Permit C ITY O F ® I GARD ELECTRICAL PERMIT
I DEVELOPMNT SERVICES DATE SSU 3/21/03 03 001 52
I
„ � 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S 110CC -15400
SITE ADDRESS: 12375 SW KING GEORGE DR ZONING:
SUBDIVISION: KING CITY NO. 5
BLOCK: LOT : 006 JURISDICTION: KIN
Project Description: 1 Branch circuit to HVAC.
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:
JUNE NIELSON SPECIALTY HEATING+ FABRICTN
12375 SW KING GEORGE DR. 9528 SW TIGARD ST
KING CITY, OR 97224 TIGARD, OR 97223
Phone: 509 - 639 -5556 Phone: 620 -5643
Reg #: LIC 66578
ELE 34 -341 CRE
FEES SUP 200LHR
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 3/21/03 $46.85
[TAX] 8% State Tax 3/21/03 $3.75 Rough -
Elect'I Final
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 -0100. You may obtain copies of these rules or direct questions to OUNC at (503)
246699 or 1 X00- 3�2- 234g,� ZA/1_,, ` Issued By: �( / �'�/l ,t�//tilt_ Permit Signature: A 0410/ ( ,(I )/1_
OWNER INSTALLATION ONLY 1'
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: - Z0 0 1-170Z
Call 639 -4175 by 7:00pm for an inspection the next business day
Mar 18 03 11:20a Specialty Heating 503 598 0718 p.2
•
Electrical Permit Application
hatereceived: _2 / 0 I • , D.3_00 a l
4111r City of Tigard ® Projcct/appl, no.: Expire date:
Ciry ofTigard Address: 13125 SW Hall 11s 1 c �, 0 -
Phone: (501) 639.4.171 Date issued: i Receipt no.:
^
Fax: (503) 598- t960 MAR 18 20 Case file no,; Payment type:
Land use approval: tc A1=tr)
�1 Y Or T,
.a•
'4,.. ")(PE OF PERIVII'I
xi. & 2 family dwelling or accessory D Commercial/industrial D Multi - family Cl Tenant improve ncnt
0 New construction )• Addition /alteration/replacement 0 Other: 0 Partial •
JOB SITE INFORMATION
Job address: /. 3 c 1 ;yam „.o_r • . Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: Block: Su.divisio .
/
Project name: 4/ c , 4.�0,- Description and location of work on premises:
Estimated date of cvmlilctiott/ictspcc tion:
CONTRACTOR APPLICATION
IMMEMINIIIIIMI
Job no: 0.3 Ef
Fee.' lyfac
Business name ,7�.ec_ - �/ � — Desrri lion
�pf �CZ - `f'�� 4 j' Newr esidentia l- singleormlti- ffamilyper
— u Qty. (ca.) Ioral no.uup
Address 5 i,,2./
-f p ZIP: /� 24 9 dwelling unit kuclutics attached
City: 6 �1 ' I State— �1 ! - I ZIP: , f SerVirahte •ut*d: garage.
C
Phone :69 ' -. 3,e) Fax4 V 19713 J E-mail: 1000 sq. ft, or less
CCB no.: C ie 5 7 is .t �3 Elec. bus. lic. no: ? . -- (./74 g',4..
Each additional 500 sq. ft. or portion dtett o 4
City /metro lie. no.: /l '6 X73 , Limitedenergy�rosidential 2
,� � [inured energy, non - residential 2
/ l� .d �L_ .e• , ' ` h r aach manufactured home or modular dwelling
Signa of supervising electrician (required) ,, Date o ; ,k ServrCC and/otifeeder • 2
Sup. elect. name (print):/ d7 . ¢i./, es f.i,sn::. nn ,gClrizx,p Services or fecders -instringi inn,
PROPERTY OWNER alteration or relocation:
ZOO amps or less 2
Name (print):.1/ e // ls-- 201 amps to 400 amps 2
•
Mailing ' !� 75 � 4 01 amps to 600 amps 2
6 �d? �/t .
• !ma 601 amps to 1000 amps 2
City'
> r1q St [ZIP: ? 7�zy Over _ 2
s � I Stt `, 1000 amps or volts
Phone: 60 -g 5•`. ‹.5114 4 I Fax: J E -mail: Reconnect only t
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 teas 2
201 amps to 400 tuupa
Owner's signature: Date: 401 to 600 amps - 2
Branch circuits - new, alteration,
Name; or extension per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch Circuit 2
City: State: J ZIP: B. Fee for branch circuits without purchase f
Phone' Fax: E or N esvire or feeder fee, that branch circui 2
Each additional branch circuit:
PLAN REVIEW (Please check all that apply) • Misc. (Service or feeder not included):
0 Service over 225 umpa- commercial 0 I care facility Machu pump or irrigation circle 2
❑ Scrvieo over 320 amps - rating of 15:2 Cl Hazardous ioCation Each sign or outline lighting — — 2
family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
O System over 600 volts nominal more residential units in One structure alteration, or extension* 2
0 Building over three stories Cl Feeders. 400 amps or more
Cl 0., u p nrt loadover 99 persons U Manufactucrd structures or RV park = ori ptio - .,
o E rrss/li htin lan - Each additional inspection over the allowable in any of the Above
K g Kp ClOther: Per inspection I I
Submit _ sets of plans with any of the above. Investigation fee
The above are not applicable to temporary cum ucxtoit service. Other - "
Not all jurisdictions accept ese it cards, please call jurisdicti for more informs Notice: This permit application Permit fee $ _ CI Visa O HlastetCani
expires a permit obtained • Plan review (at — °lo) -
C+Nit uunl number; f I within 180 days after it has been State surcharge (8%) $
Expires accepted as complete, TOTAL $ 2_, 9t
Nntnc of Cardholder as shown on credit card
Cardholder slecsa[une n,,u„:.t
440-. (its (G/ppiCOM)
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: < .(503) 639 -4171 MST
BUP
Received Date Requested 3 s AM PM BUP
Location / ' 44' Suite —' g 2003°' 06/3y
Contact Person !< 4 Ph ( ) 6 q O "3 Cv O 7 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner et 3 -00 /5
Footing
Foundation ELC
Access:
Ftg Drain 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
PAS FAIL
GHANICA
st & Burn -
Rough -In
Gas Line
k tampers
g iy i j FAIL
LECTRICA!
Servi -
Rough-In
UG /Slab
Low Voltage
Fire Alarm
1,111% 111 P RT FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
S" - ❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line - — -- - - - — — - — —
ADA a.9 7 /
Approach /Sidewalk Date / Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL