Permit CITY TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00257
' DEVELOPMENT SERVICES DATE ISSUED: 5/13/2004
V I I I .
13125 SW Hall Blvd.. Tivard, OR 97223 (503) 639 -4171
PARCEL: 1S135DD-03703
SITE ADDRESS: 11624 SW LOMITA AVE C -3
SUBDIVISION: PLAZA GARDEN WEST ZONING: R
BLOCK: LOT : JURISDICTION: TIG
Project Description: 1 200 amp service with 6 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: 1 W /SERVICE OR FEEDER: 6 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:
PARKER, JEROME W TRUSTEE MCCOY EMPIRE ELECTRIC LLC
BY SUMMIT REAL ESTATE MANAGEME 2014 SE 9TH STREET
5320 SW MACADAM AVE PORTLAND, OR 97214
PORTLAND, OR 97201
Phone: Phone: 503 - 777 - 3108
Reg #: L1C 147727
SUP 2430S
FEES ELE 26 -82C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 5/13/2004 $120.20
[TAX] 8% State Surcharge 5/13/2004 $9.66 Rough -in
Refund - [ ELPRMT] ELC 5/13/2004 - $120.20 Elect'! Service
(additional fees not listed here) Elect'! Final
Total $129.82
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 1-80.-'
Air
Issued By: ' I / �� Permit Signature: 62`1 CQ� �,
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OWNER INSTALLATION ONLY _1T
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
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' ' l' a1 i
._ * *' �1eC tr1C Permit l i CatlOil s�
, E V E J D Date received: j Permit no _ , /% ' OT -
1 City of Tigard "'._.. y Projecdappl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigdy \OR 97 204 Date issued: / B Receipt no.:
Phone: (503) 639 -4171 Y'L p
Fax: (503) 598 -1960 CITY OF TIGARD Case file no.: Payment type:
Land use approval: / F RING
-. 1 Y1 0 -. t , 1 ,., ,.. +s;: k I�: TYPE`OF : PER iV1IT� , �:: q 4x;.4 � ; 1 r
❑ 1 & 2 family dwelling or accessory 0 Commercial /industrial ►t ulti- family 0 Tenant improvement
0 New construction 0 Addition/alteration /replacement 0 Other: 0 Partial
1> afr ': �e 4ii-A. C .' b'',+ j" 4 t'' "6:t i '� '" r q '�4+,. br it x W. t. 2 ` .;?� :' 0 ' .
� �� .:� x JOB SITE`INTORA7ATIOt N ' � �� x �� �� � '� -.: a ..� t:, z�F; ��' � .;
Job address: 6„� S 2t IJJ • La /71 I TA- 1, ((Z Bldg. no.: Suite no.:1,3 Tax map /tax lot/account no.:
Lot: (16'234
Block: (Subdivision: cP.12 �3
Project name: L 'TA tm ESt oil Description and location of work on premises: l`((Lt- i1)(ZOh/ 1) 3
Estimated date of completion/inspection: 6- 30-0
�y, , W ' r , ? z -.l , f `t Q$ . TEE S CHE . ,' .. ' ; ` s. , w ; ,� ` ,5 5 Job no: ? 0 Fee Max
Business name: rc_�' ra._.. e--.L - TUC,
New residential -single or multi- family per
Description Qty. (ea.) Total no. insp
Address: "' (
��O t 4 S . 9 t-. J dwelling unit Includes attached garage. •
City: Q 0ru1 t ,_ 3. I State: 0$-IZIP:°1.3g f 9 Service included:
Phone: 2 , '+t - }s-� I Fax: ,21 I E -mail: 1000 sq. ft. or less 4
� � 0.4 6',9,.0 Each additiona1500 sq. ft. or portion thereof
CCB no.: '�' Elec. bus. lic. no
City/ etro lic. no. • - 3 Co Limited energy, residential 2
Limited energy, non - residential 2
I �-- n - ,,c 1 --o y Each manufactured home or modular dwelling
Signa( of supe is g electrician (required) Date Service and/or feeder 2
Su elect_ na rint : 1 js 'd'4. - '_ f �s- � Serncesor [ eeders- inst allation,
P (P ) (� f� License no
,, Y � �.�x; ?„ ��`t , � �� , alteration or rel
f ogre PROPERTYOWNER i ,: iK.''44 '0 - I
• - � -. r. ,� :tom• , -_�� _t f 9 �� � 200 amps or less 2
Name (print): 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address: 601 amps to 1000 amps 2
City: I State: I ZIP: Over 1000 amps or volts . 2
Phone: [Fax: I E -mail: Reconnect only I
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 installation, alteration, orrelocation:
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 amps 2
L4 :F" 4 1 ' :t. t :r ENGINEER ' x ;' V * x ' : � 4t'� ;;It' Branch circuits - new alteration,
or extension per panel:
Name:
A. Fee for branch circuits with purchase of to
Address: service or feeder fee, each branch circuit 2
City: I St I ZIP B. Fee for branch circuits without purchase
Fax Email
of service or feeder fee, first branch circuit: 2
Phone:
Each additional branch circuit:
t�� 1 A - ., .. AN RE VII } • ,, eae c he c k ; a l lltllat apply) 4 ` ` *; • Mis .( Serv i ce or feeder not included):
0. Service over 225 amps- commercial ❑ Health -care facility Each pump or irrigation circle 2
❑ Service over 320 amps- rating of 1 &2 ❑ Hazardous location Each sign or outline lighting 2
family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
❑ System over 600 volts nominal more residential units in one structure alteration, or extension* 2
❑ Building over three stories ❑ Feeders, 400 amps or more *Description:
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
O Egress/lighting plan ❑ Other.
Per inspection
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 $ jZe. "6c> /019
❑ Visa ❑ MasterCard . expires if a permit is not obtained Plan review at _ %) $ '
Credit card number. / / within 180 days after it has been State surcharge (8 %) $ _ %• 01-
$
Expires accepted as complete. TOTAL $ `2. n
Name of cardholder as shown on credit card yj!`� ,d�
Cardholder signature Amount
440-4615 (6100 /COM — /
)' �'
alIttelk (fJ � k( --
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested _ 5- 3— AM PM BUP •
Location 1/ 4 a Suite C-- MEC
Contact Person - Ph ( ) 3 _ ' �O� (PLM
Contractor Ph ( ) SWR Z
BUILDING Tenant/Owner ELC -�
Footing ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath /Shear
Int Sheath/Shear
Framing
Insulation , �,
Drywall Nailing [ v t�
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
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
Service
Rough -In
UG /Slab
Low Voltage
arm
S PART FAIL 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 S _ Z b L "I 1 �� Approach /Sidewalk Date t Inspector Ml Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL