Permit CITY OF TIGARD ELECTRICAL PERMIT
2 COMMUNITY DEVELOPMENT Permit #: ELC2012 -00109
T I GA . R IJ 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/22/2012
Parcel: 2S110AD06500
Jurisdiction: Tigard
Site address: 10570 SW DEL MONTE DR
Project: Galway Hills Condos Subdivision: LANG HILL NO.2 Lot: 57
Project Description: Repairing meter base.
Contractor: MOLLENHAUER ENTERPRISES INC Owner: FRIEDRICH, ALVIN B REV LIVING TR
11070 SW ALLEN BLVD BY SHERN, LINDA TR
BEAVERTON, OR 97005 10305 SW SERENA WAY
TIGARD, OR 97224
PHONE: 503 - 649 -6991 PHONE:
FAX: 503 - 641 -1902
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 02/22/2012 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 02/22/2012 $12.08
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112.78
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 ma obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. c
/ 1
Issued By • / i� 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 the project.
Approved plans are required on the Job site at the time of each inspection.
0 #0952 P. 001 /002
2/20/2012 23:00
Electrical Permit Application - 1.OR OFFICE USE
•
ONLY
City of Tigard - Received .
i 13125 SW Hall Blvd., Tigard, DD ECEI fa t� : r /a� , iU Permit No : '
mod, OR 972 : an ReviewI —LY phone: 503.639.4171 Fax: 503.598.1 8, E may. Other Permit:
T I GA RD
Inspection Line; 503.639.41 75 bare Ready/By: •
see P age 2 for
Internet: ww"•hg:ud- or•gov FEB 21 2012 Notified/Method: S uppiemmtallnform 1
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t�. ' �N .'. '� ••� • ... M : r J ' JF � ' �: ;,,y_ '�. , --, ..' h. 1: n A � , yZ ] . At ryiE W
ra-.0 . -••, .,i4: = _- . rl ' . ..; 4.�?.: , 7."v] . •P. ' x 6.r. :tee. r .. . - : : 1- .. ;• - w•T
p New construction Addi /altertry c , ' - ii • 9levse check all that apply (submit z sets orphan whams ehcc ed below t:
�I r 1 'SION 0 Service or feeder 400 amps or more 0 Building over three stories.
❑ Demolition ❑ Other:
:- _ �,.. --.« :',- � _ _ where the available fault current ❑ Marinas and boatyards.
: - , -,- . °'_ .. n. - :.' ,.4 :.a�ti - -. - , „,"::', , • v -- "2 . � ;._ M :- exceeds 1 0,00 0 am
,y(+....,,, - _ - „� ps at 130 wits or ❑ Ftoaing buildins5
I- and 2-family dwelling ❑ Accessory building loss to ground, or exceeds 14.000 ❑ Commerc,al -w. agricultural
y g ❑ Commercial/industrial ry g amps for all minx instalations. buildings
❑ Multi-family 0 Master builder
0 Other: ❑ fire p ump. ❑ Installation 7 5 KVA or
_ of
e,r,n _, k.M..''• .:f j ;, ini ,...,,; V a ;.r,.i7. .`;:77:;Y'3; 51V , -rsf:-�- 0
+..: X;• • • :^. , w 'j -:.. •sei'ir.: . lllb - „, 4;L • ' :,- ; ` {:r• . .t� ' ., ',,,� -,.: .��- .. ,” = c , e :: larger 2 deriveda
` ' -- � "<-,_ .� � v.;• ,; ['Addeo*. of new motor load of ❑ ..p -. separately system.
Job no.: 2 9 3 9 0 Job site address: It ■ S 14 I •f i" v A v e . ❑ 10014P ce more. occupancy,
Six or more residential units. 13 Recreational 'chicle parks.
Ciry /StateJZ1P: Ti _ a r d O Z • 7224 0 hmlth•ore facilities. ❑ Supply valte for more than
-_ ❑ Hazardous rotations. 600 votes nominal.
Suite/bldg./apt no.: Project .' e: <; , / . Gtp,(gre31 /►.. ❑ Service or feeder 600 amps or more.
Cross street/directi f4. doer . ,.:. "
or�S 10 job site ..c;: +� . �';�;' •.P; ^T �g7�:�,....
Y i A /.4 t! Derv Wan WTI Fee { Torah l •
• 1 1 New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or Iess 1111 168.54 1 d
Tax map /parcel no.: Ea. add'I 500 sq. R. or portion 33.92
-
Limited energy, residential � ' .' i `' ` ^ . w 3SS_ r
Limited (we above . ft.) 75
2
4 •
Limited energy, m ulti - family Repair meterbase
residential (with shove . ft. 5.00 I 2
Services or feeders installation, alteration and/ r mlocation
...:.T.4.7.27.- _. _._..... 1 100.70=
10070
t •• " • "" 201 amps SO 400 amps 133.56
Name: 401 amps to 600 amps 200.34 ,
Ca I. re. v H0A • 601 amps to 1,000 amps 301.04 2
Address: 2105 SE 9th Ave. _ over : ,000 amps or volts 552.26 2
City /StatelZiP: port 1 a n , 0 R• a 7 214 — - Temporary services or feeders Installation, alteration, and/or
relocation
Phone: (50 ",3 ) 4 4 5 .90 9 5 Fax: ( ) 200 amps or less 59.36
Owner installation: This installation is bein made on 201 amps to 400 a 128,08
g property that I own w hich is not .•
intended for sale, lease, rent, or exchangc, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 ,
Owner signature: Date: A. Fee for r circuits ias branch circuits - new, alteration, or extension, p parer
_ _ Xo .^ w branrcuits wah I
... :. • u _ o A y'" .d1 c:..7. :77 ^`��'� ✓ ; r ';' - ~- above stavice or feeder fee.
each branch circuit 7.42 2
Business name: B . Fee for branch circuits without
service or feeder fee, first
Contact name: •
branch circuit
56.18 2
"' Each add 'I branch circuit 7 2
Address: - Miscellaneous (service or feeder not included)
City /State/ZIP: _ dwe t service _e and/or feedtr 67.8° T ?
—
Phone: ( ) Fax:: ( ) Reconnect only 67.84 2
E - mail:
Pump or irrigation circle 67.84 2
t , x e_ _ r Signor outline li 7
,,,, .� T�� .. -- �-,'" " sx t Signal circuit(s) M Iimttedtttergy .
Business name: Mollenhauer Enterprises ,Inc . 0$A Mike's Elec , pane alteration, or extensio Page 2 I
Each additional inspection over allowable in any of the ahoy
Address :.1 1070 SW Allen Blvd
Investigation (1 hr mm) 66.25/ hr
Additional inspection (1 hr min) 662 5/ hr
Ciry /State/ZIP: Beaverton. OR 97005 _
-
Industrial plant (I hr min) 78.18/ hr
Phone: Phone: 503) 649.6991 Fax: ( 503) 641.1902 Inspections for which no fee is — -_
specifically listed (Si hi min) 90.00/ hr
CCB Lic.: 191094 Electrical Lic.: C643 Suprv. Lie.: 4230S ~^ ' '`'' - ' !! —
Suprv. Electrician sign: c, rcgtiire(!: • / !' �� %, l Subtotal: 10 7
'�` ' ads": h Plan review (25% of permit fee):
Print name: Dougla - J Mill; A A i, ... e: 0 2. 21.12 i - State surcharge (12% of permit fee): : 12 . 0
er
Authorized signature: f� �, fr/, ,� TOTAL PERMIT FEE: 1
_ • This permit application expires if a permit is not obtained within 130
Darryl Mol enhauer Date: 7 days after it has been accepted as complete.
Print name: Da
0 2 .2 1. 1 2 • Number of inspections allowed per permit.
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