Permit II , l CITY OF TIGARD ELECTRICAL PERMIT
. ' ' COMMUNITY DEVELOPMENT Permit #: ELC2009-00466
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/09/2009
. Parcel: 1S133AD08200
Jurisdiction: Tigard
Site address: 12860 SW CHICORY CT
Subdivision: Lot: 0
Project: Stolz
Project Description: (2) branch circuits for A/C and GFCI.
Owner: FEES
STOLZ, RANDY Quantity Description Date Amount
12860 SW CHICORY CT
TIGARD, OR 97223 2 crt Branch Circuits 09/09/2009 $53.50
wo /Purchase Service or
PHONE: 503 - 524 -8888 Feeder
1 ea 12% State Surcharge - 09/09/2009 $6.42
Electrical
Contractor:
HEBERLE ELECTRIC
29012 SW EGGER RD.
HILLSBORO, OR 97123
PHONE: 503 - 628 -2095
FAX: 503 -628 -3076
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $59.92
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. 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 the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OAR -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
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Issued By: Per Signature:
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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' 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.
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Electrical Permit -"- -- -- ���=� �" � |»«»�pk}/w[/�«�
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Please cheek all that apply (submit 2 sets of plans w/itanta ;hocked below);
0 New congtruction L: Addition/alteration/replacement
1:1servieo or rodeo 400 amps or more 0 Building over three stoeiaS.
Ci Demolition! : 0 Other:
where the available Atilt currant 0 Marinas and bontyardli.
JU, 1- and 2-family dwcIlittg 0 Commercial/industrial 0 Accessory building amps for an other installations buildings,
0 Multi-family . ID Master builder 0 Other: 0 Fire pump. 0 Installation of 75 KVA or
L3 Six or more residential units, eacinpancy.
0 Recreational vehicle patios.
ciNfizardbus locations, 600 volts nominal.
Suite/b14./apt 110.: Project name: 5"7"3;) — 1:Service or feeder 600 am tit Of more.
Cross street/directions to job site: 7. 6;5s- g-z____
New residential sink- or multi-family dwelling unit.
Includes attached ga . l e.
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8a. addl 500 sq. ft. or Fortiori 33.40 1
Tax map/parcel no.:
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Services or feedeni Installation alinration anti/or relocation
200 rumps or less III. 80,3 o 8
„...,,,,;,...,,,,,,,,,:,„,.,4„..„-gmh,,,,,,..,,,,,,,,,,,::-,,,...,.:,:;,..,,,::;,,,,!,.,:.,,,,)i..,,,00:.::...,..„,,i',,,,,.,..,,,,,,.::,,..;,:,.:::,:...:....,....:t 201 amps to 400 tIM /11. 106,85
Name; OM A A
• 0."411P Sr-r1 .:M11.1111 401 iiro to 600 amps I= 160,60
a
601 amps to 1,000 amps M 240.60
Over 1,000 a .5 or volts 454,65 U
Temporary eerviooe or foed.re installation, alteration, and/er
— . Fax; ( ) 200 amps or Ices MN 66,85 M11111111111
20) amps to 400 amps MN 100.30
Owner hurt . Intim: This in is being made on property that I own which is not
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intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701, 401 alnP3 to . 599 airl, IN 133.75
Owner signature:
&Foe for branch oircuita with
III
each branch circuit
Business name:
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B. Pee for branch circuits / ii -7, II
46.85 1 -1(ao
' hrst branch circuit
Address; Ar Each add'i branch oircuit nil 6.65 „s
ill i .1111
'"uommimps-- dwellil L. service and/or feeder
Purnp or irrigation circle ME 53 ' 4 ° 11=1E11
Business name; fleberfe Electric, Inc. Signal oirouit(s) or limitod-
.. energy panel, alteration, or
Address: aberie extension. Describe: Page 2 2
Each additional instection aver allowable In an of the above
Per inspection Mil 62 -lim
invontigatioo per hour (1 hr mm) 62.50
( OCt --- B tic,: I, SZ.34-17—.:(E1ottrical LiCZZLL. Iio 0 4 u . Lic. 053 -__c . Industrial plam per hour , , IIIIIMEIMI III
Suprv. Electrician signature, required:
Authorized sismature: 41.1111111.1 '17:te (12% of permit fee); IIIRWririfl!
TOTAL PI3RM/T FEE: MINIM we'''''.
Print name:
Iffilialliiii Date: This vomit sppliention explons If n permit f; net obtalued wlibtn IRO
''' Numb inventions allowed por 'Joyner. '''' g Z.—
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