Permit A -.CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00312
=r#
DEVELOPMENT 1 I r SERVICES (503) 639 -4171 DATE ISSUED: • 5/30/03 Hall 13125 PARCEL: 2 S 110 C D -07200
SITE ADDRESS: 11955 SW QUEEN ELIZABETH ST
SUBDIVISION: KING CITY NO. 2 ZONING:
BLOCK: LOT : 002 JURISDICTION: KIN .
Project Description: Installation of (2) branch circuits for furnace and A/C unit.
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:
GRACE GOEBEL EVERGREEN ELECTRICAL CONTRACTO
11955 SW QUEEN ELIZABETH 23861 SE 442ND
KING CITY, OR 97224 SANDY, OR 97055
Phone: 503 - 670 -9735 Phone: 503 - 668 -4608
Reg #: L1C 136311
ELE 3 -472C
FEES SUP 45815
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 5/30/03 $53.50
[TAX] 8% State Tax 5/30/03 $4 Rough -in
Elect'I Final
Total $57.78
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.
Issued By: / Permit Signature: DA/ e#9776
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:
Call 639 -4175 by 7:00pm for an inspection the next business day
\
04/23/2002 15:21 FAX 503,5981980 CITY OF TIGARD 1J 002
A • Elect ritcal Permit Application
• [� U IV Daterceeived 4).3 Pettnitno.• 2,i 4613/2... • ' i 1 l � v [ 1 I. no.: Ex ire datc:
F ,,.: A i! City of Tigard pro eevapp p
C Addles: 13125 SW Hall Blvd. Tigp;tQ13 22 03 Date issued: /,I ��
: - Receipt no.:
Phone: (503) 639 -4171 MA c� Lu
Fax: (503) 598 -1960
CITY OF TIGARD Case file no.: Payment type:
Land use approval: �LnING DIVISION
TV'PL OF PER:111T
',' I & 2 family dwelling or accessory 0 Commercial/industrial 0 Muld - family 0 Tenant improvement
O New construction 0 Addition/alteration/replacement 0 Other. 0 Panial
JOB SITE INFORMATION
Job address: • i i — �I QQN 1 , ! IA Bldg no. Suite no Tax map /tax lot/account no.:
Lot: IBlock: (Subdivision: g.
Project name: j Description and location of work on premises: tc-(NC.Les p — C.[ r .
Estimated date of completion/inspecdon:
CONTRACTOR APPLICATION FEE S(lIFDtLE
lob no• /^fit -atn Fe Max
y J D escription Qty. des) Total no. leap
Business name : .EJGr j EA e�� ri t 1 rte, -single ortadtidomllYPer
Address: �33't4.t L . dwelfingmdt.lnduticaattedted garage.
City: t - , Stare: OP f : Cip ' Setvieeeiteltded: 4
Phone: Fax: ;,;;t ,/, % .C; i cS (E -mail: 1000 sq. ft. or less
�LD ' Each additional 500 sq- ft. or portion thereof
CCB no.: i 3 S 1 t, � Else. bus. lie. no: 3_•-x l er e _ . Limited 2
• City /metro lie. no.: c- — Limited energy, non- residential 2
Each manufacutred home or modular dwelling
Oat Service and/or feeder "r_ 2 ,
(j no: j 1J
Signature of supervising electrician (required) ' Services or feeders - Installation,
am
Sup. elect name (print): 1 i t„ � )2,4:„. • Aeration o•rebearron:
PR(.)I'ERTA t)V "NEft 200. oriels 2
201 a • to 400 amps 2
Name (print): [ I: LD: 401 amps to 600 amps 2
Mailing address: 11 • 5 7:‘ 4 f T� 601 amps 1000 amps 2
City: a.' a ' D • � :. a / ZIP: 4 ' V Over 1000 . . or volts • i • State() - -
'Phone -4 • ' ! 46 tit E-mail: Reconnect only
Owner installation:.The installation is being made on property: I -o•n _ Tem _ • .
which is not intended for sale, lease, rent, or exchange accordingto Insdllstb0 ,niteraltaa,oreclat:Wax
200 amps or less - 2
ORS 447, 455, 479, 670, 701. 201 amps to 400 amps - -_ . 2
Owner's si Date: 401 to 600 amps 2
(lamed draft; - nerr, alteration,
or extension per panel:
Name: A. Fes for breath cheeks with purchase of
Address: service of feeder fee, each branch circuit 2 •
State: ZIP:: B. Fee for branch circuits wi ' • at purchase
City: of service or feeder fee, rust branch circuit: 1415 2 ,
Phone: • Fax: E- frail: E additional brand's circuit.
Misc. (Servieeor feeder aot Included): .
t] Services over 324 atnpecom me'eial 0 Hcalth-carafeeiliey Each pump or ITdgadon circle 2
0 Service over 320 amps -rating of I dc2 0 Hazardous location Each signor outline lighting 2
family dwellings 0 Building over 10,000 square feet four or Signal circult(s) ore limited energy panel.
CI System over 600 volts nominal mom residential units in one ammo re alteration, or extension* - 2
O Budding over three stories . 0 Foedcra, 400 amps or more *Description: •
0 Occupant load over 99 persons . - 0 Manufactured structures or RV park " EaoU additional inspection over the allowable In any of the above:
0 Egres/fghtingplan 0 Other. Per inspection - - • •. . - • • . I i . I I
. Submit seats o[ plans with any of the above. ' . Investigation fee - - . •
The above sure trot applicable to temp orairy cOostructton lee. ' Other . .._ .
Permit fcc $ ai S 0
• Niel air ixikek. a .fie card., p earl )arisdimm ter mote itQo�+�tiott Notice: This permit application Plan review (at , 9b) $
0 Visa 0 MastefCard expires if a permit is not obtained
Credit cad ramp= . . / / within 180 days after it has been Stale surC118ipe (8%) $
cs accepted as complete- TOTAL $ •
Name d cardholder as mown op credit cad
S
Cardholder sirgrmrrre wmocat , 44046x5 (dtIDICCMI