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Permit CITY O F TIGARD ELECTRICAL PERMIT PERMIT #: ELC2003 -00284 DEVELOPMENT SERVICES DATE ISSUED: 5/20/03 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2 S 109 D D -0 5700 SITE ADDRESS: 12690 SW PRINCE ALBERT CT ZONING: SUBDIVISION: BLOCK: LOT : • JURISDICTION: KIN Project Description: Installation of service /feeder and (3) branch circuits. 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: 1 W /SERVICE OR FEEDER: .-8 PER INSPECTION: 201 - 400 amp: 1st W/O SRVC OR FDR: 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: GARY CURTIS TICE ELECTRIC 12690 SW PRINCE ALBERT C T PO BOX 15009 KING CITY, OR 97224 2139 SE BELMONT ST PORTLAND, OR 97293 -5009 Phone: Phone: 503 - 233 - 8801 Reg #: LIC 166 SUP 2586S FEES ELE 26 -126C Description Date Amount Required Inspections [ELPRMT] ELC Permit 5/20/03 $100.25 [TAX] 8% State Tax 5/20/03 $8.02 Rough -in Elect'l Final Total $108.27 This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246-6699 or 1- 800 - 332 - 2344. ` Issued By: Permit Signature: 67S/ , %oLCe�i / OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale, lease, or rent. OWNER'S SIGNATURE: DATE: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N: • DATE: LICENSE NO: Call 639 -4175 by 7:00pm for an inspection the next business day 05/16/2003 14:49 503 - 872 -8290 TICE ELECT.SERV.DEPT PAGE 03 �/ 1 . •;.•:k 1'., 'zit [yr :ij , M1 ' '. : 12:0„' 1 L�'R,+ ?'0i-., f!J'tgiyl . ..71e } K:r F I •Uli 11Fl IC C [ISL Ui \L�' Electr�icalP p u c af o •1- I 1 n , , �7 :12 el:,y ,,: ' .. � wyl+t - •'�jY y' i t � '�' i, .�, �Jr .4: �SI `f i}.7 "•' �. � City of Tifgard . ., .. ... ,, v , d%a�.fi Felnn{t'No.I ' ' 13125 SW Hall Blvd. E '.! 7:::: °:':.w'^+ J ;' • !:. ' • Tigard, Oregon 97223 ' • . .. A.. J `, i : .. ' t , F • tE '•' • "t'7� Phone: 503 - 639 -4171 Fax 503 - 19 i , •., Internet: www.ci.tigerd or 1 " ' , ,13,„.' `_1 -: } , :a u ; ` -, " •., ' 1,2 a :' • 24-hour Inspection. Request 503 A t i e:-i ...1„..13,„.' ` ti.' - .•,;, W 'i: v :' ;•:::t: - «:« • . ' ,4 ,, , iomei ntl3afosntwtlo: ,,.<. • BUILDING —' - • ••: • gvnj '?itd` , V t,i s.;r'r;::..,,: • • ! ,.t, 1 . . • , 1i , '; "U :r, ,;,1, �_,.• \ 7 .i, . I .r. 1I I ' 4 .- :1.1r. •,L :'S • f ? ; li - .', ; ■'.$et'yl@OOVaf E 3- 1144111 rare thcihty L. A . I. Now construction I■ Dei;aolitien > It llar�tdous location . - . oomnraanisl t A ddition/alterationtr . • lacelncn L I ■ Other: '.:'. ' . 13 Sar me over 320 amps-sadng of • • ❑ Building over10,000'si =4. f. eoi. • t rdA I T5if.;i;'t:' f •o-� It : l': "'I;'... I & 2bYadiydweUtags . more E 'I 1 & 2 -Famil . d _ ' I I IN E. , ! '' etralaVilic li8tieial D System over 600 "It' nominal one strttchue,(.i • .,:.; :•, • -- .,, CI Building over dues stories . Ci Feeders, 400 atig or more RV park I. . AcCCSttOr Buildlt7� 8Zn1y , Q $ �i w e II , G;1 f � , , o, u ` 1N fA 1 • Master Builder , xS the abov& • { -F p u'lth any of m ?..., <'•' ): +. I T C I 1 !f') •!`t 1t .,: tai, .. J i t it yvq TlbC iliiii *rsnot•e- • eableto tent • ' nitrar,7iloti.' C& 1 Job ± address r ,,, ,. . a il �: fF ti °i`! +yfi1;;:', ;.,1 11 • Suite #: . Bld t A.t. #: .. .. ...'. •... ...r . - : • "- Number Of los , actio ' t allowed • . Pro'ect Name: Curtis . Ksw . ranitt•asvur.p.r ' ...' cross • street/Directions to. job site •d taaaae..tt rod „ .0', 0..0v — 1/•.t. 'f�• _ ?'':`'•: • . ' • • .. . l airl3' ;; Iddltidaal " h or. •. thereof • "" ' • ` -'- • ' ' .. 4 • . L Ot # • .. h7t,!'!T''; :aim_ —„' '.° >m SulldiVlb7on: .. ;ol. • ±i.1: i11(irp;.I ,, , (, a.'/• ' .. i I sec. 9f_t9 :! lt; a 0Y..1".'14:7 . •-- .. _ •_. • f s & a•• y riririg_ _ ' ac. • an ; ( ; " .�•. . -'r ..., .. ; r � •. „ 8g� 3e. .201 . ^ W. 11 --4,6-=,-**"'-- .. ,.6- :'1g: l . ItS' �' • f"""'r"•'"''...._._.:.... - '- An to , ... ,..7_....-- ..._....._ :__ .. ®I. 160.60 • • , l • 10:1000 ■•z ]......-�:. 1 • 240.60 • a i °x': !7:1 �'6'�';1 %i1.JI,7 }� °,''s'351: i'i. •� ' • p • .Name: GA-ray &.I 1 Q -(1.S ; • • • .. ..... .. • Reooanmx ®!y .. • • • 66.85 • . • • Address: . . J 2!0,i n 41.0 f R 1 NCc fl T CT. • Ts'uperary services or &lidera - Installation. elteratloo, or Macedon' • • �� s City /State/Zip: J<j •/�G C , , 6'/ 9 702.2 `f ..' awe . 200 awe or lea • 201 •• to400 iii 100.30 Phone:• . .. • : •40 1to •"amps' . ' �1e- 433:75 :`• WI E ;! :IEill';. • : ' , 1'. , ,., ,.. -._, ... 1 ., ,; „ ' , !'I . ..715.1;•: & aaiebeltsult $• new, situation,or' • Name: ; ' ”' . esteadop p r� pan� .-� • • A.tm far 6ra d with p weh o n of 6.65. 19, 95 • • Address: . • «.1 • . _ f_ h�aochoirouit . Ci /StatefZi • : : : . • • ' yyrr Ibedeete%q -.... Phone: • •Fax: .. " Each edd(donel•bfseoh circuit.' • • • • ' 6.65 ' • • . Sat,rloe or feeder not included): included): :53.40 8 • E- 1778:1: Each • • . co : •:.. - : le • ' .. . .. , • • . - • y ' • •" - U •l:a,' • or ,•, ti �, 53.40 © Job.No: - . ' • ' its • H - ' �,Qz -.) ' s . • cirarit( s,) ma tiooitrd ® ,. Business Name: Tice Elt t. f c Co Daaipofon Ion . :.i k f• , , , , ...... •• • • • , .. a , • PO BOX 15009 • • Each addItloaal Impecttoa over the allowable In • - of the above: .. . • Ci /State/Z1 •: • :..fft♦ „. .. e1: • — t t . .. • _ , •.per , . _ mm;l.hour :..-_._ --•- -'+ : -- �'�'.. : Phone:. 503- 233 - 8:01' F:. 503 -872 : 290 iff� " . s • CCB.Lic. #: 166 •• . Lie 2 ..�.- _._ -.._; ��t.;= . „,I,'i�',�,�,ia, � 4 _ _ . _ ..,. _ -. -_ Supervising electrician / . „• . . .. ..._.,�;.�....!._...^_� ; �-p ..;. - . sl •, � : ttl>,e r-• � tared: • . . • ,. ..... �... :... 1 J •'� 1!CcYi Y. of Pcrurit Fee' Print Name: - • • ..'�'s!l�I Lie. #: • S ' '' Stns Surcharge (S% of Permit Fee 1 MN= , • - • . - . u, , : :. ..._.: _ :..:•TOTAL .$.. .: • Authorized .. - .. . , 1Qeticet'Thls permit eppnetttloa esplra If a penult b not obtained vfllthla .. • Dom ' : 180 days otter It has been accepted as complete. Signature: , • ~ : *Fee methodology set.br TVS- Count* Building industry Service Board. (Please print name) . • ' EOII r s e t.. ize it CA! ufrny •,:1:'ufl :... • . . I:\Dst. smut Formsll:lc.PsimfilA00,doe 01/03; , . • ' •. ”: .,.. .' ..' • • • . • .. L.. .. • . < .. ` i •. �. 'SSi , .i1 ;•.i.,..... .. .t•••. • • 05/20/2003 08:57 5036393771 CITY OF KING CITY PAGE 03/03 :r� • • K .• • 15300 S-W. 116th Avenue, King City, Oregon 97224-2693 : .111 Phone: (503) 639 -4082 • FAX (503) 689.3771 • • • • • • • • • Notice To Contractors Working In: Icing 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, stinply complete the • appropriate application legibly and submit it to the King City staff. The in 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 permit application whether you would like the Tigard staff to call you when the permit is re' jdy for issuance or whether you prefer it to be mailed without any notification. Any incomp lete or illegible application will be returned to King City staff for correction and no pros sing will occur until a complete, legible application is received. • If your permit application DOES REQUIRE PLAN REVIEW, this fo i mitst 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 Count. located at 13125 SW Hall Blvd, Tigard, ro submit applications and plans. Development Servic•;s Technicians are . • available at 639 -4171 Ext. 304 should you have any questions concerningisubmittal requirements. All permit fees will be assessed and collected at the City oil Tigard. The City of King City hereby authorizes applicant to pursue permits at th- City of Tigard ' 1 Building Department for the following project: 10 A.t L^ L;., i located at: /Q tD P />.1�/t,c _ o_ _ „ �� Q�,t at . ! • • King City Representative j . • • • I: D5T5XCIJSt o0C • • • CITY OF TIGARD 24 -Hour BUILDING Inspect' n Line: (503) 639 -4175 MST INSPECTION DIVISION Bus' ess Line: (503) 639 -4171 BUP Received Date Requested "O A//M�� PM BUP Location , - (o 7d f /Li e- d4uite MEC Contact Person Ph (_) 9-3S PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELCa el0 3 a 6 -0N 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 C/95( 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 PASS PART FAIL MECHANICAL Post & Beam Rough -In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Service Rough -In UG/Slab Low Voltage Firr. larm 4410 PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. S 0 Please call for reinspection RE: ❑ Unable to inspect — no access Fire Supply Line f� ADA Date v In ector � o 8 L� Ext Approach/Sidewalk p Other: (1 Final DO NOT REMOVE this Inspection record from the Job site. PASS PART FAIL