Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00426
G.,.. DEVELOPMENT SERVICES DATE ISSUED: 6/17/2005
- 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 25111 BA -09800
SITE ADDRESS: 09519 SW BROOKLYN LN ZONING: R -4.5
SUBDIVISION: SHANNON MEADOWS LOT : 003 JURISDICTION: TIG
Project Description: Electrical to AC (2 branch circuits.)
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+ amplvolt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
CHEN, PAN MCCOY ELECTRIC CO INC
9519 SW BROOKLYN LN. PO BOX 42428
TIGARD, OR 97223 PORTLAND, OR 97242 •
Phone: 503 - 639 -1706 Phone: 503 - 234 -7521
FEES Reg #: LIC 8277
SUP 2
Description Date Amount
ELE 26 -82-82
C
[ELPRMT] ELC Permit 6/17/2005 $53.50
[TAX] 8% State Surcharge 6/17/2005 $4.28 REQUIRED ITEMS AND REPORTS
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 OA2- 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 -80!- 32- 2344.
Issued By: / ��`�� Permittee Signature:
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 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Jun. 16. 2005 2:52PM MC COY ELECTRIC No. 2955 P. 2/3
, Plect�rical Permit Application
Date received /7 0 ' Permit no
.Z ,.. —OD JJ
d
A City ol< an f Tigard g � • � P�caject(aQpl. no_: Expire date:
Cfry ofTig ord Address: 13125 SW Dail v t ga �R� /222 Date issued; By: (503) 639 - 4171 Y Receipt no.:
IP off' Fax: (503) 598-1960 Case file no.: Payment type:
7 Land use approval: JUN 1 f 2005
f C. TY OF IlaMMrtiiu 7
TYPE OF PERMIT .
is I & 2 family dwelling or accessory CI C. ercial/industrial CI Multi CI Tenant improvement
U New construction °6 ! 3', Addition/alteration/rcplacemept ❑ Other: ❑ Peal
JOB SITE INI'OR1L1TION _
Job address: ` 1,.1 r5ro0 +, 6,, Bldg. no.: Suite no.: Tax map/tax lot/account no.:
Lot: • Block: Subdivision: •
Project name: Descri Jtion . d loeati«nof work on premises: nSTe 1! t*It_ NQ ('.,
Estimated date of corn .letionrins • - tion: MEN
('ON'I'RACTOIt APPLICATION .',..,..``. ILL SCIIEDIJLI '
Job no: r7 7
_ Foe Max
Business name: Co �( c'C C, Description Qty. (em) Total no. imp
Address: / 1.4 s' oi T A u t�
New residential - aurgleot multi fatttllypet
dwelling tort. IId udes attached garage
City: 1 v`Tfo.h at !State:// e ZIP: 4 7 7._( L( servioeincludod:
Phone: 2 14275-z/ I Fax :Z 3 if 9 (73i E -mail: 1000 sq. rt. or less 4
CCB no.:. 8 a a Ele bus. tic. n o: c; Each additional 500 sq. ft. or portion thereof
Limited coct}Sy, residential • 2
City/ • lic. no -:
Limited energy, non-residential 2
s� ' 6 — ` e, .- p y— Each manufactured home or modular dwelling
Signatur4o supervising electrician ( •aired) Date Service and/or feeder 2
Sup, elect name (print• Z lf1f` • .. 2_ .,( L. License no:0) , Services or feeders- installation,
PROPERTY OWNER
alteration ar relocation: .
•
200 amps or less 2
Name (print): nt��t� / 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 of volts • 2
'hone' , 3 .-/ 70, Fax: E Reconneotonly ' t
Owner installation: The installation is being made on property I own Temporary serYlCes feeders -
which is not intended for sale, lease, rent, or exchange according to Installation, alteration, arrelocation:
ORS 447, 455, 479, 670, 701. 200 arTa or teas 2
201 amps to 400 aims 2
Owner's signature: Date: 401 to 600 amps • , I [ 2
Branch circuits -new, alteration,
or extension per panel:
Name: . A, Fee for branch circuits with purchase of
,
Address: . service or feeder fee, each branch circuit 2
City: I State: I ZIP: B. Fee for branch circuits without purchase /
Phone Fax: E-mail: ' of service or feeder fee, rust branch circuit: 1 1 1 / 4,95 .-
/, ] 07 5 - 2
Each additional branch circuit . ( ir t0.' (,6S'
PLAN REVIEW (Please check all that apply) Mlsc . (Service or feeder hot included):
O. Service over 225 amps - commercial O health catetacility Each pump or irrigation circle 2
O Service over 320 atnps rating of 1&2 ❑ Hazardous location Each sign or outline lighting 2
family dwellings O 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 mom *Description:
❑ Occupant load over 99 persons O Manufactured structures or RV park
Each additional Inspection over the allowable In any of Ybe abort:
O Egress/lighting plan . O Other Par inspeelion I I I
Submit _ sets of plans with any orate above. ,Investigation fee
The above are not applicable to temporary construction service. Other
' 14 tau accept credit cards. please call juriadicdoa for ate informatloa Notice: This permit application
Permit fee $ 5 , S C)
sa . ❑ MasterCard expires if a permit is not obtained' Plan review (at %) $ _
a°dit crud. number. 1 / within 180 days after it has berm State surcharge (8%) $ 2 5e
E"D1°; accepted as complete_ TOTAL $ i
Name at ca dholde t as shown an credit car's
$
Cardholder signature Amount
■
440..4415 (6/00/COM)
0 SA.
CITY OF TIGARD ,�
BthLDING DIVISION PERMIT #: ELC2005 -00426
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6117/2005
Phone: (503) 639 -4171 - a4iruni
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WOR EET FOR DATE: 7/22/2005 TIME: 7 :09AM PAGE: 61
SITE ADDRESS: 09519 BROOKLYN LN CLASS OF WORK:
SUBDIVISION: SHANNO MEADOWS LOT #: 003 - TYPE OF USE:
PROJECT NAME: CHEN
DESCRIPTION: Electrical to A (2 branch circuits.)
OWNER: CHEN, PAN, PHONE #: 503-63 %1706
CONTRACTOR: MCCOY ELECTRIC :.0 INC c PHONE #: 503 -234 -7521
•
M �oNo�� -�1 I s� co l,E� ,.
Inspection Request Scheduled For: Date: 7/22/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 01 ' 9.01 503 -403 -2066 N
Corrections /Comments /Instructions: fj Q MI
aER,Ad
/ PASS n PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: V ® Date: "1 2 Phone #: (503) 718 - ZILI t
.*
CITY OF TIGARD j
BUILDING DIVISION PERMIT #: ELC20 -0G426
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 6/17/2005
Phone: (503) 639 -4171 i a s pilNpul pii u l li l h l \
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 7/1W2005 TIME: 7 :O8AM PAGE: 76
SITE ADDRESS: 09519 SW BROOKLYN LN CLASS OF WORK:
SUBDIVISION: SHANNON MEADOWS LOT #: 003 TYPE OF USE:
PROJECT NAME: CHEN
DESCRIPTION: Electrical to AC (2 branch circuits.) •
OWNER: CHEN, PAN, PHONE #: 503- 639.1706
CONTRACTOR: MCCOY ELECTRIC CO INC PHONE #: 503 - 2347521
Inspection Request Scheduled For: Date: 7/19/2005 Pour Time:
- - - - # Inspection Description Confirm # Contact # Message
199 Electrical final 011687 =01 5503 -234 -7521 N
Corrections /Comments /Instructions:
W O 0 A---- ,' -- N 0 R .cc € S
C ..
C. 4144 ' O tl a L 1(1:14°S
J
a PASS ❑ P TIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
Or ' ► ` CALL FOR INSPECTION Ell ADDITIONAL FEES ASSESSED
Inspector: Date: r -/4 - Phone #: (503) 718-