Permit CITY-OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004-00259 kl� DEVELOPMENT SERVICES DATE ISSUED: 5/14/2004
A ,, I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 - 4171
PARCEL: 1S125DA-07800
SITE ADDRESS: 09185 SW 69TH AVE
SUBDIVISION: KINGS VIEW ZONING: R -4.5
BLOCK: LOT : 075 JURISDICTION: TIG
Project Description: 200 amp service install.
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: 1 W /SERVICE OR FEEDER: 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:
BROWN, BECKY MCCOY EMPIRE ELECTRIC LLC
9185 SW 69 2014 SE 9TH STREET
TIGARD, OR 97223 PORTLAND, OR 97214
Phone: 503 - 684 -9055 Phone: 503 - 777 -3108
Reg #: LIC 147727
SUP 2430S
FEES ELE 26 -82C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 5/14/2004 $80.30
[TAX] 8% State Surcharge 5/14/2004 $6.42 Elect'l Service
Elect'I Final
Total $86.72
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 -800-3 -2344.
Issued By: _� � , _ _ Permit Signature: t'1
i 0
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:OOpm for an inspection the next business day
' . , A Electrical PermitApplication
received, ffd Permit no.: . ■ � , � ' R EC C
A
I I� City of Tigard E� • •e c�a 1.
pp Expire date:
City ofTigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: ' '�
Phone: (503) 639-4171 MAY Receipt no.:
Fax: (503) 598 -1960 MAY ' � o Case fileno.: Payment type:
Land use approval: GI1Y OF TIGARD
+hi c.lENG!!EERING
TYPE OF PERMIT
1 & 2 family dwelling or accessory ❑ Commercial/industrial
6 CI Multi-family O Tenant improvement
New construction ❑ Addition /alteration/replacement 0 Other: O Partial
JOB SITE INFORMATION
Job address: • S 4 W .. r� _ 116 Bldg. no.: Suite no.: Tax map/tax lot/account no.:
Lot: Block: Subdivision: q I Z23
Project name: a(1,04) I.) `Description and location of work on premises: /00 — 2' c Anne Sre`ti/ -
Estimated date of completion/inspection: — 2, —
CONTRACTOR APPLICATION \------ ; FEE ,SCIIELILI . G ,
Job no : ■ 3t 05' Fee
Max
Description Qty. (ea.) Total no. ins
Business name:
Mc Cc, -G:n x_
Address: 1 y S _ .I q New ° - or nadd family per
dwelling atilt. Incladts attached garage
City: Q®gC. ► l -,0 fa. State: D IP: Ci - l 44 Service included: •
Phone: A 34- 45 7.1 f Fax: 2 9u 4 43 ( E -mail: 1000 sq. ft. or less 4
Each additional 500 sq. ft. or portion thereof
CCB no.: ) � 4 Elec bus. lie. no: aco81 G
Limited energy, 2
rgy, residential
City/ etro lie. no.: 26 Limited energy, non- residential 2
e z 12 _O y Each manufactured home or modular dwelling
Signs of supervising el 'cian (required) Date Service and/or feeder 2
Sup. elect. name (print ):3 i j -4 a1. Services or feeders installation,
P (P ) Licen no alteration or relocation:
PROPERTY OIVNER 200 amps or less f 1 2
Name (print): B t- IAA L i 201 amps to 400 amps 2
Mailing address: (--- 401 amps to 600 amps 2
601 amps to 1000 amps 2
City: ( State: ( ZIP: Over 1000 amps or volts 2
Phone:l (4/-- 065IFax: I E -mail: Reconnect only 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 on, al on, or relocation:
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 am . s 2
ENGINEER Branch circuits - new, alteration,
or extension per panel:
Name: A. Fee for brunch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: ( State: ( ZIP: B. Fee for branch circuits without purchase
Phone: Fax: E-mail: of service or feeder fee, first branch circuit: 2
Each additional branch circuit
• PLAN REVIEII' (Please check all that apply) Misc. (Service or feeder not included):
O Service over 225 amps-commercial 0 Health -care facility Each pump or irrigation circle 2
O Service over 320 amps- rating of 18r..2 0 Hazardous location Each sign or outline lighting 2
family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
O System over 600 volts nominal more residential units in one structure alteration, or extension' 2
O Building over three stories 0 Feeders, 400 amps or more *Description:
O Occupant load over 99 persons 0 Manufactured structures or RV park
O Egresstightingplan 0 Other. Each additional inspection over the allowable in any of the above
Per inspection 1 ] 1 1
Submit _ sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Not all jurisdictions accept credit cards, please call jurisdiction for more information Notice: This permit application
Permit fee $
O Visc 0 MasterCard expires if a pe mit is not obtained Plan review (at _ %) $
credit card number: - / / within 180 days after it has been State surcharge (8 %) .... $
Expires accepted as complete. TOTAL $ g `p . 2
Name of =dim estsown on credit card $
cardholder signature Amount 440 -4615 (600/COM)
C (4-6C K— L ` Ate.
CITY OF TIGARD 24 -Hour
BUILDING a Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST
BUP
Received 17): 4 Date Requested 5 J AM PM BUP
Location 9/ f5 9A'L Suite MEC
Contact Person / Ph 23 5 — 2 J - PLM
Contractor 7)4iC_ C --P-tP • Ph ( ) SWR
BUILDING Tenant/Ow r ELC
Footing
Foundation ELC
Ftg Drain Access:
ELR
Crawl Drain
Slab Inspection Notes: / SIT
Post & Beam o / . % /
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation 'O2"/ ED Fait f F YA _7
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm tvitrek..._ n ea ,501)411) GA/A . c- 1-4/X,p , / ?7 --
Susp'd Ceiling
Roof /11 - G45+PPE/& IP69E — 2 e - Er uJ1-7L(
Other:
Final CO ) B A-/K5 eit- B 1.'WZ FJ ,
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab 7 isRA -Atc K c,(i.c_v r -s V /(t-td
Rough -In Al FEJ) P em T Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
�6ervice
UG/Slab
Low Voltage
F m
' •ART FAIL D Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
Please call for reinspection RE: Unable to inspect - no access
Fire Supply Line
ADA Date 2 - 8 -- or Inspector/4 - /O M /9 & f' Ext
Approach/Sidewalk
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL