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11720 SW King George Drive
CITYO F T I G A R D _ ELECTRICAL PERMIT
PERMIT#: ELC2001-00641
DEVELOPMENT SERVICES DATE ISSUED: 12/18/01
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639-4171 pA^CEL: 2S110CA-00800
SITE ADCRESS: 11720 SW KING GEORGE DR
SUBDIVISION: ZONiNU:
BLOCK: LOT : JURISDICTION: KIN
Proiect Description: Instal' underground power supply for cable TV.
RESIDENTIAL UNIT_ TF!AP Sk`,/C/FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: � _PUMP/IRRIGATION: —�
EACH ADD'L 500SF: 2^1 - 400 amp: SIGN/OUT LINE LTG:
LIMITED ENERGY: 401 - 600 F.Pp: SIGNAL/PANEL:
MANF HMI SVC/FDR: t,_, •amps - 1000 volts: MINOR LABEL (10):
SERVICE/FEEDER BRANCH_CIRCUITS __— AD►i'L INSPECTIONS
0 - 200 amp: 1 W/GERVICE OR FEEDER: PER INSPECT ION.
201 - 400 amr): 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCF', CIRC: IN F'LANT:
601 - 1000 amp: _ PLAN RLVI_EW SECTION
1000+ amp/volt. >=4 RES UNITS: _ > 600 VOLT NOMINAL:
Reconnect only SVC/FDR >=225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contrac.or:
TEMPLIN, ELMO L/BETTY J POWER TECHNOLOGY
11720 SVV KING GEORGE DR PO BOX 1766
KING CITY, OR 9722.4 OREGON CITY, OR 97045 EXPIRED
Phone: Phone: 503-657-0315
Reg #: LIC 11:;287
ELE 3-511C
SUP 3575S
FEES Required Inspections —_
Type By Date Amount Receipt Underground Cover
SPCT CTR 12/11,'01 $6.42 2720010000( Elec;t'I ',ervice
Elect'I t-inal
PRM i CTR 12/18/01 0.30 2720010000(
Total $86.72
This Permit is issued subject to the regulations contained in the Tigard Municipal Code. State of OR Specialty odes and all ether 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 rule i adopted by the Oregon Utility Notification Center Those
rules are set forth in OAR 952-001-0010 through OAR 952-001-0080 You ma/obtain copies of these rules or direct q'iestions to OUNC at(503)
246-6699 or 1.800.332-2344
Permit Signature: a- / Issued GBy:
hA ,�7�,/�./[!'t-,L. _ �� .ice ��.ii....��• !.G
_O'NNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, cr rent.
OWNER'S SIGNATURE: _^ _._ DATE. _
CON)-RACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: c, _ _C_ DATF:— _.-
LICENSE NO: �5 z 1115, 15 -- -- — --
Call 639-4175 by 7:00pm for an inspection the next business day
Doe 1? 01 11 : 29a Narictj James 503 657-0942 p.
p
%nal no.:
received
City of Tigard
ieyojYisord Addxt, 13123 SW Hall 131A,Tigard,OR 97233
rhr,r,t- (S03)639-4171
Far.:(303) 599-1,16,0 Oat n1a no paym=typ:
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12/13/2001 10:27 5036393771 CITY OF KING c',IT`," PAGE
KING4CITY
16200 9.W 119th.Avenue,King Cicy,Oregon 97224,2693
Phone:(0 J)839.4(,82•FAX(W-1)639-3171
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Notice I'ol Contractors Working In Cl
ty1 PM-4
Due to an intergovenuriental agreement with the City of Tl nrd, mangy. building re!a7.ed permits
for projects in King Cit are issued and ;n3pected by the City of Tigard.
i
If your permit applic,&t4n DOES NOT REQUIRE PLAN REVIEW, simply cornple,
appropriate application egibly and submit it to the King City staff. The King Cin• stat wi
coilect all fees and fax t 1e application to the City of Tigard. City of Tigard staff will rhea create
the permit. issue the pe it, and perform. inspections. Please indicate on the. permit application
%vhcther you WOUld like the Tigard staff to call you when the permit is ready for issuance or
whether you prefer it to i e mailed without an, notification. ,Any incomplete or illevible
application will be retu ed to King City staff for correc�ion and no processing will occur urAtil a
complete, legible application is received.
If your perm:; applicatioh DOES REQUIRE PLAN REVIEW, this form must be signed by a
King City staff person. 'ing Citi- staff simple 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 sut mit applications and plans. Development Setvicey Technicians are
a4ailabl(; at 639.4171 E, t. 304 should you have any questions concerning submittal
requirements. All permit fees %vill be assessed and collected at the City of Tigard.
The City of King City ht4Teby authorizes app)icant to pursue permits at the City of Tigard
i
Building Department for the f'ollo,,ving project LUJ/�PX�i(27Un®
located at ., �, R.1 rub_ � �-
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King City Representati%e
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