Permit � CITY OF TIGARD ELECTRICAL PERMIT
1_y COMMUNITY DEVELOPMENT Permit# ELC2011 -00602
Date Issued 10/27/2011
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Parcel 2S115AA04800
Jurisdiction Tigard
Site address 10861 SW CHATEAU LN
Project MODUGNO Subdivision REBECCA PARK Lot 5
Project Description (2) branch circuits for furnace and water heater
Contractor OWNER Owner MARATUKULAM TRUST
BY DOMINIC J /LIZZIE D MARATUKULAM T
6362 EL PASEO DR
SAN JOSE, CA 95120
PHONE
PHONE 408- 439 -6556
FAX
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 10/27/2011 $63 60
Specifics. Service or Feeder
1 ea 12% State Surcharge - 10/27/2011 $7 63
Type of Use SF Electrical
Class of Work ALT
Type of Const
Occupancy Grp
Total $71 23
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 952 -001 -0090 You may obtain a cop of the rules orquestions to OUNC by calling 503 232 1987 or 1 800 332 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' Date
LICENSE NO
Call 503 639 4175 by 7 00 a m for the next available inspection date
This permit card shall be kept in a conspicuous place on the job site until completion of t h e project
Approved plans are required on the job site at the time of each inspection
10/26/2011 12:27 2067060784 FEDEX OFFICE 1918 PAGE 03/04
Electrical Permit Applicatiog rot; (rl I u r > rsl.::r)�u : v I
City of Tigal d ct p ,s tie s
Dram, F1.4 ?v /I -aO r'�t
III " C • 13125 SW Hall R1vd , Nerd, OR 9 T 2 6 201 Plat Review v
Phone: 503,718.2429 Fax' 503 590.1960 Due/B liter Permidl a ? I -wit b
'ft❑Aa0 Inspection Line 503.639,4175 Tr Dale Rendy/By, " "Tax Pnta26
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❑ Now construction ® Addition /alteration /replacement Please check all that apply (enb it 2 ceta ifnlonx whtoma drocred below)
❑ Service or feeder 400 amps n mute Building over three annex
❑ Demolition ❑ Other• where the available Malt n, , era Mean! and 10.000 amps at 150 volt, or Floating Wit bans rd,,
t, ;,F,mP;, ' v , I 'T , t yy, A s tttxit d mmi ,°,:� +I,4 {wi r'5,5' r'a'l(1,/,(`e+ ' exceed, Witham,
n
r Z 'sh4 ' 5 r `15eCwG• ' Y l d ^,.raw,.,. . s 1 4d-. aw.
® 1- and 2 -family dwelling ❑ Cottuncicial/industrial Ira s o romld or to aeads I a, (] b il dinM9101 -use sgnadmN
❑ Accessory building amps for all other mstnlinds w. buildings
❑ Mullt- famil f] Master builder ❑ Other ❑Fire pmnp ❑ Installation of 75 fCVA or
a 'M,yn ^ ° Ina`' �i,,x m�e l n.�, ;{ , ,,v '' QBmtttmnev system larger separately
! r c.r:3 ,t „thii' ArtIR 1 le#,I j06 �6.0til9i . .:ib,. , r, pn "1.3 " avatem
I M1, r .�upYY,d`k. y�,,: a,' ❑ nddlhma ofacwmomrlovd f ] "A °`ST•'�j 7,• , "l.i^
Job no.: Job site address 10861 SW Chateau L ii
0 Six or Six or or arm occupancy,
mom residential ram ❑ Recreational vehicle pads
City /S1ate/ZIP: Tigard, OR 97224 ❑ Iicalth ^cam f,ahtios 13 gnppiy voltage fm more than
❑ binrmdous location& 600 volts nominal
Suite /bldg. /opt. no.: I Projeel name. ❑ Service nrfexder 600 anpe rmorc
; gPiidpi.I &;,:' ;:- , :8t,"IfiSd�rvYJY t;;;' rs; %1111 i „��,}i
t
Cross street/directions to job site SW 708 St. to dose Durham Rd nnennuan �0b I rat,, (" nrtea nl
New residential single- or trlti-fmily dwelling unit.
Includes attached garage. )
Subdivtson: 11.ot no„ 1 000 tel. ft. or less _I 168 54 4
Es add•I 500 sq O. or pother d 33 92 1
Tax map/pared no.:
.
Limited energy, cesidonani
f)_,:,(111i.'°:;ar.E rte. °;titi�rvY,," '., r � „•�(tidy�l:�' I�ttr ' -75,1, ,t1 rte' !;t; °r,eJr1� ",''„1'Y,(irii7(1. i -c) (wlth ahovea4, (t.) 15 2
Limited energy, multi -family
Replace existing furnace with new 95% efficiency unit, residential (withabove sq. n,) �L 75,00 2
Services or feeders inst'allpfian, nit'{Iratirn. and /or relocation
Replace existing water heater with new water heater of same capacity 200 amps or Icon 100 70 2
- ,., F7r(stun, W S friel11t 4810 ,t lif a ii rya li itu tt 7%'r: ttt,i'� t� : t o ,' � «�t,C 0 : ,, 201 amps to 400 amps _..___... 113 56 2
401 amps to 600 amps _ 200 34 2
Name: Traci, David Modugno 601 amps to 1,000 amps 30l 04 2
Address. 10861 SW Chateau Lit Over 1,000 amps or volts 552,26 2
Temporary services or fee less ito, nation, alteration, and /or
City /State /ZIP: Tigard, OR 97224 relocation
Phone: (503)670 -7640 Pax:( ) 20D am a or loss � 39 36 1
201 amps to 400 amps 125 08 2
Owner installation: This installation is being made on property that I own which 19 not 401 amp, to 599 snips 168 $d 2
intended for gale, )ease, rent, or cxclumge, according to ORS 447, 449, 670. and 701
Branch circuits — new. Accretion, dJ extension, or panel
Owner signature: rw Date: _ A Pee for branch chwits wit/ 1
l
ai;.ti Cd6ll, ^,- . ;'��'1fp J 1,'Vsik '1,y.; a:n 'l, "iii e Tr"tr �I�,., above sumo or feeder lee
alp ,'"WC., h d y(by;�,,s, .. W,�� „ -'. Jl,• ", "ya each breach circnit 741 2
Business name: Dominic Maratukniam (Propery Owner) B ice for branch circuits wirr
service or feeder fee, first 7 f 56 I R
Contact name: Dominic Maratukulam branch circuit 5 2
/1 tech add occult branch c cultt / 7,42 7.42 2
Address: 6362 El Page° Dr. Miceafsnemaa (service or feeder no t included)
Filch manufactured at module
City /State/1_1P• San Jose, CA dwolhnp, service and/or fecde 67.34 2
Phone: (408) 439 -6556 I Fax:: ( ) Reconnect only 67 84 2
E Pump or irrigation circle [ 6784 2
Sign or outline Iigilang � L 6784 2
'ed' .,(;:tie.'!.• �q¢,¢' „i,', ^;,: ILA I C 1 �,, t , p)' cfn�`d:mm : ,, "i,vi`,C Si exent or hmMo d•coergy
. rn n I a " ",Y�y'; `�'., ., A; , ---
Business name, panel, alteration, or estrnslan. __ Page 2 2
OLD /r Each additional inspection lover all wnble in arty of the shove
Address: lilt//// Additional mspeetrmi (1 hr min) ` 66 25/ hr
City/State/ZIP, Investigation (1 hr mm) I 66.25/ hr
lndasmal plant (1 hr min) 1 78.18 / lir
Phone ( ) Tax.( ) Inspections for which no fee is 9000 /hr
s,ecifreall listed % lu min
CCB Lie ; I Electrical i,io.. Supra Lie.: 11311138n5113aM ' lifI i' Tf,;;r 1'S )s;jG ";:::
' 63 6
Supra, Electrician signature, required: —.4
, Plan review ( 5% of pt mit %c)-
Print name. Date: State surcharge (12% ofphnit fee); ..44PM 1./4
�,/ TOT IL PER. a T P'F?R• 7 /•
Authorized signature: M� r A pe n`
fhb p¢pnit application It h et i n ecePte in s c mh
o Wt e. within 180
Print name: Dominic Maratukulam
Date: 10/26/11 days after It hue men arc4irrd ns complete
Numhm of inrpoedens allow pct pur'Yt
IdaaddmaWcrm cLC•PcnlApp,doc 07 /01/10 440.46131111 /PVCOMIWEB
1