Permit A, :CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00721
AL./Mi ‘e DEVELOPMENT SERVICES DATE ISSUED: 11/10/2004
13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171
PARCEL: 1 S136AA -01500
SITE ADDRESS: 10313 SW 69TH AVE
SUBDIVISION: FUR VALLEY ZONING: R -4.5
BLOCK: LOT : 006 JURISDICTION: TIG
Project Description: 1- 200amp serv. and 5 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: 5 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:
LUKE -DORF TICE ELECTRIC
10313 SW 69TH PO BOX 15009
TIGARD, OR 97223 2139 SE BELMONT ST
PORTLAND, OR 97293 -5009
Phone: 503 - 624 -0866 Phone: 503 - 233 -8801
Reg #: LIC 166
SUP 2586S
FEES ELE 26 -126C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 11/10/200' $113.55
[TAX] 8% State Surcharge 11/10/200' $9.08 Rough -
Elect'I Service
Total $122.63 Elect'I Final
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- 332 -2344.
Issued By: /` 7 Permit 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: &S
Call 639 -4175 by 7:OOpm for an inspection the next business day
11/09/2004 09:24 503 - 872 -8290 TICE ELECT.SERV.DEPT PAGE 02
11.0. 2p :33 FAX 5035981960 1 �i003
-� �1 9 •
d CITY O F TIGARD
Elestr�ical per A cat o; n• • I'm( t_r1' LE
• FJCF. . ONLY •
. City Tigard. ,,_. ..
h' 8 .. , a : it 10 0 156 nrp,it u' ,1 oOi-/ -00 9,1
• :3125 SW Nall Blvd., Tigard, On 97223 '"
Plea Aeviy«
Phone: 50!,639,4171 Fax 503.598.1960 '•ii,t DateiB: Other Permit:
,ntpeoeon Line: 503.63: � - Q1 ', . ,a ' _AL' Al' 1 Dose /11Y: &! See rase 2 to
internal www.ci,tigard or.u5 ' ' ° ,•,, tJ o - - NontletYmelh -' / od: / Sup - Weenie' lnformatinn
rftPB: Olr Wolue 1 ..
New const:uctlon Dk !/a)uiationtteplaaemont Please check all mar cooly:
0 Demolition _ �f Other: . .. • OSC*vlce over 223 amps, eornm'1 [Jfiaz doue location
• _ DServiee ovor 32a amps - rating 0Suileng over 10,000 Al. 1.
G512'EGAAY ; (3F' CWii9r Rf�CrTpN of I - and 24a/oily dwellings a or Marc new residaat:al I f
❑ 1. and 2- family dwelling ZJ Commercial/industrial d Accessory building ❑ Sys aver 600 volts nominal units in one structure
°Buiilding over Over statics ❑Iroodcrs, 400 amps or more
( [l :1I'_(tl- 113ily Q Master builder ❑ QOeenpant Maid
d over 99 persons Manufeetured structures or
} :101 $'1TE PtFORMATIO"1. ii.ND• LOCATION : QEgressilighting RV perk
QMeoith•earc facility ElOther
• Job no.: 99.9259 . Job silo address- 10313 Sw 69th Ave Submit 1. sets ofplens with any of the above.
. City /Stare/ZIP: The above aro not applicable to temporary construction service.
Tigax'd 97223 " FMS•• 'SCItRDUlt; • •
Suite/bldg. /apt:. no.: Project name: • poo.rpll Q e. r.. veal ! ••
•
Cross ureet/.dirattiots to job site: New residential single- or multi fancily AWeUiog uau:
Includes attached garage.
• 1,000 sq. t< or ku 145.15 4
• Subdivision: . )' .ot n0 : f _� wt 500 s q. it or pardon in r 33.40 1
Cox map/parcel .
?0 - J tad anew, maiden:in/ 75.00 2 ,
• - • . • hutted camp,
non - residential 75.00 ' 1 2
• .- ' •.'DESCRIPi'ION OF WORK :' ' ' each macufiewtadormodular
dwelling, tatvka and/Sr fcoder 90.90 I z
. New service . - mile wiring flax . r�del
• Services or feeda.a in.taUatior►, attar'tio� and/or relocation
. . 200 amps or leas _ - 1 80.312
• • ` P1top 'rX OWNRR : ❑ ENAl!(T 201 amps to d00 mps
a 1 a6.eJ 2
- . 401 ow t0 600 stops 160.60 1 z
Name: Luidet3orf Inc, _ 601 amps to 1.000 mops 240.60 1 2
. Adereea: • 10313 SW 69th Ave • . OVA/ 1,000 raga or VOiu 454.65 . 1 2
' Reconnoctonly 66.85 1 2 • • City/State/2V: • Tigard OR 97223 • Temporary services Of feeders lmtalladon.'lteration, and for
relocation
• PF.ana: ( 503) 246 - 5493 1. Fax: ( • _ 200 amps or lase 66.85 • 1
Owner humiliation: 'ibis installation i6 being made 9n'prOperty that 1 owrt which is not 1 201 amps re- 400 maps 100.30 2
mtend.d for sale, lease, rent, or exchange, according to ORS 417, 449, 670, and 701. _
W I amps to 60U amps 133.7 2
• Owner signature; ' ' Date' Brooch circuits - new. alteration, or eettasiui . per panel
❑ AP .
RLICAN't 1.. • .. Q .CON[Twt'I' PYRSdN ' :, ...: A Ace 1br braacL circuits with
rsr v i ee or fCC re"Cil
• Business nnnte. Munch circuit 5 6 31 751
2
Cantat t' oarie: • g. Fee for branch circuits
+Willow service or fee$er fee, ' 46.83 2
Address: - each batch circuit
Each add'1 blonds 'circuit 1 6.65 -- 2
C :y /Start /ZIP; Miscellaneous Wavle* or reedir sot included) ...
-
I Phore (.. ) 1 Ft*: , ( Pump or imgatio i circle 1 53.40 ! 2
Sign or outline lighting , 53.40 2 J
• E -mail: Signal cireuit(s) or limited.
• • • • • : ::. CoNT.RActim .'.: •: ; energy paw a or I
• " - extension, Describe: 1 Page 2 2
' Bustncss name: Tice Electric Co. i
.i3d: qs:
-4. : • • • 1 1 • • E$ch additional Inspection user allowable In a oy of the abort
/Z Por tland Olt' 97293 -5009 - investigation stigation (I
per hour 623
City/State/Zip: IP: ••••• luvcatig.deet» 62
•
ia • .50
,,,.A. t 503 233 -8801 >tax; ( 503) 872-8290 lndustrialplantperhoar , 73.73 1
I�'6 r • .. S ." • e> X ECnt psw ,r MS*
CCB Lk.: .: • Electrical Lio • 26 - 6C slam.. ti 2586$ Subtotal 113.55
� .5uprv Electrician Si gtlature, required: - . • • / Plan review (25% of permit (ee)
• a • '. 1 • Sate surcharge (8%ofpctmitfoe) . 9 -Ulf
Pynt ,utle. John a Malone • D ate;
• TOTAL PERMIT PEE 122.63 1
Authorized signatwc; ' . op .. ..� ' /, , 1u►t permit applb Ward euplres If a permit is oni o ard wlthtn 1 VO
nays atter It has bean ecceptod es comply
• i Print same, John Maloney. Due 11/0q/n4 • Fly m.rsodaasay as byIfi -cew.y ewl4ing !Mussy a,.vicr Dora
•• Number of inspeetlmu per penrdt showed.
e.ikin -r.?"-vs. 1'an3 4'O-4bu'rrt01e7 /COSYW:S
CITY OF TIGARD 24 -Hour
BUILDING Inspection•tinev-(503) 639 -4175
INMION DIVISION Business Line: (503) 639 -4171 MST
BUP
Re gd co-L:5 5 Date Requested 9 AM PM BUP
Location /6 3 3 Co 9 „ ,4 ±€ - Suite MEC
Contact Person Ph ( )34 - 73.0 c PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC t
Footing
ELC
Foundation
Ftg Drain Access: ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear /
/
Framing
Drywall ,Ll f2saA . y/2.:1-
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final -
PASS PART FAIL
PLUMBING 4(
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 f 11' L ►�
Fire Alarm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
SITE LI Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line ADA Date i" I 1" V S Inspector \lo.'�.� I r� 6‘... i k1 N 6 Ext
■ Approach/Sidewalk
Other:
Final DO NOT REMOVE this inspection record f om the Job site.
PASS PART FAIL