, Tigard, to submit applications and plans. Development Services Technicians are
available at 639 -4171 Ext. 304 should you have any:questions concerning submittal
requirements. All permit fees will be assessed and collected at the City of Tigard. •
The City of King City hereby authorizes applicant to pursue permits at the City of Tigard
Building, Department for the following project: email")
C 4
located at ;_j_,1) .v ty,ea� •
• King City Representative (Gr.- 2.� -6/
I D5 r5 DOC
•
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24- Ho'.ir,Jnspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested AM PM BLD
Location • f 2 / Suite MEC
Contact Person Ph PLM
Contractor Ph SWR
BUILDING: Tenant/Owner ELC /— o 00 qui
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing.
Firewall
Fire Sprinkler /I
a Susd Ceiling (/( €� c — eelm n E' e
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
•
Under Slab
Top Out
Water Service _
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
'MECHANICAL::,:..£.• :°T.."�':y�
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL t , 5 ;;°,
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
• ART FAIL
•
•
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at•City Hall, 13125 SW Hall Blvd -
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access .
ADA
Approach /Sidewalk
Other -
Date 9 / Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site