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Permit CITY TI G A R D ELECTRICAL PERMIT i ' DEVELOPMENT SERVICES DATE ISSUED: 1/19/01 ;�fil PERMIT #: ELC2001 00036 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 - 4171 PARCEL: 2 S 115 B B -03900 SITE ADDRESS: 16060 SW KING CHARLES MAINT. SUBDIVISION: BUILDING ZONING: BLOCK: LOT : JURISDICTION: KIN Project Description: Installation of (1) 200 amp service, (1) 125 amp feeder and (2) branch circuits. 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: 2 W /SERVICE OR FEEDER: 2 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 NO 4 DOUGLAS G. CLAPSHAW ELECTRIC • OWNERS OF ALL LOTS 1722 17TH AVE FOREST GROVE, OR 97116 Phone: Phone: Reg #: ELE 34 -410C LIC 107185 SUP 3870S FEES Required Inspections Type By Date Amount Receipt Wall Cover MENU CTR 1/19/01 $173.90 2720010000( Elect'l Service 5PCT CTR 1/19/01 $13.91 2720010000( Elect'l Final Total $187.81 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 copie e rules or direct questions to OUNC at (503) 246 -1987. PERMITTEE'S SIGNATURE ' / ISSUED c , 4,, , - OWN R INSTALLATION ONLY The installation is being made on •roperty I own which is not intended for sale, lease, or rent. - OWNER'S SIGNATURE: DATE: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N: , 'Q i--a - 4 ( DATE: LICENSE NO: g - Call 639 -4175 by 7:00pm for an inspection the next business day i i y1 '� " it 1' /,FJ' 4 i 01/19/01 FRI 10:15 FAX 503 598 1960 CITY OF TIGARD ('(p;92 ; 41 s -1 . J Y .',;1: "i s ff F � i " ,m ,.�. i . , ", 1 � >a`�4'y ' '.'. EJ1ec� i I (��] fi 4 1 x t }�"� � .. t . �� f�{' 2,.�tiYU4L ®� ls� �, P: i4 :,4, �' x�„ ' � t u4'`i �.,iR I k :z L � �'� $ .: � .�: TY'�r.Ys � .-. � G ,� - h� ,Y ty�'� k. - , � -� �) a 4 zr d fi' �,, nn `` i T °`,,, Datereeetved. / se ) fi n e 1 - i y'U P ermit no.: 2, ( , 0001 00 , i �. Oil , i .�i� City , ul'� Tigard 1( � � 1 �, -, 'f;' ':s x Project/appl_no.: Expire date: li,.' ,:i,i t Address: 13125 SW Hall Blvd, Ti aid, OR 97223 " ` � � Pt City of Tigard g` Date issued: By: Receipt �(`i' 1 a�ij � `� il�; Fax: (503) 598 -1960 Case file no.: Payment type: Phone: (503) 639 -4171 I `pa B.' it + i ` ' k '� ,• I' Land use approval: i 1 t : 1 41 ' r a , IA "'' TYPE ©F P I -I['I, „ � ,> Vet t ' ,th :' r , t 4..;" r' . 1. 4 ,4 1 1'n, . ., - . _ ,V,:i ,a 5 .#' 'i ` ' h x .„ , g '11,$.".";,:$ ∎ r, r t T ..1% 0 1 & 2 family dwelling or accessory ll Q-ornm ;rcial/industrial 0 Multi -famil ❑Tenant im rovement . I { t { I " a,.' li 0 New construction 0 Addltie n/alteration /replacement. 0 Other: CI Partial : � " , 44 arr11 ° 'VT „, 4 l VI i r' V, ,e ' �. 're rid 5 ; ;' ' s r : ,r i0$ n I + +NF filMIsIO21i '' r' ' r � .. 1: ,! ":. " '' ' r ` i g � ` � ' i .' Job address. �M • .fr Bldg. no Suite no Tax map /tax lot/account no.: lif -in i!.: tli;)r'l 'r ,, Lot: Block: Subdivision: � (' /� 2 Descri tion and location of work on premises: j�'w `„ 4 . ' Project name: G O�^F l Pty tiCO �- s �(� � 1' 1 y * omp on/inspection: / co' a • `a ✓d. i_ /a -- �IJI_� / - f . � r : ' -1 Estimated date of completion/inspection: PPL' t ; , 1q' 1 , '; n 4, ,; k ;4' 5 x1 1 , yam* «, ,�. , i i'l� , "s`'sP'" lj �Y r - EE { SCl3EDULIJ '` �s . ., 3N . r .,, � , max, r�a�¢ak,.u>dt _ t ,.. , .l . IC ;I''' , ds. " �' , "� �a �� "f� Job no: Tee ' Business name: ymw / , , ex � / � Ai Description Qty. (ea.) Total no. hasp Address: New' residential - single or multi- family per 7 1 7 /1t? , dwellingu it.Includes attached garage. . ' , City: 17.i e O . , State: Of ZIP_ 7 f/ 6 Seniceiveluded: . Phone: Fax' ft _ 3.5L�! - 35� -��ai E -mail: 1 000 sq. _ or less 4 CCB no.: / 07 l�> I Each additional 500 sq. ft. or portion thereof • _ Elec. bus. lit. no: Limited energy, residential 2 Git metro Le. no.: Limited energy, non- residential 2 I Q / d / — Each manufactured home or modular dwelling Signature of st pettitstng ele Vivian (required) Dal / i Service and/or feeder 2 Sup. elect. name (pnnt) :o Lic nseno: Q se��lcesorfeeders– installation, r r, xix, S alteration rrelocat'non: b ` s ._, ''''1%.' . ''''A PERit'Y O VER a r?t;n "m;' 6 - " " '` "' . 200 amps or less '� 2 Name (print): a : L C 1 Sse r 201 amps to 400 amps r111111111111 2 , Mailing address: 401 amps to 600 amps 601 amps to 1000 amps 2 City: Ki _ M I Z I P : 57 4 Over 1000 amps or volts . 2 5' { ,'' " Phone: ..,Fax: E -mail Reconnect only 1 ,1 Owner installation: The installation is being made on property I own Temporary services or feeders - which is not intended for sale, lease, rent, or exchange according to installation, alteration, orrelocation: ORS 447, 455, 479, 670, 701. 200 amps or less 2 20l amps to 400 amps Owneres signature: Date: 401 to 600 amps 2 1 M: '> �' ' J'� iv"�C1N �LR i ;' - ' . p "; ,.ti',- Y ,,*' Branch circuits - new, alteration, ■ ' '' a �: � rry w'.'"" w ,"4`4 , or extension per panel: ' C Name: A. Fee, for branch circuits with purchase of /� / t W '� Address: service or feeder fee, each branch circuit p (. (0' . 0 2 * City: State: I ZIP: B. Fee for branch circuits without purchase • Fax: E-mail: of service or feeder fee, first branch circuit: 2 Phone: I >, " """' � Each additional branch circuit: 4 - 1 1.t1N ItE1Vi +'G�'1` (iP eae eh Il that r � V - ; Mist. (Service or feeder not included): 0 Service over 225 amps O Health- carefacility Each pump or irrigation circle 2 0 Service over 320 amps - rating of 184.2 0 Hazardous location Each sign or outline lighting 2 family dwellings 0 Building over 10,010 square feet four or Signal circuits) or a limited energy panel, CI System over 600 volts nominal more residential an its in one structure alteration, or extension* 2 0 Building over three stories 0 Feeders, 400 amps or more *Description: 0 Occupant load over 99 persons 0 Manufactured strut tures or RV park Each additional inspection over the allowable in any of the above: 0 Egress/lightingplan 0 Other: — Per inspection Submit_ sets of plans with any of the a hove, investigation fee • . The above are not applicable to temporary consul Ietion service, Other - $ l73 Not all jurisdictions accept credit cards, please call jurisdiction for more furor riatiou Notice: This permit application Permit fee r Q Visa 0 MasterCard expires if a permit is not obtained Plan review (at lb) $ Credit card number. I / , within 180 days after it has been State surcharge (8 %) .... $ /3 , e rj Expin;s accepted as complete. TOTAL $ / t Name of cardholder as shown on credit card / . 3 Cardholder signature Amnu ri 440.-4615 (6/00 /COM) - I ,, 01/19/01 FRI 10: 16 FAX 503 598 1960 CITY OF T I CARD fgraigiqt.' Fps, wmolii* ...14:4 ,„ . Electr:ice Per lit Fees: United Energy Fees: : i4A A 1 - 11- -1 41V ki v.' ,, . ' TYPE OF WORK INVOLVED - RESIDENTIAL ONLY4 :e' Complete Fee Schedule Below: ' i lr 1 ; 1 11' Restricted Energy Fee , VA V '-f "44 ! Number of Ins .ections per .el mit allowed (FOR ALL SYSTEMS) Service included: Items Cost 'fotal 1, ,:i,.., ii:).3,, Check Type of Work Involved: li.:!, • 1 ii I■ i,::•• 1 1,A ,14,11 Jir .-4 Residential - per unit '''ei 1 • xi,IJ II t t 1000 sq. ft. or less $145.15 4 E 1. Audio and Stereo Systems t ,,, 5 q Each additional 500 sq. ft. or 1/...-e ii , • , ', ,N, 4 t . l portion thereof $33.40 1 . I I Burglar Alarm ,Idb• ii 1 , i. ' II Limited Energy $75.00 , f4:r4!' '- '1 '*;- ', . fiii Each Manufd Home or Modular 1 i r '6 1 1 Dwelling Service or Feeder $90.90 2 I I Garage Door Opener a ' . 1. 4. , "I il 'I I S t - , 0 .„ !..1.!, • , ' if Services or Feeders Ventilation and Air Conditioning System* pi Heating, 1,1 f 5 ifi. Installation, alteration, or relocation 200 amps or less . $80.30 _LW 60 2 201 amps to 400 amps $106.85 2 I I Vacuum Systems* *I0' . r!4 i. ity, ir •il 1 11,1 14 401 amps to 600 amps $160.60 2 r0 rv.,i , e's"...''P' 601 amps to 1000 amps $240.60 2 I I Other _ • . lifY L. ' Over 1000 amps or volts $454.65 . 2 1 ". YA:1 f' Reconnect only $66.85 2 - - 10:0 el ,04rAlgtlati; Temporary Services or Feeders • TYPE OF WORK INVOLVED - COMMERCIAL .. , Installation, alteration, or relocation Fee for each system - 'S75.00, 200 amps or less ids- _f $66.85 2 (SEE OAR 918-260-260) . . , 201 amps to 400 amps ' $100.30 2 . . 401 amps to 600 amps $133.75 2 Check Type of Work Involved: Over 600 amps to 1000 volts, . . see "b" above. . 1 Audio and Stereo Systems , • Branch Circuits . • ,• ' . New, alteration or extension per panel Ell Boiler Controls . a) The fee for branch circuits with purchase of service or . . Li. Clock Systems feeder fee. gi 30 b) ee circuits $6.65 Each branch circuit i :2 2 1 Data Telecommunication Installation • The f for branch . . . , without purchase of service - • I I Fire Alarm Installation ' or feeder fee. First branch circuit $46.85 ' , • , Each additional branch circuit $6.65 I I HVAC . , Miscellaneous Instrumentation , • (Service or feeder not included) . •i. i :1. Each pump or irrigation circle $53.40 • • i'•1 . :;, • - Each sign or outline lighting $53.40 El Intercom and Paging Systems . Signal circuit(s) or a limited energy • panel, alteration or extension $75.00 ' • . 0 . Landscape Irrigation Control* • . , ' • Minor Labels (10) $125.00 . . . Each additional inspection over El Medical ,- • i6 • the allowable in any of the above . . . Per inspection $62.50 . I I Nurse Calls • . . , . • ' Per hour $62.50 In Plant $73.75 [J Outdoor Landscape Lighting* . - • Fees: ni Protective Signaling 73 9 0 - - • Enter total of above fees $ / Li Other • . 8% State Surcharge $ /3.9 / . . - Number of Systems . • 25% Plan Review Fee See "Plan Review" section on $ .* No licenses are required. Licenses are required for all other installations front of application. Fees: Total Balance Due $ zg 7 / Enter total of above fees $ E l Trust Account # 8% State Surcharge . $ • Total Balance Due $ . 1 . . . • . • . - . . I • . . • i: \dsts\ forins\etc-fees.doc 10/09/00 • . . .. :, ,,. 41/ . KING CITY • .. 1 5300 S.W. 116th Avenue, King City, Oregon 97224 -2693 memowo Phone: (503) 639 -4082 • FAX (503) 639-3771 Notice To Contractors 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 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 permit application whether you would like 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: A� e�j ' �° Gb-UtA;` l �- located at: I (7 0 60 SW kin as -45 i V . id, tiL • , King City Represen ative I DSTS'•KCINST DOC CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24- Hour•Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested 2- 7 AM PM BLD Location / O ) $� ��`- Cl/4/4,) X C' Suite MEC Contact Person Ph O z./ PLM Contractor 9 j Cis r Ph SWR 'BUILDING ,y �` . Tenant/Owner ELC 2 "—C' 0 63( Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes: Slab SIT Post & Beam Ext Sheath /Shear Int Sheath /Shear Framing Insulation Drywall Nailing Firewal I Fire Sprinkler / CZ/ep Fire Alarm Susp'd Ceiling Roof Misc: Final .07 PASS PART FAIL - PLUMBING.% pp Post & Beam Under Slab Top Out Water Service Sanitary Sewer Rain Drains Final PASS PART FAIL MECHANICAye HI:.µ Post & Beam Rough In Gas Line Smoke Dampers Final _PASS PART FAIL .:gLECTHiC .I-) Service Rough In UG /Slab Low Voltage Fire SS ART FAIL Backfill /Grading Sanitary Sewer Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line [ ] Please call for reinspection RE: ] Unable to inspect - no access ADA Approach /Sidewalk Other Date 2 :7/-:?/ Inspector Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.