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Permit CITY OF TIGARD ELECTRICAL PERMIT • PERMIT #: ELC2003 -00023 '1 - l DEVELOPMENT SERVICES DATE ISSUED: 1/23/03 13125 SW Hall Blvd., Tigard. OR 97223 (503) 639 -4171 PARCEL: 2S110CC -09900 SITE ADDRESS: 15695 SW QUEEN VICTORIA PL • ZONING: SUBDIVISION: KING CITY NO. 3 . BLOCK: LOT : -012 JURISDICTION: KIN Project Description: Install 2 branch circuits in kitchen. 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: ' DARRYL MAURER BOONES FERRY ELECTRIC INC , 15695 SW QUEEN VICTORIA PL PO BOX KING CITY, OR 97224 WILSONVILLE, OR 97070 Phone: Phone: 682 -4936 . Reg #: SUP 3170S LIC 88482 FEES ELE 3 -223C Description Date Amount Required Inspections [ELPRMT] ELC Permit ' 1/23/03 $53.50 [TAX] 8% State Tax 1/23/03 $4,28 Rough -in Elect'I Final 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 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699 or 1 -800- -2344. / / Issued By: I/1, , / / 4 Permit Signature: ,t1,Qc. (0 ��. 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: /9 / d Call 639 -4175 by 7:00pm for an, inspection the next business day . 1 -03 08:: 52A boones ferry electric ' P.01 • I • Electrical Permit Application 1 O 1 . E � Date received / -a3-195. ,Permit no. &A-0,5:49,' .iJ,' 6 • City Of Tigard RE C V C G Project/appi, no.; Expire date: ' ' City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: Eng Receipt no.: Phone: (503) 639 -4171 - JAN 21 2003 .- Fax: (503) 598 -1960' Payment type: • Land use approval CITY OF TIGARD . l l'1 01' I'l.lt:lll I I & 2 family dwelling or accessory ❑Commercial /industrial , . ❑ Multi - family ' ' ❑.Tenant improvement ' • New construction , 45 .. Addition/alteratioa/replacement Cl Other, Cl Partial .1(111 .1I Ft. I \ I OR 11 1 I IO\ Job address: J ' ate e." V: c 4. . PL Bldg. no.: Suite. no.: Tax map /tax lot/account no.: . - Lot: Block: • ] Subdivision: ' Project name: ' Play re r [Ilescription and location of work on premises: , j, a 'C r k4 5 • et ki a c h e Estimated date ofcompletion/inspection: Jan 03 . (Y)\ I R 1.( I OR 11'I'1,1(.\ I'IO\ VI F S 11 [.DI I I Job no: ) I3o ' . Max Ive.rr.:idrt�l.I- per �' Tam aolnsp Business name: Boones Ferry Electric • Address: P .0 . Box 626 dwelNagaau.lachrdesanachedgarage. City: Wilsonville State:ORIZIP:97070 Ser+'icelat : Phone: =4"936 Fax: 682- 79,I$•mail: moo sq. R.or less . - CC'B no.: : : 4 : Elec. bus. lie. no: 3-223 C Each additional 500 sq. ft. or portion thereof I,imitod clergy, residential City /met • li e. no.' 0000 2 8 51 Limited energy, non- residential .l 'Wa J — 2.1 - 03 Each manufactured home or modular dwelling Signa . of s . - icing electrician (required) Date Service and/or feeder Sup- ea.. rrame Z5 7 Herron Services or feeder. - Installation, a (print): L icense no: ''IB alteratl000rrelocatloa: 1' R O I' l R IN O 11 NI It 200 amps or less Name (print): pcx.,,. y i - r1 ay r e, ✓ 201 amps to 400 amps • 401 amps to 600 amps ' Mailing address: 601 amps to. 10 amps , City: I State: ] ZIP: Over 1000 amps or volts , Phone: . 'Fax: , I E -mail: ' Reconnect only " Owner installation: The installation is being made on property. I own Temporary 'evokes a feeders - - which is not intended for sale, Icase, rent, or exchange according to Imtallatloaalteratltra ,orreloeatloof ' • ORS 447, 455, 479. 670, 701. 200 am p'' or less 201 amps to 400 amps Owner's signature: ' , Date: 401 to 600 amps I \4 :I \I R Enoch circuits - new,alteratlon, or extension per panel: • A. Fee for branch circuits with purchase of Address: service or feeder fee, each branch circuit 2 It. ode far branch circuits without branch purchase � © ol' service or feeder foe, first branch circuit: Each additional branch circuit: I'1. RUN II 11 (Pleas(' clht•uI, all that apply) Misc. (Service or feeder not Included): LI Service over 225 amps—commercial U Heahh<are litcility Each pump or irrigation circle U S over 320 amps- rating of I &2 CI Hazardous location • Each sign or outline lighting . family dwellings U Building over 10.000 square feet, four or Signal circuit(%) or a limited energy panel, U System over 600 volts nominal ' mom residerital units in one structure alteration, or extension" U Building over three stories U Feeders, 401 Imps or mad ' 'Description: U (Occupant load over 99 persons ' . U Manufactured structures or RV park Each additional Inspection over the allowable in any of the above: U Egress/lighting plan U Other: -- --- Per inspection ' Submit sets of plans with any of the above. Imrstigatjoo 'foe ' • 'Ilse above are not applicable to temporary, construction service. Other Permit fee $ 5 • 3 . so 'No all i tiredrcnnns accept reedit cards. please call junsdicuon tier mar infnrmaurm Notice: This permit appliention U Visa' :;) Master(:aril ' Plan review (at _ %$ ^ ' expires if a permit is not zhbtainced ) . • Credit card muster . . - . , ' ( % . within 180 days after it has been , State surcharge (8 %) $ - • , e . • Expires accepted as complctc. TOTAL • $ S 7 , 7 3 Name o f cardhol as . show n on rude card -' . -. ..Car rr Cardholder sianane _ ... . _ - 1441-461.5 I(UfX1,CUM) • 01/21/2003 13:24 5036393771 CITY OF KING CITY PAGE 02/02 . • , - • KING 41 CITY o Ism sw.. 116Ch Avenue, King City, Oregon 97224.2693 ., E GEIV .....* Phone: (503) 639.4082 • FAX (503) 639 -3771 JAN 2 .5 o • BUILD GM( . D SIGN Notice To C Working 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 PLAY REVIEW, simply complete the appropriate application legibly and submit it to the King City staff. The 1. wing City staff will collect all fees and fax the application to the City of Tigard. City of Tigai d staff will then create the permit, issue the permit, and perform inspections. Please indicate on t permit application whether you would like the Tigard staff to call you when the permit is re iy for issuance or whether you prefer it to bcf mailed without any notification. Any iricompl ,tte or illegible application will be returned to King City staff for correction and no proce.;sing will occur until a complete, legible application is received. If your permit application GOES REQUIRE PLAN REVIEW, this fora] 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 Counte: located at 13125 SW Hall Blvd, Tigard, to submit applications and plans. Development Servic - s Technicians are available at 639 -4171 Ext. should you have any questions concerning •5ubmittaI requirements. All permit f 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./LOA/ �.1� .. �,q� � "7 -01.1-1 2r?" r/ located at: AS to 9 Sk, ) QM ILO q t 0.1 _" -,� f�„� • __&.a..14....)-1-41 King City Representative 1 1: DSTS'XCINST DOC • • CITY OF TIGARD 24 -Hour - ,, BUILDING - Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP Received Date Requested r° AM P BUP Location / 5C7 -' &(.2 � ( a suite `� MEC Contact Person rc� F.�� ��y -ei, Ph (• ) 6 g Z - 3� PLM Contractor O Ph ( ) SWR BUILDING Tenant/Owner G.1 ELC v WD 23 Footing ELC Foundation , f , Ftg Drain es . ' - • / �"v Mae- 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: • Other: Final PASS PART FAIL PLUMBING (1/ 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 Fire arm 40 ���� J Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. 4 :41110 PART SI ❑ Please call for reinspection RE: f El Unable to inspect – no access Fire Supply Line � ADA �J ~' �, Approach/Sidewalk Date - Insp or � Ext Other: Final DO NOT REIN OVE this Inspection record from the job site. PASS PART FAIL