Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2001 -00570
0� DEVELOPMENT SERVICES DATE ISSUED: 11/14/01
��� 13125 SW Hall B Tioard. OR 97223 (503) 639 -4171
PARCEL: 2S 102 BD -01701
SITE ADDRESS: 12830 SW PACIFIC HWY
SUBDIVISION: FREWINGS ORCHARD TRACTS ZONING: C -G
BLOCK: LOT : OOA JURISDICTION: TIG
Project Description: Install 2 branch circuits to HVAC and swamp cooler.
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:
GREG WHITE AMP ELECTRIC
12830 SW PACIFIC HWY 12209 NE FOURTH PLAIN #U
TIGARD, OR 97223 VANCOUVER, WA 98682
Phone: Phone: 360 - 892 -4499
Reg #: LIC 78152
SUP 3869S
•
ELE 37-561C
FEES Required Inspections
Type By Date Amount Receipt Ceiling Cover
PRMT CTR 11/14/01 $53.50 2720010000( Wall Cover
Elect'I Final
5PCT CTR 11/14/01 $4.28 2720010000(
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: ,Q �y c t 1 Issued By: (ii /e
`T . 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
Electrical Permut Application 11'
is
- . y.
Date received: / I 0 I Permit no.:� -770 r
City of Tigard Pro ect/a I no.: Expire date ` . '
.
City o�gard Address: 13.125 SW Hall Blvd, Ti OR 97 Date issued: By: /1 I Receipt no.: i -a: =`
Phone: (503) 639 - 4171 - -1' ,,.i Fax: (503) 598 - 1960 77 Case file no.: Payment type: I ',1q -'
Land use approval: ('`.`
TYPE E OF I'1•_R:MIT
O 1 & 2 family dwelling or accessory Jt Commercial /industrial O Multi - family , ►- ' `mutt improvement * :::!,,O New construction 0 Addition /alteration/ eplacement O Other: O Peitlal .
, ;
,108 SITE INFORMATION f "., ;
O. ad ,�*;'i�'/ " ' ,: )gg. no.: Suite no.: ; ax' ' ap/tax . cotiint no.:
Lot: Block: Subdivision: 5, ` ` '
Project name: Q4(/ /fDwf ; s i r s ,.,, Description and location of work on premises: C - f c m.,° co fLlf
Estimated date of com . letion/ins ' ection:
t t)\ I It \t' "lOIt . l'I'1_I('ATI01 i ?. I ".1 ill t); i
o.. L
a u ' `:
Business name: A e p, p ELC 6-7 /G Desert O° , `,. -
N ew residential - single or mid-family per t r.. '41:s;
Address: /22 0 9 //S /./ /ctrl /h/ /2 / ti dwelling unit. Includes attached garage. P ;`':
City: , ZIP: ' P- F2 Service include&
. ,, ' . g!, 100 sq ft. or less ; $,
. 9L- Fax 2 6 / E i'
CCB no.: 79/52. Elec. bus. tic. no: jZee/ C Each additional 500x•. ft. or portion thereof 111111 NM
Limited energy, residential MI 111111N11 .., .,
City /r etro lic. no.: Limited energy, non- residential _— 2 ' •
de" / I 0—' — / 1 -8 -0 / Each manufactured home or modular dwelling >;
-�. acre • su. psi ; electrician (re.uired) Date Service and/or feeder III `•;
elect oame not ., �/ 6, T License S Services or feeders- Installation 5 :
Sup. (p ) :.T— alteration or relocation:
.,t:`,:
1'1it►l'1:1( % %NIR 200 amps or less ; ; .
Name (print): 201 am to 400 amps 2 '
401 amps to 600 amps 2 . .. - :',
Mailing address: 601 amps to 1000 amps 2
City: State: ZIP: Over 1000 amps or volts 2 -l?r
Phone: Fax: E -mail: Reconnect only 1
Owner installation: 'Ilse installation is being made on property I own Temporary services or feeders - 'ti''
installation, alteration, or relocation: '' `-
which is not intended for sale, lease, rent, or exchange according to ,
ORS 447, 455, 479, 670, 701. 200 amps or less : -:(
201 amps to 400 amps C '' '
Own(a's si: ature: Date: 401 to 600am.s — lila `7
1 Branch circuits - new, alteration, _
or extension per panel: ,::: '.'
Name: A. Fee for branch circuits with purchase of
Gre gg: service or feeder fee, each branch circuit
City: State: = l' . '
C
S tale: ZIP: B. Fee f branch circuits without purchase •
i : .
of service or feeder fee, first branch circuit: 2 . q
Phone: Fax: E-mail: Each additional branch circuit:
1'L.\ \ 111' II tt (Please check all that apply') Misc. (Service or feeder not Included): —
0 Serviceever 225 empf- commercial 0 Health -care facility Each pump or irrigation circle 2 y " F ,
0 Service over 320 amps-rating of 1&2 0 Hazardous location Each sign or outline lighting 2 I Frt. .
circuit(s) or a limited Signal ener T., ' �'` family dwellings O Building over 10,000 square feet four or Si g gY Panel, ,,, ;,. Ps 0Systemover600voltsnominal more residential units inonestructure alteration, or extension* 2,- '',a0 Building over three stories O Feeders, 400 am or more . Descri , lion: +�' i- 0 Occupant load over 99 persona 0 Manufactured structures or RV park Each additional Moira* l Inspeetion over the oi,s* arm)' of the above:
0 EgressI ightingplan 0 Other. Per inspection { c Submit sets of plans with any of the above. Investigation fee _, 'Ilse above are not applicable to temporary construction service. Other s
Permit fee $ • to..',
f�'�r.� '
1t all judrdictices aexpt credit earth, please call jurisdiction for more information. Notice: This permit application : ; ,
a.
0 MasterCard a— expires P
ex Tres if a permit is not obtained Plan review (at , %) $ "'r �,-
o cu d number 09 - 6 8 PO' -• DO /O - � p '& / ' I within 180 days after it has been State surcharge (8%) .... $ '( 2 F I( "
,q tr..� + p
'r /. ��,/ 6h-r Expires accepted as complete. TOTAL $ . e • >
�C- • r:v
arcar es mown on credit earl .::,?'', "`
Amount ` .
dnrol ttl gnftnca i 4464615 ( 6 1 00 itw ma4 .- s k •
T 0 ' d T9LLZ68092 0 , l l3 •wtj Wiz' 00:60 TO— £T —AON