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Permit 4 AV CITY OF TIGARD ELECTRICAL PERMIT ' • PERMIT #: ELC2003 -00269 DEVELOPMENT SERVICES DATE ISSUED: 5/13/03 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S110CB -01600 SITE ADDRESS: 15475 SW 123RD AVE SUBDIVISION: ZONING: BLOCK: LOT : JURISDICTION: KIN Project Description: Install (5) branch circuits for kitchen remodel. 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: 4 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: SCHWARTZ, CONTANCE J LYNE ELECTRIC 15474 SW 123RD PO BOX 7004 KING CITY, OR 97224 BEAVERTON, OR 97007 Phone: 503 - 620 -1451 Phone: 503 - 648 -9459 Reg #: ELE 34 -452C LIC 123438 FEES SUP 4154S Description Date Amount Required Inspections [ELPRMT] ELC Permit 5/13/03 $73.45 [TAX] 8% State Tax 5/13/03 $5 Rough - Elect'l Final Total $79.33 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- 332 -2344, J 'f� )� // r'', / 0 1 Issued By: vC�, - 'lcc� l � U_ / ,' f. r Permit Signature: Cq l �� L 6 / 0 yam. 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: t Call 639 -4175 by 7:00pm for an inspection the next business day OD - 2003 07:18 5033568347 PATRICK LYNE PAGE 01 4 FOR OF TiC'L t NSF O \lONLY E Peal Permit Application Received fi,eetrical `� te/B 5: - /,2-rte, 4 Permit No. i- om a R �= - V �� na Planning Approval P ern City of Tigard Dateta P,+rlt,tt Nn.: Plan Review Other 13125 SW Hall Blvd. MP 0 9 20G Date/By; n Re Permit No.: Tigard, Oregon 97223 ' Land Use Phone: 503 639 17I Fax: 5 j 96 � Q G A 4,;,,., Da tc/11 , _ Case No.: 1 FT d'H l w,e1 ` I ' ( ' 1 s(� Se P age 2 f Interact: www.ci.tigard.or . 1:513?-T195 p t r: Contact 24-hour Inspection Request: 5 0� = Namcllvlcthod: - _ Supplemental Information. r,!; i i,; lra,�] ORK ;,Ir; ". ;: , .. ..� Sc � Health-care facility ti,: �i ;. W. , ; ; i 1 .1 11 " Ct rviee over 225 a s- [� N" ew eonsixuctiorl1 _ a Deln _ commercial ❑ hazardous location 1,4 Additionlalteration/re.lacement Other: 0 Service over 320 amps- rating of ❑ Building over 10,000 square feel, .{ I��{•�. W . rwN " , •. I & 2 family dwellings four or more residential unit4 in .',;,h'�:ii''' rkt; i! f�` Y4��' �' 27iM1��1rd���: �. �; 1�': �, ���J .���1',�u,�a:���t�' „ ; .,. . �t 0 System over 600 volts nominal one structure 10 1 & 2 -Tamil dwcl.lin •_ Commercial/Indus Building over three stories ❑ Feeders, 400 amps or more w Accessory Building ❑ Multi-Family . Ei Occupant load over 99 persons ❑ Manufactured structures or RV park ■ Master Builder Other: Li Egress /lighting new h an of the above. c /li h Hn an !d ! U�3 `;iTE:NtFIlOR11►T'Ii01�11'iui, "Ci�r [JI<!: Submit scls ofpla it y :,: a i The above are not +p ac t s of. to tam era, construction service. "�`' t ` '. � i I s 1F1 41 I` !fN L• ,4' rF:::.�. Job site add ( ( 7 I V _ ::; r „r;! ,t' :' ,. r e,ii.!i. i'E,. d;: „�4: •rp :. =.:.. .. Te ss: �::'::il� ��� � ��'!�!ii,;:�;u �,,�5�u �.: „� Bids !A t #: Number of inspections per permit allowed Suite #: Description Qty Fcc (ea.) Total 1 Project Name: ' New residential - single or multi - family per 1 Cross street/Directions to job site: dwelling unit. Includes attached garage. Service included: 145.15 4 1000 s . & or less 33.40 4 Each additional 500 sq. ft. or onion thereof 33.40 2 . k • . A / ,.... Limited energy, residential Su 17,71.1 division: LI Lot #: Limited coal!, 'TeX non residential 75 00 �© Each manufactured home or modular dwelling • l • arGOI #: nd/or feeder 90.90 • ” III 1 iiaii.17 5,11 r.iiry51, . ;•Ii!..4' t. Q• • ' • • • ' ' ::, ' ' ' '` . . y ,.� . , �;r ,:� : ''i ' ', <' i : ,;;:r' service and/or Services o r feeders - installation, ' ' v :G to L t- (, 4 alteration or relocation: K; *A44 Remodel , zp0 a o l ess SO -30 �- i `C PIrp{ ,a... 106.85 r l ��!Q- f7 . 201 amps to 400 amps 1-e2 _ 41/4AS 401 amps to 600 amps 160.60 Q 0 11 n .1711 a+!„'” 11;,!11 a :01 o f 3 ,� : ” "u; l ; 601 amp to 1000 r amps volts s 454.65 t ' Over 1000 amp • C • eta w p Z Reconnect only 66.85 Name: o w r1. _ — - s W i 3�� Temporary services or feeders - Installation, Add reS3: 7 alteration, or relocation: 66.85 City /State /Zi .: .. C:+ A r. ` 7 .?+ ` - 200 amps micas 100.30 201 amps to 400 amps Phone: 5 _(gyp.. ( ® Fax - rr� ��yr y�y 401 to 600 am•a 133 -75 { 1:,11 !' 1 •!. h I' t ;l!iC�§i,i11i'. I p�11 K !' it i 00 1 v 4'Y'l errlG O , , '' Branch circuits - new. alteration, nr extension per panel: _ Name: �, . �-`i r A. Fee for branch circuit+ with purchase of Address: t et i 1 Id .' r %co Got„ c r+ service Or f eder fee, each branch circuit 6.65 City/State/Zip: IStatCity/State/Zip: City/State/Zip: , 5. � H R Mt) &- a /� t. H. service or feeder fee, first branch circuit Pee for branch circuit' without purchase of 46.85 Y 7EE11 • Phone: 5c:), -14. Yp 4 tj5 Fax: Each additional branch circuit �'a 6.65 411:411:115 Misc.(Servicc or feeder not included): E-mail: Each p or irrigation circle 5340 II _ it f , � ! t ' j1.11 !1 rig ttWa 1?OR1111,,I a '.a•,,:,: i i Each 53.40 Q I n :!;•r•^ is ;. , I ; � div tr�'��' - ,.�Y j�IR�' ' �, ";�:: a 1i•ht {n: iii 1 �•Y,1i' p ' � 1R �1 r '••� .' � � 1,Lh� �= � 11115 f1� 1',� • J Each si • ar autlin - "'` Signal circuits) or a limited energy panel, Job No _ — alteration, Of extcnaiQn Page 2 li Business Name: I.y tec -'1" r G Description: f Address: P 6 • . Dx 7 Each additional inspect o th allowable In an of the above: City /State /Zi // p'a'r /J O r , 7� 7 ` Per inspection per hour (min- 1 hour) 62.50 r - 6)1 Phone: sO - va ' '� Fax:.f5C3 - z•�.�(p_" C � + _ lnvesti ion fcc: M� 6 r� . S{ O .. ° , lie:• , _f CB Lie # : , 9 y 3 r.+ t� 4/6'2 ➢ . y 1 t'k� E'. .. .-- _ L1C. #: 3 T ~ !trtiP �'''':':It�:�;1! �w �!�'E ^.�i�'1 r� r.,�. ' �f�.'»: Pa� �: �, • L'h ' �. - �' , r � . Supervising electrician �I` a Permit Fee Subtotal s 7_ . - P 4- QG✓ � .�� Pla Revie 25 /o of Per si = attire re � U , ed: State Surehar _ c 8% of Permit Fee $ Print Name: '' PiGi� -7'll Lie. #: ',/ TOTAL PERNATT FEE $ 72 ' �o -/ v Aut h o rized �r - �„ C,'� P p3 Notic This permit application expires if ■ permit Is not obtained within //! `"'�i77'' � 180 days after It has been accepted as complete ' Signature: Date: *Fee methodology set by Trl- County Building Industry Service Board. U a� /el ( G- /....y ,- e (Please print name) i' \Dtts\Pcrtttit Forms \ElcPer'mitApp,doe 01/03 05/12/2003 15:47 5036393771 CITY OF KING CITY PAGE 02/02 . REcu 11146/ KING CITY 15300 SW. 116th Avenue, King City, Oregon 97224 -2698 MAY 12 2003 ....sommig Phone: (o03) 639 -4082 • FAX (o08) 639 -3771 CITY OF TIGARD BUILDING DIVISION • Notice To Contractors Working In King City Due to an intergovernmental agreement with the City of Tigard, many buLlding 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, surlply complete the appropriate application legibly and submit it to the King City staff. The ILing City staff will collect all fees and fax the application to the City of Tigard. City of Tigaid staff will then create the permit, issue the permit, and perform inspections. Please indicate on l'he permit application whether you would Iike the Tigard staff to call you when the permit is really for issuance or whether you prefer it to be mailed without any notification. Any incompl ate or illegible application will be returned to King City staff for correction and no proce; Icing 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 indicati ag 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 Servict.s 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: . NSLav,te '1� IJ `4 located at: /sq7� S /013 �"`�"� LQIIAZI tk •.,__,61_ King City Representative t • nsrs.crssr ooc CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 - 4171 MST BUP Received Date Requested S D AM PM BUP `ocation 1 S 7 &q 3 4 Suite MEC Contact Person P Ph ( ) l 9 - ? $� PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC " ..6 Footing Foundation ELC Access: /64;17' C� Ftg Drain ELR 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: Final PASS PART FAIL PLUMBING Post & Beam Under Slab Rough -In Water Service ` \ Sanitary Sewer 1 Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final PASS PART FAIL MECHANICAL Post & Beam Rough -In Gas Line Smoke Dampers Final FAIL Se - Rough-In UG /Slab Low Voltage Fire Alarm 4.5110 ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PART FAIL D Please call for reinspection RE: Unable to inspect — no access Fire Supply Line ADA v Inspect r ' / Ext Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL