16695 SW QUEEN ANNE AVENUE C
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16696 SW Queen Anne Avenue
�� �� �� A(G��� ELECTRICAL PERMIT
PERMIT#: ELC2001-00627
DEVELOPMENT SERVICES DATE ISSUED: 12/11/01
13125 SW Hall Blvd.,Tiqard, OR 97223 (503) 639-1171 PARCEL: 2S1 15PC-08400
SITE ADDRESS: 16695 SW QUEEN ANNE AVE
SUP,DIVISION: ZONING:
BLOCK: LOT : JURISDICTION: KIN
Proiect Description: Installation of underground power supply for cable TV. Job #West 2001-54
_ RESIDENTIAL UNIT TEMP SRVC/FEEDERS _ MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: �PUMPIIRRIGATION:
EACH ADD'L 500SF: 20 400 amu: SIGN/OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANE HMI SVC/ FDR: 601+am,)s - 1000 volts: MINOR LABEL (10):
SERVICE/FEEDER __— — BRANCH CIRCUITS_ _ADD'L INSPECTIONS _
0 200 amp:— 1 WISERVICE OR FEEDER: 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 CaCC:
Owner: Contractor:
BARNEKOFF, KERNAN A POWER TECHNOLOGY
NAIDYNE E PO BOX 1766 Ovr
16695 SW QUEEN ANNE AVE OREGON CITY, OR 97049,—.,P�p1E
TIGARD, OR 97223
Phone: Phone: 503-657-0315
Reg#: LIC 129287
ELE 3-511C
SUP 3575S
FEES Required Inspecti vns
Type By Date Amount Receipt Elect'I Service
PRMT CTR 12/11/01 $80.30 2720010000( Elect'I Final
5PCT CTR 12/11/01 $6.42 2720010000(
Total $86.72
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 130 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)
2466699 or 1800-332-2344.
Permit.Signature: 7•� i Issued By:
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: -
Cali 639-4175 by 7:00pm for an inspection the next buslnst•c� day
r_
Dec 07 01 12: 23p (Taney Jones 503 657-0942 p• 5
11%02/2001 09:24 FAX 5035981860 0111' OF 1'1GA" WIvv•
�:lec�a-ical Fle
/ \ — Due mcdvad: ; U I plertNt tw,:
City of Tigard Projee,_;,d.no.: 1?xpireoau:
Adilmu: 13129 Sw Hall 1{Ivd.'rigmt 00 471 [kncissued: By: Y! Rwoiptoo.:
ciyoJYfsard Phone:(503)639.4111
ILL I Y Uf� T1UAR1j �K nla no payment type
Fax:(503)599-1960 BUILDING DIVISION
Ladd use appmvri
fd(CommnctellinJuslnal D Muld•fnmtly 0 Tenuni impiuvemetn
Lj 1 & 7.tafmly dwcliiny,or ac:rssary (�Putiel
U New 1_onstnI,lion I]AdditiodalletatiorJteplacerncnt 7 othet:�_--
)ob eddiess: y5 ( n Z �U�, g.no. Su1tc no., Tex the tart Iotlacr_�unr nnv
1, Hlak: Subdivision:
Desctipnon and location of work on -
VtEaisdtmi—m�:ed
came { llt"i - _
Jatc ofcomplrtio rn+ltrc tion
r
Fie M:t
7A=ddfmWsr:
)6� rr 1 . _ - D_rr nptfon� Oh, kal Total no.Imp
l c `�O t�4Ll����t �State( Z �?_� tofIIrwvlp n o1lu�r�t'�1 _ItC10C.bus.lie.t10' -i L„„fedel.rereeidendel ?
city/t Otrolic..no.; unUo CA LI ladslrraY,eee-reailiaatid
r 1 -�-� ;, V gmeA�e-diowuad horse er(nodular dwtlltta 1
�•�yY1�[V, rye1L ��.. Service eodlor hada( _
Sleaeram ofsypon l"ll I Imo_ I. - -r- .. unkraorfee ar lUdletien,
Suy.dttceanle nnr) (. ! is Lcaue )_� adsetettanetrntneatbro
1110ampoorlest _ a V'. 2
iot.,ops to e0o.mpe a
Nao!e(ptintj —� —
401 Ir of eW emOt x
Mtilling uldtess: 1 amp+tu 10W 3fnM v 1
9tote 7.]P Uva IaOa amps m vola --
t�IIY: - Rmomectoely _ I
Phone: Fax: _^ �• ' .ar.;ea/r ttodev-
Owner installation:The arlst4lladon is being made on property 1 own Irtrelbties aMaefaa,ernNestire
which is not intended for tali,Ices0.tent,cr exchsnPe■ccnMing to Ian onR,r nr lea --
ORS 447,455,479,670.701. 1 amp!ro a00 slew - _-- 1
Uatr 40,to 600 ---- 1
Qv+na s s edttro: - —
ehtlrnib-rrerr,a ,
or exieasloe per prtet.
Name: A Fee for twearlleilteltiwidtpvtdiescod 2
torAer nt Meer fe.-each Mtnrh ctltndt
Address:
City: 1.11: -
- Porectfar bar40
rtrcfed"(Wo,
.(mat
Ianclrh<hdaoaaettle
_ I
Phone. Fxx: E mail: Cachad& ndhtnlchcYcvil.
tae.(Centre nr/radar nor Intladadh
Sloth pump or irtipriae circle I
o SeAvicenvrr't1SI-mpol111111 Ctal G Hedtbrdtelalalitr - I
R1pa Al U Humdouflocathm EadrrleooreutHaaU !!."e _
O Senim over 310 a of I l2 Slant cirmh(t)or a tinted carrp7 paod,
family dwellings U nulldlrlg o•er 10,000■qM W%RN IMw a 7
]51■wno'er 600voltsnani” mnmrmftmthdWit if,Orr urutture dlaratien,lwr■vn9i00•
0 8uddine over(bra none, ]pa,s�t,400 tripe w more •[)(•cert 'on
d Oceopsa load nvu 49 pertonr U M WMnV qW,d ttroerurr■m RV pax aver the eMarr■ah{e to-may of*m eve:
U Chher —. _ — perine tcooll �L----l�
c7Fltrett/OeMineplan _-- - ----
Sssbtail ads of plea+"ph my oribe ab orre. mvr� -
T1he eMw ere ssal eMplltwlie rn te�y aa�pleMltMasl atlniet• r
_ Pettit fro..-.. ..........$
Ner dr d.Ir11 a rcgx enMt esea pMaK r0 W�3cum ser na<idew.ese Notice: Min perm
sR eppnoilim Plan feview(at %) S
0 Mae :7 sxpita Ir a parn,it la nd ebtabrer{ State irmharte(9%) ...S �.
cRm1 u 1 to ��� l j _r 1 Q within Ito days ancr it has been TOTAL......... 73,..
;�Irr acrYpteAlsrnmplete
- 140 4119(1refN nws
upq■w _ � notal
FICA 7
12/11/2001 09:54 5036353771 CITY OF KING CITY PAGE 02/02
KING CITY
15300&.V 1160 Avenue,King City,Oregon 97294.2693
Phone;(503)629• X82•M(503)639.3771
7
Notice To Contractors Workinb In Kinn City
Due to an intergovernmental agreement with the City of Tigard, many building related permits
for projects in King Citi 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 Cite staff will
collect all fees and fax the application to the City of Tigard. City of Tigard staff«.ill 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 issuinee or
whether you prefer it tAe mailed without any notification. A-ny 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 applicatiin DOES REQUIRE: PLAN REVIEW, this form must be signed by a
Kin¢ Ciry staff person. � ing City staff will simple sign this form indicating land use approval.
Take this signed form to,the City of Tigard Development Services Counter located at 13 1 A"-5 SW
Hall Blvd, Tigard, to submit applications and plans. Development Services Technicians are
available at 639-4171 Elt, 304 should you have any questions concerning submittal
requirements. All permii fees will be assessed and collected at the Cit} of Tigard.
The City of king Cite h�reby authorizes applicant to pursue permits at the City of Tigard
Building Department for',the following project: fL JU,a
located at:J(�09f)--
King City Representative 111-Ii-01
I Nrs:c 1%;T CIG"