Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2001 -00284
li' DEVELOPMENT SERVICES DATE ISSUED: 06/01/2001
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S11 -5BC -01200
SITE ADDRESS: 16660 SW QUEEN MARY AVE
SUBDIVISION: ZONING:
BLOCK: LOT : JURISDICTION: KIN
Project Description: Installation of (2) branch circuits, wiring to NC and furnace.
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):
SERVICEIFEEDER 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:
WOLF, RAY E + JOAN NE WEST SIDE ELECTRIC CO INC
16660 SW QUEEN MARY 1834 SE 8TH AVE
KING CITY, OR 97224 PORTLAND, OR 97214
Phone: Phone:
Reg #: 1 1 - 1 50306
SUP 1556s
•
ELE 26 -135c
FEES Required Inspections
Type By Date Amount Receipt Wall Cover
PRMT CTR 06/01/2001 $53.50 2720010000( Elect'I Final
5PCT CTR 06/01/2001 $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 Si ? Issued By: 440 .
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: (r4 012 ,9/( DATE:
LICENSE NO: 1-laCn 3 5
Call 639 -4175 by 7 :00pm for an inspection the next business day
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Electricaj l eruirt Application '" '
E7f
...4 't. �, city of Ti rd Project/11W,nu,. E thito:
C & pa/ igeld Atidr88s; 1312.5 S Nn1I Rhd,'I'igarc, Olt 91123
Nur let *aIUd: By: Racetptpu,;
Phone: (103) 639- 171
Pm: (503) 598.19 0 Girt nle no.: Payment ypc:
•
II use spine al: —_ _
Till OF 1'h.li N1 I'1' .
CI 1 1 family dwelling or access n7 U Co mneteialfinJuetrial U Multi family Q Ten Irrq+rover ent '
G Ne o trarteltetina U AdJltlnalallerntiodrrplaecrnant U Other: _• . _ • - , _ _, CI Perri
�e t11 1r� .11)11 sl I I: INI:mr.%1, .I 111V ' :; is, •
sura»;i ; t Aii Suite no.: Tex ma.. tax oil • •cunt no.: .,
Lot; Block: S bJivislon: I
Project. - - - -- _. _. .. .. _. _...., . - - - -• -
-_ nnme: We . 1)eFcdp,itln and location of work lmpretNses; t. , Q
EetIrna oil dote of C0111 /ICI ilt!Ji1 r 1i:�ir -
CON! lin(.. APFLI(:AIION I'1'I:. S('III i)1'I.1
Jos se 7 FIR
BUbiae' � 3 I r ,B - rial t 4 . eW .. Noce tloa r
f�ili?I�ttii�a �: - - - e % re • s' _ ..aro* -el Inlet . •
dweltly*all Inds*. attadtd wags
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Phone: 1- t- t V • f ruci■'. a ntn ila' , e 4 ``r •Ooe s s
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Bach midlttonol0Va -, n.or • nttl nntherell
CCl9 n* .. • • . (o _ c � e. bug. lie. nu. , Z (p - 13 5,7(,__ � MN -- .. rr ,rear clunk!
Cl in fro lie, no,:
- w __�� C n 8y, non roeidvn n!
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_ 1 e- Q Gash ch maiinuf m rctraed hpmo or odule► dr olinig IIIII
I 1 of to r 'Darn Sardine WUYortenter
. name (l*ltnt 1�.._ ., IA, pucena, 2. f 3 s sort no erreeeens - IeriZtiml; _ •
etterallton srrelocation
1'11111'111 1 I' O N l i.R 200 a orlon ba■ 2 p
•rh11 : IMS..,/ . a 1 0 . , drape Men
701rr•.eto6000 .a
Medlin • address: , • J . ,. , , . - , -- amp �
401 am io 1. 0 an e
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Cl : Ft -- State: y ZlF: Ova 000 "In , torvolts -, =� •
Phone: x: &
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�� � • eccecrct o
Owner nstallatiorf: The ins taiatitm ..t Nino mode Cot l)l'ONnrty I uwu t.pariry serneeser ee. -
' which i. Mit inletdesd fur etdo,:ease rent, Of exehangr! according to MetaUsuon, ■Yecarhen,nndersUont 1111111111 .
MS 4.7, 455, 479, 670, 701_ f 200 ea .s ar ion •
151 am eto e' r a 1111111111111 .
Owner" s = milt re: Uq.e: no as RID Lon a INN 111111=1111.J♦1i1r
I..rt:I vI l' It .e c , .new atlelat on, •
•
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or ulasilen 141
None, A. I for brotch cireuila will putchnee at ff e, '
Address: aenlcc or react ree hrm,clr circolt 'lb 5
City; • t • rune: ZIP! B. Its Mr htsrsit circuits Without purchase
Phone: Fax: 1� fi•InBil: ott> 4rvl :vor reeler ha,Nttbrlukbulrculy ,'
!?c�chiaJilional branch el /wit: EMI immium —
II..hN Ill, vtl•. y1• 1 1 '1*•,rar'rheek'nII Ilea nl'II)•1 Ulf esor hider ro* Inc u•e•)1
O Sind - o's22!erupa4artmerelsl O IIe iib•cuetscWi Each • in a(ert cliele
O ^ ^— •
Beni over3 m F4.2. U
20 es - r. , I of I Hourlong !wailful Fads el: n or outtino li hB 1lrt�
tpmlty.A ' 0 Nuliding„ -er $O, :Ott lrpi ns 14e lour in Shied e;tculue) or n for n IlrnileJ energy parrot, III
O System over 600 voila lumina/ more rdriil.mtsl units In one rwclure elteragon, or eatmalun•
O Il„ lIdLigover three alullee Q Foccler., 4nu grope ur rtegre r
OOttuplrrt lend ewer 94parsons 'Cl NIrminetureJ 6WCWr.nornV pant 'Vend -lion: t o
_
O tee 'It Pon Unlink/II un • Ytrg.ctlga 'ovine Wloha6 • . are
Ci 8 YI+Imr U new __,,, l4tl�*. ,:non ����
Subell art. Opt I r any ur the .bays. —
e above are rot *applicable 1. (emperor) curw redo■ melee. e
not ell arm aeespl crarN li es: , view ml) :d.&lhn Vol tn bit mul ' Notice: '1'flta pennit appliCatiol Perrot fee $ '� 7
0Vise ! l.7 Mann Ond P lan Itview at . . % '
e:rl,Lrea If ■p t o out o ( ) $
Credit eve ombet: ( _L_ within 180 Jaye alter' It hhh boat St to surcharge; (8%) ,,. $ � _ �
�Na�ie of cii eldae a, aw„ uei c.edtt ceh� - - � t+ : �'•s accepted al convicts. TOTAL ........... .......... $ _`7. - 7 g,
4
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T0'd LL90 92L 20S 0I21103 - 13 3QI9 133M Wd 2Z:90 TO— TS —AUW
05/31/2001 15:39 5036393771 CITY OF KING CITY PAGE 02/02
KING CITY
lh,Ai
15300 SW 116th Avenue, King City, Oregon 97224.2693
Phone: (503) 639.4082 - FAX (503) 639-3
�_�
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Notice. To Contractors Working In King. City
Due to an•intergoverrimental 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 no processing will occur until a
complete, legible application is received.
If your permit application DOES REQUIRE PLAN REVIEW, this farm 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; Z r 4
located at: /' / &1v6) 6Qen )'li.
King City Representativ
I DSTSKCINST DOC;
•E 6/28/2001 Activities for Case #: ELC2001 -00284
• 9:57:47 AM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELCA001 Application received 6/1/2001 BB DONE No Hold BB 6/1/2001
ELCA003 Permit created 6/1/2001 BB DONE No Hold BB 6/1/2001
ELCA720 Wall Cover No Hold BB 6/1/2001
ELCA799 Elect'I Final No Hold BB 6/1/2001
ELCA500 (F) Issue permit 6/1/2001 BB DONE No Hold BB 6/1/2001
F
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