12050 SW IMPERIAL AVENUE k '
I
12050 SW Imperial Avenue
�:i rY OF -CIGARD BUILDING INSPECTION DIVISION
MST
24-Hour InspeLtion Line: 639-4175 Business Line: 639-4171 - - �--- -
SUP
Date Requested_ j .�-_D6'�� AM PM BLD
Location Suite �/ MFC y_
Contact Person _ / r� Ph G 6�q DC_ PLM ^_
C ►ntractor -72j rf ,�� � 1� Ph _ SVVR
BUILDING Tenant/Owner ELC I�X>l Cl)-6 j
Retaining Wall Er R
Footing Access:
Foundation FPS
Ftg Drain -"
Crawl Drain Inspection Notes: SrN
Slab
Post&Beam - — - SIT
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation ,
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc 7r1[, 6k �_t_,___���_' • i � 17
Final _ - / L •.•� f�,
PASS PART FAIL
4 {�
PLUMBING
Post,',Beam
Under Slab
Top out r�
Water Service
Sanitary Sewer
Rain Drains �,,y .e - L-)zqFinal _
PASS PART FAIL
MECHANICAL
Post&Beam
Rough In
Gas Line - - -- — -- -----
Smoke Dampers
Final -- --f:
PASS PART FAIL
ELECTKICAL
Service
-
oug
Rough In
UG/Slab -'
Low Voltage
Fire Alarm _
A 1 PART FAIL _—
SITE _
Backfill/Grading _
Sanitary Sewer
Storm Drain [ ]Reinspection fee of$ _required before next inspection. Pay at City Hall, 13125 SW Hail Blvd
Catch Basin
Fire Supply Line [ ]Please call for reinspection RE [ ]Unable to Inspect-no access
ADA �"'
l..
Approach/Sidewalk
Other _ Date /��2-QA-01 Inspector- , 7 Ext
Final --� ! `1��
PASS PART FAIL no NOT REMOVE this inspection record from the job site.
�ITY OF TIGARD ___—ELECTR!CALPERMIT
DEVELOPMENT SERVICES DAYS S UIED: 08 06 20006400
13125 SW hall Blvd., Tiqard. OR 97223 (503) 639-4171
SITE ADDRESS: 12050 SW IMPERIAL AVE LAUNDRY PARCEL: 2S11 OCA-00200
SUBDIVISION: KING CITY ZONING: ?
BLOCK: LOT : JURISDICTION: KIN
Praiect Description: Remove hot water heater from dedicated meter and reconnect toa building meter.
RESIDENTIAL UNIT _ TEMP SRVC/FLEDERS 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+arnps - 1000 volts: MINOR LABEL (10):
m _ SERVICE/FEEDER BRANCH CIRCUITS
_ ADD'L_IIvSPECTIONS
0 - 200 amp: W/SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 di-ln: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp. PLAN REVIEW SECTION __
1000+ amp/volt: >=4 RES UNITS: > 600 VOLT NOMIN_ AL•
Reconnect onN SVC/FDR >= 225 AMPS: CLASS AREA/SPEC OCC: �_ )
Owner: Contractor:
WESTON HOLDINGS GEORGE + SONS ELECTRIC CORP
2154 NE BROADWAY PO BOX 339
PORTLAND, OR 97212 CLACKA4AS, OR 97015
Phone: 503-284-2147 Phone: 654-8634
Reg#: LIC 35600
EI_E 3-117C
SUP 3185S
FEES — Required Inspections
Type By Fate Amount Receipt Rough-in —
5PCT CTR 08/06/2001 $3.15 27200100001 Wall Cover
Elect'I Final
PRMT CTR 08/06/2001 $46.85 2720010000(
Total $50.60
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 wort, will be done in accordance with approved Flans This permit will expire if work is not started within 180 days of issuance,or if work is
suspended for more than 180 days ATTENT ION Oregon law requires you to follow rules adopted by the Oregon Utility NoVication 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)
2466699 or 1.800-332-2344
Permit Signature: T Issued By: / r-
OWNER INSTALLATION ONLY
I he 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: hA,' Ca-. K1 �.Cts 4i-o DATE:__
LICENSE NO: --- 3� b ✓- 5 - ------ ---
Call 639•4175 by 7:00pm for an inspection the next husinesq ow
Electrical Permit Application
Date receiv _ Pentut no. �
City of Tigard Project/appl.no.: Expire date:
Address: 13125 SW Hall Blvd,Tigard,OR 97223 Date issued: By:7 Rewe
Phone:
C'uyq(/igurd Phone: (503) 639-4171
Case file no.: Payment type:
Fax: (503) 598.1960
Land use approval:
1
U 1 &2 family dwelling or accessory U Commercial/industrial W Multi-family ❑Tenant improvement
U New construction 0 Addition/alteraliotJreplacement U Otter. U Partial
1RMA ION
Job address: 5 E'
Bldg.no.: Suite u.r . Tax map/tax lot/account no.:
LVI, Block: S bdivision: iNG Ci 14
P.eject came: --
Description and location of work on premises: e u.ro
Est.r.wacd date of cumpletion/inspection: <�� i c.7 ,th r r eco r_ o
SjUMMM1
{K M1tar,
.IOb n0: Z 4 r— — lk�cripNon4dwellifng
y. (eq-) Tulrl nc.Ins
Business name:�e r �'�' ` 2- New reside -s6rgk or multi-fanJ
t'addrCss:�p! yl dwellingunit.InLludessitachedgarag_City:Ce/< State:o ZIP: 'J7oi.S Service included:
1(x)0 sq h.or less — _ 4ne: y- P6 Fax:lSf 3�� C mill' Each additional,SW a .ft.or onionElec.bus.lic.no: //7-G 2CCB no.: 3 GOD Limited energy,rcsidcnlialCity/melt ic.no.: O Limitcdenergy,non-residentia) 2Frch manufactured hmne or modula2
Date Service and/or feeder
Si netur su rvi electrician(required) Servlceso (feeders-Installation,
Sup.elect.name(print) r!IV41 r S' Licatse no: - alteratlon or relocation:
PROPERTY200 amps or less 2
201 amps to 400 amps 2
Name(print): A/ C 401 amps to 600 amps 2
601 amps to 1000 amps 2
Mailing address: 2
City: State:0 Z1P: z/a. Over 1000 amps or voles l
Phone'
Fax: E-mail: Reconnectonl
Temporary services or feeders-
Owner installation:The installation is being made on property I own huullat{on,ahemtlon,orreloatlon:
which is not into-Jud for sale,lease,rent,or exchange according to 200 amps or less 2
ORS 447,455,479,670,701. 201 amps to 4W amps 2
Owner's si mature: _ _
Dale: 401 to 6W ams 2
Branch circuits-new,alteration,
1.119 12,11 A I or extension per panel:
Name: A. Fee for branch circuits with purchase of 2
"— aervice or feeder fee,es,h branch circuit
Address: — B. Fes for branch circuits without purchase t/j
Citr - SlIIle: ZIP:_- of service or feeder fee,first branch circuit: rC 2
City:
Phone. --- I'as. E-nutil: Eschaddi imnalbranch circuiC —
Misc.(I Ml Saralee or feeder not Included): 2
Foch pumpor irrigation circle 2
U Service over 225 amps-contrnerciar U I lealth-ca c kwilny Each sign or outline 1iphting _
U Service over 320 amps-rating of 14e2 U Hazardoualocauon Signal cuil(s)ur a limited energy pool.
fantilydwellings U Building over 10,00U square feet four or Signalccirn,oreatuion• 2
U System over 600 volts numunal ,lure residential units in one structure _ — —
O Building over three stories U Feeders.400 amps or more •Descri tiom. ---.
U L`ccupa,load over 99 persons U Manufactured structures or RV park Each addltional im_pectlon over the allowable inany of tlm r;suve:
U Egress/lightingplart U Other: Perimi coon
Submit____sets of plans with any of the above. Investigation fee -
The above are not applicable to ternporar)thtt ry construction service. Permit fee..............I......$ S
Nota:t jurisdictions acceta credit canis•Please call jurisdiction tar own mfo,narion. Notice:This permit application plan review(at w %) $
O Via& U MasterCard expires if a permit is not obtained State surcharge(8%)....$ --2715-
Credit card cumber: within 180 days after it has been
spires TOTAL SO r 6
__ occcpted as ahmplete. ..............•....... s
ane of cardholder u show,,on c_m Ir surd s
440-4615(610arCUM)
-- Cardholder si6nattue _ Amount
07/30/2001 15:12 5036393771 CITY OF KING CITY PAGE 04
KING CI'T'Y
13300 S.W.116th Avenge,king City,Oregon 97224.2693
Phone;(003)638.40822•FAX(603)63P..1771
Notice To Contractors Working In King City
Due to an intergovernmental agreement with the City of Tigard, mane building related permits
for projects in King Cite are issued and inspected by the City of Tigard.
If your permit application DOES NOT REQUIRE PLAN REVIEW. simplv.y complete the
appropriate application legibly and submit it to the King City staff. The Kine Cin staff will
collect all fees and fa,_ the application to the City of Tigard, City of Tigard staff v.ill then create
cl-ie permit. issue the permit, and perform inspections. Please indicate on the permit application
whetheryou would like the Tigard staff to call you when the permit is read,- for issuance or
hetFler you prefer it to be mailed %without any notification. Any incomplete or illegible
application will be returned to King Cite 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 Cin' 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. 301 should you have any questions concerning submittal
requirements. All permit fees will he essessed and collected at the Clty of Tigard.
The City of King City hereby authorizes applicant to pursue permits at the Cit% of Tigard
Building DMpartment for the following project: Jf4u y�.�, &IJ) A��•�_
located at: /.205D .Sial ��
*
King Cite Representativ
I D5TS4Xrn5T Doc