Permit CITY O F TIGARD G A R D ELECTRICAL PERMIT
r PERMIT #: ELC2002 -00290
' �� I / i
DEVELOPMENT r SERVICES
o
SERV 97223 (503) 39 -4171 CES DATE ISSUED: 6/27/02
PARCEL: 2S 110CA -01600
SITE ADDRESS: 15245 SW 116TH AVE
SUBDIVISION: ZONING:
BLOCK: LOT : JURISDICTION: KIN
Project Description: Install 1 200amp service and 3 branch circuits to shuffleboard area.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: 1 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: 3 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:
KING CITY CIVIC ASSOCIATION DOUGLAS G. CLAPSHAW ELECTRIC
15245 SW 116TH 1722 17TH AVE
KING CITY, OR 97223 FOREST GROVE, OR 97116
Phone: Phone:
Reg #: ELE 34 -410C
LIC 107185
SUP 3870S
' FEES Required Inspections
Type By Date Amount Receipt Ceiling Cover
PRMT CTR 6/27/02 $100.25 2720020000( Wall Cover
Elect'I Service
5PCT CTR 6/27/02 $8.02 2720020000( 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 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -6699 or 1-800- 332 -2344.
Permit Signature: Issued By: / ge j j ..0.4„,r4_, A
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: i- CAlaf Q DATE:
LICENSE NO: c
Call 639 -4175 by 7:00pm for an inspection the next business day
Jun 26 02 08:46a Doug Clapshaw 503- 357 -4221 p.1
r s
Electrical Permit Application OFFICE USE ONLY
received: •r� —U — Fcrinit no. d(J - DOr, c!7(/
..1i+ City of Tigard lrroject /appl_ no.: Expire date:
(.iiy of Tigard Address: 13125 SW Hall Blvti LL''��,// JVED
Date issued: B Receipt no.:
Phone: (503) 639 -4171 `C1
Fax: (503) 598 -1960 Ca file no.: Payment type:
Land use approval: JUN 2 2002
❑ I & 2 family dwelling or accessory Sd-Commcrcial /industrial 0Multi- family 0 Tenant improvement
0 Ncw construction 0 Addition /alte ratio n /replacement J Other: Cl Partial
/ 1 JOB SITE INFORMATION
Job address: 15,2 S. t ic., , 16 Y� nt
Bldg. no,: Suite no.: Tax ap/tax lot/account no.:
. Lot: Block; 'Subdivision: J
Project name: . _ .. I ,., ,)escription and location of work on pretniscs , , (, 7l Y�,C Ci r
I: ;rtim.Ife(l dale of completion inspection: . N A 3 . ., • • 4., • ra' A
mail 0
r
CONTRACTOR APPLICATION FEE SCHEDULE
Job nu: /� _
I .. _ a l:+ V �� ..OG • Fee maw
Business name: 1 n _ Y description Qty. (ea.) Total no. Ins p
• �` r ` � i Newresi dential- single hrmilyper
Address: a a ._ •)-1-, P
dwcllin>;onil.lnclntics rlttachetlgarns ; c.
Cit --1- G r p./0_ State: ZIP97 1 I Servierincludcd: _
Phone: F ax: 4
X5 - 4a L - __. 7 E -mail: _ 100(1 sq. ft. or Icc.e
` Each additional 50(1 sq, tc, or portion thereof
CCB no.: l67 /'5 I , Wee. bus, lie. no: q T 1 O � Limited ener residential 2
City /metro lie. no.: &- 3- -0i JO - /-° _ Lit rr itetl energy, non- residential 2
t� 62 L .. 2f J Q Z liacli manufactured (ionic or modular dwelling —�
Sit;na ;c f stt c
orvi.utt; a Date lt'iri ; lira (required) f0_ /_p Service and/or feeder 2
Sup, duct. name (print), 110 . at• • 5il0_t_►► License lio: 76S Services or feeders— Installation,
alteration or relocation: V
PROPERTY OWNER 200 amps or less I o _2d. 2
Nartle (print): 201 amps l0 400 amps 2
— — 4111 amps to 600 :Imps 2
Mailing address: 601 amp, (000 amps �. 2
City: WM~ State: I ZIP: Over won amps or volts 2
Phone: 'Fax: E-mail: I Reconnect only _ I
Owner installation: The installation is being made on properly 1 own Tomporaryservieesorteedcrs -
which is not intended for sale, lease, rent, or exchange according to htsta list iun ,altcrat ion, nrreloeAtlort:
ORS 447, 455, 479. 670, 701. 200 amps or ter 2
201 amps lu 400 amps 2
Owner's signature: _.. _ Date: .I01 to 600 amps 2
ENGINEER Branch circuits - nen, alteration,
or extensiun per panel:
Name; A. Fee for branch circuits with purchase of /
Address: service or feeder fee, each branch circuit 3 �ji 4 � NI' 2
City: f State: ZIP: 0 . rue for branch circuits without purchase
of service or feeder fee. firs) branch circuit: 2
Phone: Fax: F- 111111; Bach additional branch circuit:
PLAN REVIEW (Please check all that apply) Mice .(Serv feeder not included):
U Service over 225 amps - commercial 0 lleallh -care facility Lath pump ter irritation circle 2
0 Service over 3.1.0 a mps- riling of Is,2 I:1 Hazardous location Each sign or outline lighting
family dwellings 0 Building over 1(1,(100 square feet four ter Signal circuit(s) or a limited energy panel,
U System over 600 volts nominal more residential uuiis iii one structure alteration, or esionsiono 2
0 Building over three stories 0 Feeders. 400 ;unps or more •laeseriplion;
7 Occupaul ball over 99 persons U Manufactured struchires or KV park Each additional
U bgressllightinn plan ID Other: - per inspcctiun
Submit sets of plans with any of the above. Investigation fee
The above arc nol applicable to temporary construction service. Other
Nor nil jirisdic■inns :weepy credii earls, please call jurisdiction far ' nrmatioa. Notice: This permit application Perm it fcc $ fell"' .5
paViaa U MasterCard )� expires i f a permit is not. obtained Plan review (at ___ (90) o) $
/ Cred / t cacard numher' 2% 7 1 Ap./ ? -- � f2 I 102 within 180 drtys after it has been State surcharge (8 %) $ � g 9. __ _J._! a,.. uLe. �C'l = - f+r.2 !. I:s
accepted as cam TOTAL $ / • -1
f complete. ) Q
Nnutc of clicaold n• town nr crud it card / ... cP 7
iii. / .. $ iti
.C: , say arc - 1 1mou 441> 4615 16/60 /COM)
4L 380 '2581
06126/2002 08:13 5036393771 CITY OF KING CITY PAGE 02/02
KING CIT
15300 s -W. 116th Avenue, King City, Oregon 972.2 -2693REGO
mom
Phone: (503) 639 -4082 • FAX (503) 639-3771
11°
,UN 2 F) 200't
ok 11- 101.1
DWIS
Notice To Contractors Working In .Kin a City
b
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, 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 pen application
whether you would Iike 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 form 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: / - . , 4„_ -- i, , d
located at: 15.1—'45 S O I//
King City Represent ive
D5TS' CI \ST DOC
CITY OF TIGARD 24 -Hour -
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received t r _ Date Requested --)1/ AM PM BUP
Location l s a 4 (g° ZI/k- Suite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) J ' S 7 / ( SWR
BUILDING enant/Owner ( ELC c;"'
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT 4
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 rw
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
Fire Alarm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
t PART FAIL
SITE Please call for reinspection RE: El Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date `` L Inspector c Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL