10830 SW GREENBURG ROAD-1 I
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1 1)830 S6l ORE::WBUR0 ROAD
CiTY OF T; GiAI-�D 24-Moui-
BUILDING Inspectio,, Lige: (503)639-4175 MST
INSPE"7;ON DIVISION Business Line: (503) 639-4171 Sup
Received —_- _- —Date Requested___ _/�22 AM— —_ PM _ __ SUP —
Location __--_--,� �'� -- - � 1� .Suite_ —__—_ MSC c �
�-
Contact Person —.— -- ----_-._--_ Ph( (/—) — PLM _-__--
Con`,ractor --__—__ — _-- Ph( ) -- SWR
BUILDING - Tenant/Owner _ ELC, -- _---
Footing ELC --
FoundaJon Access:
Ftg Drain ELR —
Crawl Drain SIT
Slab Inspection Notes: --�--
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
AIL _PLUMBINQ — — -- - -
Post&Beam -- - -
Under Slab ---
Rough-In
Water Service ------ - --Sanitary Sewer
Sewer --
Rain Drains --- —
Catch Basin/Manhole
Storm Drain %
Shower Pan —
Other: - — --
Final --
PASS PART_FAIL —
MECHANICAL -- -- ----- - — — —
Post& Beam —
Rough-In -- — ----_.�-- — ---- -
Gas Line
Smoke Dampers — ------------ -- — ---- — --
MIT
PART FAILRICAL ---- ------- - ------- --
Service
Rough-In -
Urn/Slab
Low Voltage — -- - -----
Fire Alarm
i 'r"3i L-] Reinspection fee of$.-, ___ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
— Unable to inspect-no access
SITE Please call for reinspection RE:_______ _— _ P
Fire Supply Line
Ap roaclVSidewalk ADA Daft -_ Inspector _Y1 ------------Ext ---.----
P
Other:
Final OO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL
CITYOF TI GA R u^ _ ELECTRICAL PERMIT �—
PERMIT#: ELC2002-00221
" DEVELOPMENT SERVICES DATE ISSUED: 5/15/02
--�' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171
PARCEL: 1 S135BD-01300
SITE ADDRESS: 10830 SVS/ GREENBURG RD
SUBDIVISION: ZONING: C-G
BLOCK: LOT : JURISDICTION: TIG
Proiect Description: Repair of roof conduit.
_ 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: SC1+amps - 1000 volts: MINOR LABEL (10):
SERVICE/FEEDER !BRANCH CIRCUITS AGD'l. INSPECTIONS__
0 - 200 amp: W/SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FOR: 1 PER HOUR:
401 - 600 amp: EA ADD't. 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;_ Y
Owner: Contractor:
SCHAEFER, ROBERT M + SALLY J + GEORGE SONS ELECTRIC CORP
MILLER, GERALD V PO BOX 339
BY SHIL.O INN-WASHINGTON SQUARE CLACKAMAS, OR 97015
PORTLAND, OR 97225
Phone: Phone:
EXPIRED Reg #: M-65 4
ELE 3-117C
_ SUP 3185S
FEES__— _ _ Required Inspections__ _
Type By Date Amount Receipt Ceiling Cover
5NCT CTR 5/15/02 75 2720020000( Wall Cover
$3.
Rough-in
PRMT GTR 5/15/02. $46.85 2720020000( 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 pert,it will expire if work is rot 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 ordirect questions to OUNC at(503)
246-6699 or 1.800-332-2344
Permit Signature: �'� Issued By:
OWNER INSTALLATION ONLY
Tho 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. ELFC'N: � ) _� � `_ e DATE:_ _
LICENSE NO:
Call 639-4175 by 7:00pm for an inspection the next: business day
F15/08/2002 09:46 503-653-6886 GEORGE & SONS ELECTR PAGE 01
17"'RE®
Electrical Permit A pplim ion
ketrait iso,: V
L*y ®fnn)ecy.ppl.no.: Bxpkedw:
Cilyn'jirard Adiftm: 13125 SW Hull 91wI,j%Wd.OR 97213 I)ttteissued: I By: t i Rotriptn0.-
Phone: (503) 6394171 rMo��: PaywLat rypc:
."ax: (503) 599.1W
Land use approval: ! _,
U 1 dt 1 family dwelling;Woew- A
('mme.rriallindustrial U Multi-famiiy U Teunt ituptovmwat
U New tibO r�ddlfi(mlaltcration/replacrment C]Crihec _ _--_.__ U Paul
Jtth a(lttreLLp Suite no.: Tax mtlphalr lotlxcotlot no.
( - B1a:k; divi on. pu -
'i
rXwvi on trod location of work on ntifiefl: RALy. ►r tr'm�ectn�mc• S� a �•l-tom• _..�_ _
f�timatd doe of COM0060WUuu:
Fee FROM
Jai not .�_ Total
11ttRi nttp nate:� - --- 1 t'---- t�,� _ New twwr*dN•etoRL s arwlYFAaeYy pw
Addroa.' j�¢ p}s►K _� --- _ Iwetbt{wwlt keelLdeoallaelaAtrlr+4t
City: SghCO Z1P: O/ fllerHwlwdwMtti �---
1000 sq.fL of Mae 4
Mone: TY-86f P'71-4-11-09 B.rJ,.dsltuuodsoo .tt tx oeutment --
CCB nd: Da Mac.but.Hc.no: S//7-c urnited!"Y,ra 2-
24 Lltttited nun•twidendd 2
-
Each manul'W"r tf home or iiodivist 2
_ _oL Savke utOhx feeder _
f if vvvvww w ) 9atrvlowerfooinrt-1 �
Sup.den arwo e t N m: dtee•atlow Or rowid"!
2
200 anve or)tss _
(�� 201 l a 100 eenpe 2 -
io 1 to 6W wpe�_ -2
Matt ad*IM! 601 ttmpe to -
Cit StaOe: 7dW. Over IOQO nr volts i
&tllsil: RtxMrwtoc*od
1rlrooe: Pltlt Tempsmy se►vleoe w ibdars-
()wner htrlallatlon:The inWdlpi)n in being made(tis prt)prny I own halitnedea,wmwwliba.orrekaAm
which io"intentind ftx Late.,kailo,MI.or exchaege acm. -ding to 21 M!ut4v t,r loses 1
OILS 447 455,4'79,670,701, 2o1.mp�w+a,— 2
401 iso 600 er_e 2
Owra''s --
"Marh ebcwke•eKw,danUoa.
a extewdor per ps"L I
A t•M ftn Nwmh nmuite with pum4wm Of
mvim is,fwdo fist.each hrswcb cimdt
Ad_dfoa :
State: Z.1F'' F'ee for brartclt dreva wit
thwtt potcha.e
('it of nervine or feetie:(M.first Iwwnch Chit: �_ 2
�'
MOW: Pax: Fxh eddidart It:
MMe.(isarvloe er feede►aoe listlima 1f
Hoch pump a_adi m circle
ts .r 2
L]Sev a. 221 a-M i w.osedel O F AW*M'.er:tttdlky top _
U Ytrvw�twgr'120 urgta rtNgt of I R2 U Htsxdow lOratlon
t3whalor
Mily daviletp U BuLA4 over I OAW aquae feet rfwr to Silngil dttvlt(s)or o lltnfad WWZy pard. 2
p Syeteun own t300 rrAn rrmnrul •more reeldmdd ants in erne structure altersdon.or eftlemleM--
Bulltkn(ovA tlaee enwHa U FvwA% ,100 wt[w t*nnrr •Desch•
J l k<rpetM load over 9u pr fu,tr U Marmtf k-tumd eUvrlwra tx N V perk tackMcRestlew oven llee telt+waMe r wn7 eR IV about.
U f4modwhitietplM U Other' _.._ Perfnepectitr+
Ani wll _ ndo aI I�l=w01r wf f!w wrera. Invad Won fee --
lla aMew will 110111 @Mdkmbk b� MI I Ukhm
permit fee ..S —
ria ell ti-+>bt w**P ,.�.ne„�,„n�.±.thero ed.errsielwtaetiea NMioe:This(terMil Itpplicaticm Rut review(at %) S
expires if a peamit is INA Dwinerl 7�
�•e.. L7 rlaiwrC� �y State aurrhwrgr(R(II,) S
t f Not t.rrl _MOO�f.7 V STS �' within 110 days wRer It Iw been
......................
N '•�"' acoeptetl u oomplele. TtD'1'I►lt --
r c rti.>reae�f �� 4111415 OMCAV 1
w
CITY OF TIGA RCD 24-Hour
BUILDING Inspection Line: (503)639-4175 MST _- —
INSPECTION DIVISION Business Line: (503) 639-4171 BUP -
AM - PM . -_- BUP
Deceived __—�___---Date Ftequeste�t,L���-----
Suite MEC
-_--
Location -1�i�T1-.� � --
._
Person ,� R� Ph .x'03 ) _ x (03 PLM
-- -----------
Contact Peones -- --
r _-
Ph 3WR
Contractor
TenanUOwner J7 Iy - r`'4
_BUILDING ELC
Footing -
FoundationAccess: ELR _--
Ftg Drasn
Crawl Drain �"-' SIT
Slab Notes:Post&BeamShoar AnchorsExt Sheath/Shear �-
Int Sheath/Shear --
Framing ----- ----....--_�.—
Insulation ---
Drywall Nailing
Firewall -
Fire Sprinkler -
Fire Alarm
Susp'd Ceiling —
Root
Final —.—
PASS _PART FAIL
PLUMBING -' -- ----_---�
Posi&Beam -
Under Slab
Rough-In -----
Water Service
Sanitary Sewer -
Rain Drains ----- — —
Catch RaEin/Manhole
Storrs Drain
ShowerPan �''`y \►^� 0�� �-1
Other. - t ►.� �3 1 —
Final --
PASS PART FAIL
MECHANICAL
Post& Beam I
Rough-In --- -�
Gas line
Smoke Dampers
Final — —_---
_PASS F...: ---
ELECTRICAL
Service
Rough-In - ---- ---
UG/Slab
Low Voltage -
e Alarm
Pay at City{lall, 13125 SW Hall Blvd.
Reinspection fee of$_ required before next inspection.
S SS
PART FAIL r� Unable to inspect -no access
SITE Please call for reinspection RE:_ -- --- —
Fire Supply line �+
ADA O �- Irw+���+ctt�r - --- Ext
Approach/Sidewalk '
Other-
Final
ther Final IDO NOT REMOVE this irt;specitioill record from the Job site.
PASS PART FAIL
CITYT
-T*RICPL PERMI*�,*
I
PERMT #: ELC9 -111453
OF IGARD DATE ISSULD: 096/20/96
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd.Tigard,Oregon 97223*8199 (503)639-4171 PARCEL: I S I 35BD--@ 1 3011
TE' I ;". .1, - - . . I -0
SUBDIVISION- --
SLOCK. . . _ _ . . . : L.01.. . . . . . . . . . . . . ZONING:r_--Cj
Project Description: Installing 24 brunch cir,cLlits.
---RESIDENTIAL UN.T.T--..-.-- SR
/FEEDERS—— ------MISCELLANEOUS--.--
1000 SF 013 LESS. .. . . - it) 14 - 200 amp. . . . . . . ; 0 PUMP/IRRIGATION. . . . 0
EACH ADDIL 500SF., . . : 0 811.1 - 400 amp. . , . . . . : 0 SIGN/ou'r LINE LTG. . 0
LIMITED E.NERG1•. . . . . : 14 4.01 - 600 ,amp. . . . . . . : 0 SIGNPL/PANEL. . . . . . . 0
MANF. HM/ SVC/FDR,, . - 0 601 +amps-1000 volts. : 0 MINOR L.ABEL (10) . . . : @
.......--SERVlCE/F*EEDr_'R---- CIRCUITS---- ------ADD"- INSPECTIONS --
2,00 ramp. . . . . . .. 0 W/SERVICE OR FEEDER- 0 PIER INEP"ECTION. . . . . 14-1
01. 400 -..Arrp. . . . . . ... o 1st W/O SRVC OR FDR. PER HOUR. . . . . . . . . . . : V.,
6@0 amp. . . . . . : 0 EA ADDIL BRNCH CIRC: 23 IN PLANT. . . . . . . . . . .
100,71 ramp. . . . . .. 0 REVIEW SECT
1000+ amp/volt. . . . . : 0 )=4 PES UNIT'S. . . . . . . . :
1'tecoyinect only. . . . . .. IZ, ,VC/FDR > = AmpS. . > E-00 VOLT NOMINAL. . '
CLASS AREA/SPEC OcC. .
FEES
-)HILO INN t y I..)a Amomnt by date r-ecpt
1,0830 SW GREENBURG Rf) FIRMT 150. 00 CJS o9lF,0196 96-264200
5PCT $ `"O
I IGORD OR 97E23 CJS 09/20/96 96---284'17_'lAV,
Phone #:
Coriti,actai,-.
GEOPUE & SONS ELECTRIC CORP, 157. 50 TOTAL
Flo Box 3139
REQUIRED INSPECTICINS
C-ACVNAIIA�3 OR 971,7115 Wa I I G o V e i-- E tect' I Spl,-v ice
c'110ne #: 503-654-6634503-654-66346::;4
Undet-gi,-oLind Love Elect' l Final
Meq it. - : 35600
This persit is issued sub)ect to the regulations contained in the
Tigard Municipal Code, State of Ore. Specialty Codes and a)I other Perm ittee Signat lare
3pplicable laws, All work will be done in accordance with
approved plans. This perslit will expire if work is not started
within 180 days of issuance, or if work is suspended for sore I
than 180 days. '-000!r
"
Issi.ted by
I-h.e installation is being made on property i own which � c� riot intended for,
tale, ieasp, or- rent.
OWNER' S SIGNATURE- DArF- .
---CON 7 R(-)f-TOR INSTAI-LATTON
bIONRTURE OF SUVIR. ELELIN- McAj'jem
D(4TF_: --a-6
LICENSE NO:
Call for insPOctic", 639-4175
Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hail Blvd
Tigard, OR 97223 Permit # EsCy
Date Issued tet- Iry
Phone (503) 639-4171
1 01 FAX (503) 684-7297
CITY OF TIGARD TDD No. (503) 684-2772
Inspection (503) 639-4175
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development ` q, (��) Number of Inspections per permit allo%ed
Address to 9 3v S u/ G�--�'E /V �� �-11L� Service Included Items Coshea) Sum
City/State/Zip i001W, _ 4a. Residential -pet unit
r 1000 sq ft or less __ $11000
Name (or name of business)_.J�/L O 1 �r l� Each additional 500 sci ft or _---
portlon thereof $25 00
Residential ❑ Limited Energy $25 OU _
COmfnefClai L .. Each Manurd Home or Modular ''
Dwelling Servire or f=eeder $88 OC --
2a. Contractor installation or.ly: 4b. Services or Feeders
'/ m�tellatfon,atteralion,or rerocelion 2
Electrical Contractor �O/x� sC�'y t `�r 200 amps or less $60 00 2
Address _ _ 201 amps to 400 amps —_ $8000 _
�__ �_ $110 00 2
401 amps to f00 amps
City��4 G�C/1 S _ State L/�� Zip-?76:'l p $180 00 =_ 2
601 ams to 1000 amps 2
Phone, No._�_�__��3 � � Over 1000 amps or volts _^ $340 00 _
Reconnect only $5000 2
Job NO. _ -'�
contractor's license NO 3 4c. Temporary Services or Feeders
Contractor's Board Reg. No. 35 Installation alleration orreloretlon
Signature of Supr. Elec'n 6�,e:N *� 200 amps or less 2
S Phone No.e ' - ��i 201 amps to 400 amps $5000 1
License No. zLY
401 amps to 600 amps —� $1500
Over 600 amps 10 1000 volts $10000 -- -
2b. For owner installations: see"b"above
4d. Branch Circuits
Print Owner's Name__ __ New.alteration or extension per pane
AddfeSS _ __ a)The fee for branch circuits with
It �— ;;tate_ Zip purchase of service or feeder fee.
City _ _ Each branch circuit $500
Phone No. _v_ _ b)The fee for branch clrcuirs without
The installation is being made or property I own which is purchase of servlee or feeder fee. -
First branch circuit 1 $35 oo .T
not intended for sale, lease or rent. Fach ad0ional branch circuit ,�� $500 T/
Owners Signature _.� 4e Miscellaneous
(Service or feeder not included)
3. Plan Review section (if required): Each pump or irrigation circle $40 rO _
Each sign or ounne Pghting ern III
Signal c.,::ufl(s)or a lir-fled energy
Please check appropriate item and enter fee in section 5B. panel.aneration or extension $4000
4 or more residential units in one structure Minor Labels(10) loci Co
_ Service and feeder 225 amps or more 4f. Each additional inspection over
System over 600 volts nominal the allowable in any of the above
Classified area or structure containing special occupancy Per Inspecfi,.n 13500
as described in N E C Chapter 5 Per hour _ $5500
In Plant _ $5500
Submit 2 sets of plans with application where any of the above
apply. Not required for temporary construction services. 5. Fees:
5a. Enter total of above fees $ U
NOTICE 5%Surcharge (05 X total fees) $ =
Subtotal $
PERMITS BECOME VOID IF WORK OR CONSTRUCTION 5b. Enter 25% of line A for
AUT14ORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF Plan Review if required (Sec 3) $
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Subfofal $
A PERIOD OF 180 DAYS A r ANY TIME AFTER WORK.IS r
COMMENCED M.,�,�m4e��•. 1__j Trust Account 0 $
Balance Due $
ELECTRICAL PERMIT
CI(14�0 4k 11 Tpt#10*F T 010G AV
*r4ft"Of f
PERMIT#: E 0453
DEVELOPMENT SERVICES DATE ISSUED: 9/20/5620!96
13125 SW Hall Blvd., Tiqard, OR 97223 (503) 639-4171 PARCEL: 1S135t3D-01300
SITE ADDRESS: 10830 SW GREENRURG RD
SUBDIVISION: ZONING: C-G
BLOCK. LOT : JURISDICTION: FIG
Proiect Description: Installing 24 branch circuits.
_
MISCELLANEOUS
PRESIDENTIAL UNIT _ TEMP SRVC/FEEDERS
1000 SF OR LESS: 48 0 - 200 amp: U PUMP/IRRIGATION: 0
EACH nDn'L 500SF: 0 201 - 400 amp: 0 SIGN/OU T LINE LTG: 0
LIMITED ENERGY: 0 401 - 600 amp: 0 SIGNAL/PANEL: 0
MANF HM;SVC/ FGR: 0 601+amps - 1000 volts: 0 MINOR LABEL (10): (1
_ SERVICE/FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS___
0 200 amp: 0 W/SERVICE OR FEEDER: PER INSPECTION 0
201 - 400 amp: 0 1st W/O SRVC OR FDR: 1 PER HOUR: 0
401 - 600 amp: 0 EA ADD'L BRNCH CIRC: 2.3 IN PLANT: 0
601 - 1000 amp: 0 _ PLAN REVIEW SECTION_
1000+ amp/volt: 0 >=4 RES UNITS: > 600 VOLT NOMINAL:
_ Reconnect only: 0 _SVC/FDR >= 225 AMPS: CLASS AREA/SPEC OCC:___ r
Owner: Contractor:
SHILO INN GEORGE + SONS ELECTRIC CORP
10830 SW GREENBURG RD PO BOX 339
TIGARD, OR 97223 CLACKAMAS, OR 97015
Phone: Phone:
Reg #: 503-654-8634
FEES Required Inspections
Type By Date Amount Receipt Wall Cover
PRMT CJS 9/20/96 $150.00 96-284200 Underground Cover
Elect'I Service
5PCT CJS 9/20/96 $7.50 96-2842.00 Eleci'I Final
REIN CTR 5/6/02 $62.50 2720020000(
Tota $220.00
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 he done In acoordance with approved plans. This permit will expire N work is not started within 180 days of Issuarce, or if
work Is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow n s adopted by the Oregon Utility Notification
Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0080. Y�nay obtain copies of these rules or direct cuestions to
t L�
Permit Signature: r ���, '3l3u9
OWNER INSTALLATION ONLY
Thp instalIntion is being made on property I own which is not intended for sale, lease, :)r rent
OWNER'S SIGNATURE: _ _._ DATE:—
CONTRACTOR
ATE:CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: — DATE:
LICENSE NO: _� _�_.- --------_-.-- _-- --- __--
Call 639-4175 by 7:00pm for an inspection thn next business day
05/0'_-2002 15: 17 503-653-6886 GEORGE $ SONS ELECTR PAGE Al
0400ydr 44wa/ 7400", E44 % MV 0
Electrical Permit Application
tgrgEc
- r�ttt.ltlogiled: �no.:��w__0
Ali City of Tigard R RvpcUappl.no,: Saps a date:
�sty,)f ngtod Addrerw: 13125 SW Hall Blvd nate issued: By: Rocco no.:
Phexte: (501) 6394171 —
Fax: (.503) 598-1960 Can filen.: Papatarttypt"
Land area appnlival: • i.l i h r.:t
C2 1 Cit 2 family dwelling or accessm qCm utne :isUindustrisl U M1116 family U'renant impr»vrinent
rU New construction 0 Additi(Waltenuicrn/replaccmcnt U Other: __- U Partial
Jab addMAS: Bldg.no.: Suite no.: Tu.-nWtax IoUaccount no.
W. Bloc _iSutxtivirirxt:
Project name: IT._1YV r4cnpuon and location of work at premises:i
na►.ed date of c;om letimfins don: Cee � s".
Job" Fie kis
Hilaire"ItJ11t10: WxTt _ es.) Taw tao _
New rodkoW•�or tad&-(WAY►.P
Add-eea: -*PQ uot!beYsissuarh doWT ,
ci%:fir _ sl.rrl� 1
zIP: ter.teetntlldth
MOW: Fax - f mail: 1000 sq.R.or Was _ a
bacti CCD no.: Dom- Ela hus.lk.i>n: //7� te4 nom, v� thereof 1
I
Ci!Y/Metjr lic.ru)' O mitedesrerp.oar-rmtdantial �— _
Each nunufaceumd home or modular dwelling
SI of++ rdeMt clu fired _ Dole - �P.Z� Service orwar feeds 2
_�...--•--.__. 1 -_. 3ervk:easekaien-IsataltNler,
Sop.eiect.sum(print); oweT oiISeYr/ Lieenaaao:j/86-5
altenUsa yrrrtocafierr!
200 of Iris 2
Mailing addirm:
_ 601 tuop11010010D 0 amps 2
—'�---- - _ State: LIP: _ Over 1000 Norm volt 2
Phone: -- Fu _ �Iraail: ttecatrteax
Owner lnatalhuicnl.The installation in haing mule on property I own Te1MmMasevk�raerNKbta-
which is not intended for sale,laase,cent,of c:.change se:cttrdinv,to kftmmoakok"°im,vw
ORS 447.433.479.670,701 200 or IOU - 2
201 amps to 400 amps
Ownex's si t)ate: 401 to 600 -
rser,slfarrlloe,
or ealamlos pr prat:
Now: A. Foe for bunch dreuit with pueehaw of
Address: service of faader be.each branch dreait z
State: 7.ilP: B Fee forhrancF Circuit without parchate
` of uervke Of Feeder fee,fine brand,citeult: e
MOWN - Fax: P-rr1a11: Each addidooalbunch cbmlt: ---
MEMM'us"' MIME"
Mine.(%rdrewfimisrrM is -
U Survive over 225 amps vwwwrisl 0 Mu kh-cw frcdlity Each pump or Irritation circle --
U Servkc over 120 amps•raring nt I R2 U Wazor"s kxvUon Goch sign or outline II h _ �-
f Na ilv 4wBIn0 U nuMing over 10,000 aqusrr frri four m Signal circuit(s)ora limited erkfty panel.
U Systrm ervr+6W w.lt rnmunul more residential unix in(me atrucum _dllfadon,or extrrrrion• W — 2
U RarldingnVoriti +rrcMier U Feedo .400 w"urrmm enpe.i�'
U C kruparrr kw ovrr q9 pmons U Manufactured mucturo or RV park FDAMadkinraal twrPM11oa ovrt Ire 00"b"IN i of 60 nbuvw
U r4rTswlighnngplen U(hher per ins don --
ffrr111M veto of pins whet racy of do atom I Investipdon fee
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