Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2000 -00125
� Ali
DEVELOPMENT H P Tigard, ) 639 -4171 DATE ISSUED: 03/22/2000
PARCEL: 2 S 110 C C -20900
SITE ADDRESS: 12364 SW KING GEORGE DR
SUBDIVISION: KING CITY NO. 5 ZONING:
BLOCK: LOT : 086 JURISDICTION: KIN
Project Description: Electrical alteration
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: 1 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:
JOELLE LEWIS STREAMLINE ELECTRICAL
12364 SW KING GEORGE 6017 -B EAST 18TH STREET
KING CITY, OR 97224 VANCOUVER, WA 98
Phone: Phone: 360- 993 -5080
Reg #: LIC 116514
ELE 34 -432C
SUP 2197S
FEES Required Inspections
Type By Date Amount Receipt
Elect'I Service
PRMT BON 03/22/200C $42.85 0000850 Elect'l Final ORIGINAL
5PCT BON 03/22/200C $3.43 0000850
Total $46.28 •
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 -1987.
PERMITTEE'S SIGNATURE' - _ ISSUED BY jt
OWN 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: Cu- _ cav DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
03/21/2000 05:37 13609935082 STREAMLINE ELECTRIC PAGE 02
�. li.. u .P:ccp Jostle Lewis 503- 224 -1445 p•2
CIl'Y OF TIGARD Electrical Permit Application Ran C►teclt
13128 SW HALL BLVD. Rec•o ay
TIGARD OR 87223 Date Reed 3 - 7- 2 7-a:
Phone (503) 6396171, 11304 Date to P.E.
Date to D6T
InspOCUon (503) 639 -4175 Print of Type penal* C -C/z - MI
Fax (503) 698 -1960 'now/mote or Illegible will not be accepted Coiled
1. ,bb Address: 4. Complete Fee Schedule Below:
Name of Development nu of the a
Name (or name of business) r'LL.0 LE ;S Service Included: Items Cost Sum I
Address l 2...U,, 1 St Kit.) 3 V V g (,C '44. 11rae1dentiel - per unit
City/State/Zip t .14.16 t000 co. II. or toes $ 117.76 4
L.a A L Esch 46ditonel 900 0Q. rt or
portion thereof I 2475 1
Commercial CI ResidertialIS tweed Energ s 40.00
East Mature Hone or Valuer
2a. Contractor installation only. Dweain4 Service or Feeder 8 77.75 2
(Prior to wink balance, applicants must provide otlarectar licess. 45. asrvicoo or t
Information for CoT data brae). I I,atietwen, occesten, or reloG8tlon
Eledrical Contractor S . !)w 200 stripe arias 9 64.26 2
Add / Z. f ( ak. 201 an to 400 snipe
CO 4 6.30 2
401 amps to 600 seas 8 126.50 2
State 1 �4k Zip g(�l�f 001 amps to 1030 amps $ 192,50 2
Phone Over 1000 taws or voua 9 393.75 2
Job No. Reconnect only 9 53.80 2
Elec.. Cont. Line. No. �/ Exp.Date,< 4e. Ternponny Smola* or Ran0020
OR Stele GCB Reg. NO - Exp.Da'o _c t! LIC ) Inatoa elOn. alieraaan. or ralerO8on
COT Business Tax or Metro No
pate swim a or ho 5 43.50 2
/ 201 amps to 400 amps 9 00.25 2
Signature of Supt. Elec'n ? G� � >t 4 0 1 amps to 600 amps $ 107.00 2
Over 400 amps to /OM Veda.
coo "a" ammo.
License No I - Eep.Date je, (de*
Phone NO. 3 C� 4d. Branch Circuits
�-.. teas, tettea0an or mansion par pane
a) The Ise for band% timults
2b. For owner installation: wie pre agme of o vivo Or
Print Owners Name Caen brands wad% $ 0.36 2
Addr1 b) The too tor art
tan Creults
City State Zlp Mawr cm of sartrba
Phone No. Few wend, circuit I $ 27.50 �� ` 7
Each sddltionat branch awe L..... 5 5.35 $7 7 9
The installation is being made on property I own which is not ea. elks llanceua
intended br sale, bloom Of rent. gamma or meow Mb inclose)
Each pump or Irrlpadan drdr 1 42 75
Owners Signature Each glen Or mans 114Mlnp a 42.75
Slpnal drogue) or a Roiled envy
Pawl. e1tete1nst Of eater aeon 5 60.00
3. Plan Review section (if required). a minor totals 110) $ 6e41.e4
Rome dwelt approprtets item and alter fee In t on 88. 41. Es4$ aadldenal Inspection owe /a,
i 4 or more rea teal units In ono structure � � �y 1114 MOW
i S4rv�a and feeder 225 atltps or more Rot hour s 50.00
I Per her $ 00.00
System era 900 Vona nominal In Plerq - 5 6800
Classified area or struNere containing special occupancy as ^�
iasaribet In N.E.C. Chaplet 6 5 �J tote of goers few 8 0 L K
o , /4 Bur tsrgs (.05 x total roes) 5 �(i
stoma 2 wits of plans with epptica6on rMere any of 1718 above aPRN • ;,:.
Not tee 4rrpd tar temporary oonsteuction eervteos. Subbed S
Ob. Vaal' 23%arline Bahr
NOTICE Pm Review if rjauiroQ (sec. 3) 3
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AuTHOR1ZED Steroid I m IS NOT COMMENCED WITHIN 16C DAYS, OR IF CONSTRUCTION OR ,`
(
WORK 16 6UtiPENDED OR ABANDONED FOR A PERIOD OF 160 DAYS 0 Trust Account d _ / 2 `
AT ANY TIME AFTER WORK 19 COMMENCED Tome/ balance Owe \ ti rmainci
t:tdsta trmnttsiearic ,doe
'tad KING CITY
15300 S.W. 116th Avenue, King City, Oregon 97224 -2693
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: _r22c- k g t,c 60, 4 /G
located at: /,2,3 6 KW1Gt 6„er1vS,( ,
Ki n g City R: I resentative
I; DSTS\KCUNST.DOC - - -- -- - - - - - -- - -- - -
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
_ BUP
Date Requested 325/6 6 AM PM BLD
Location /0234 c/ o Suite MEC
Contact Person -� Ph — 2 PLM
Contractor Ph SWR �
BUILDING, . °;$ ° Tenant/Owner Odd -ac 61-3
"
Retaining Wall ELR
Footing
e s:
Foundation Acc FPS
Ftg Drain
Crawl Drain Inspection Notes: SGN
Slab . SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof n q
Misc: /
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line �
Smoke Dampers
Final r
PASS PART FAIL
TRfCAL '
Service(�'�
Rough In „;
UG /Slab
Low Voltage
Fire larm
P RT FAIL
B ackfill /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 3 -- 3 -- .
Other Date � � Inspector ��_ /ii " / // - A Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
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