Permit II CITY OF TIGARD ELECTRICAL PERMIT
I COMMUNITY DEVELOPMENT Permit #: ELC2012 -00329
Date Issued: 05/31/2012
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 2S103BA00500
Jurisdiction: Tigard
Site address: 11695 SW WALNUT ST
Project: Latimer Subdivision: LERON HEIGHTS NO.2 Lot: 28
Project Description: (2) branch circuits for surge protector
Contractor: MOLLENHAUER ENTERPRISES INC Owner: LATIMER, KRISTI
11070 SW ALLEN BLVD 11695 SW WALNUT
BEAVERTON, OR 97005 TIGARD, OR 97224
PHONE: 503 - 649 -6991 PHONE: 503 -473 -6215
FAX: 503 - 641 -1902
FEES
Quantity Description Date Amount
2 cr1 Branch Circuits w /Purchase 05/31/2012 $14.84
Specifics: Service or Feeder
1 ea 12% State Surcharge - 05/31/2012 $13.86
Type of Use: SF Electrical
Class of Work: ALT 1 ea Services or Feeders - 200 05/31/2012 $100.70
amps or less
Type of Const:
Occupancy Grp:
Total $129.40
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 0' - 15 -Or r ' 90. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232..19987 or 1.800.332.2344.
Issued By:
` / - / Permittee Signature: 6/11 .1-//44/C.9-779 A/
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 603.639.4175 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.
05/29/2012 03:09 #1192 P.001/002
11E0E1 if c Electr Permit A.Uplication ' : oR ei FicE USE ONLY 1°
- City of Tigard : MAY 2 9 2012 t P«,Nt
.-_ 13I25 SW Hall Blvd., Tigard, OR 97223 11' 1.8. . ! 42:1 C, ri y A :, Plan Review
l oth permit o� ;
• • �. Phone: 503.6 t Fax: 503.598.1 1 f y.
� .� i Date/By.
�
Inspection Line: 503.639.4175 U D? �1i„ IA'. � i : j • RR , Date ResdyBy: 0 See Peke 2 for _
•
TIG_1 D . ,.:.�iq
Internet www.ti or.gov Notified/Method: J !49 S •
eatallofpwation 1
_ _
. c
, Q New construction i] Addition/alterationfreplacement - Plea -
ea:F t lick Rai
vvw (submit 2 std a f plates wiitt n15 checked bel )
❑ Soviet or feeder 400 amps molt' ❑ Building ova mnz cones.
O Dem0llti0t! ❑tom
: where the available fault current 0 Marinas and boatyards
000 ❑
. _ + s: _. x','v. - - ` ± =. '�`' "}_ 1 .,,,,;• - -{; < ' p - `. • - exceeds 10 an.px .i 150 wtss or 0 Fla t..dl
. ' • '.:. . o a.? .. ... 4,' .:"..,,;,,i,_:, a =" : :. ' .. • -!- :„.h: .
1 7 d:n�
cSS to Velma, or exceeds 14, C:omr..erocl -,se . ncultu
[l 1- and 2- family dwelling 0 Commercial/indusu'iat 0 Acces building i
S amps for al! other irstallatio0i buildings..
❑ Multi - family 0 Master builder 0 Other: O Fire pipap- ❑ lastallanon of 75 iC V A or I
:R v'¢!s --;. ti - . r: - . _ .. ::•::. ❑ Finer
r. . ti : : ° f C �' .'Y "� a ; . � Emergency system. larger sepmatety derived s. seem j
.i ........ ... . •. vMtiR .a s .. r.: :2 ,- _ .xf,•. �_ _ _ : ` � :v: ❑Addition of new motor load of
Job no.: 83397 Job site address: I I IO0HP or more. oceupan
11695 SW Walnut St. I ❑ six ur mote residemial umi% ❑ Ry reatiorml vehicle parks I
I Ciry/State/GIP: Tigard, OR 97224 ❑! t� faeilitils. ❑ Supply voltage for more than
D Hazardous locations 600 volts nominal
•
Suitr/bldgJapt no.: Project name: ❑ service or feeder 600 amps or MOM
Cross street/directions to job site: .* ...ry ._ r
taw..•.:a+.. ... , .. , _ ... • 1 ore ... Fee. I Told TH
New residential single- or multi-family dwelling unit. j
Includes attached gaga
I
Subdivision: I Lot no.: 1 1 .000 sq. ft. or less 1 li 168 54 •
•Tax map/parcel eel no.: I Ea. add'! 500 sq ft. or portion ± 33 92 1 1 I
aa : , identiat _1
1 Limitedenersy,rts I
•
^; 73 � :. w tT: ._. . . .� :,... :.•'-= 7i.g , 76.0(1 I
' :2 ;f1 V A x ,.. : m (with above Sq. it)
�
,. •: 1 .,.. ;r,.e : :•. : : o Limited enem. multi - family i
Service & two 1 circui is for CFCI & serge protector ,estdelttrtal (with above ft.) 1 7500 . 2 I • -
Services or feeders installation, alteration, and/or relocatiwt "�
• _ zoo amps or less I
•�.: �1I4:'di$1�• '7... � . ._ ate ... •S M t wM .. i 10070 �OV.71.1 •� '
i`i ., :#: ... -. - -. : _. _._. • ;�;.:' ;sr :• ¢g•F ;,air.;. =:; ,; . L.! amps to T N 8tf� 1.3356 i l l 2
Name 401 amps to 600 amps 200:34 i 2
g rx Ste L3tiln�r 601 amps to 1.000 amps ? 1(11 ; 04 2 I
Address: 11695 SW Walnut St . over 1.0 am ps or Potts 1 I 53216
Ciry /Statc/21P: Tigard, OR 97224 relocation tterncesOr feeders [ °sta 8 a(aoo- alteratio0.and/or �
Phone: (503 1473.6215 Fax:( ) 200 amps or less 5936 ; - - T 1
Owner installation: This installation i5 Ilicin m ade 'on g property that I own which is not 201 amps to 400 an 125.03 i 2
intended for sale, lease, rent, or exchange. according to ORS 447, 449, •70, and 701. 401 to 599 amps 168.54 i
Owner signature: Branch circuits - new alteration, or extension. • .. ael --1
Date; A. Fee for branch circuits with 1
::r.; -:: - F .. - `� - ,,Y.., ^ _ =: -Y' ' , 2 73 i N, r r:. I above service or feeder fce 2 I —�
:..: _.. ...'..7 - ". li �irenit 7.az I 14.841 , �
,ach i i
Business name: B. Foe for branch circuits wirhpw _____ �
f
•
. service or feeder fee. first
Contact name: branch circuit 56'18
Address: Each add' I branch circuit • 7:42
2 1
Miscellaneous (service or feeder not included) �i
City/State/2.1P:
• Each manufactu ed or modular .84 �
' I i
I 1 dwturF� 67
Oe and/or fcpdm 2 -
Phone: ( ) Fax: ' ( ) Re connect onl 67 :84 - z
5 -mail: r irrigation circle
�.. .
:_.:.. ,..:4. yr . . .
.... _ ,:�::::, . �...:. r Or outline 11 67 84 � I �
. ' : ,,. • ` • - '•.. � ' ; � Si atcuir(s) or Ilmitedelezg "i
Business name: Mollenhauer Enter rises Inc . * 1 l �kmu� exiettsion I p
p r DBA i :Mi ke s Elec , Each ad lag lion over allowable in of the aboe
Address: 1 1070 SW Allen. B 1: Additional
�.YSl • • I nspaxion (I hr min) 66.25 / hr 1
City/Stare/ZIP: Beaverton . OR • 7005 investigation (1 hr min) 6625/ hr
_
Industrial plane (1 hr min) 78. I& hr — i
Phone: ( 503 649.6991 Fax: ( 503) 641.1$02 for which no fee is `
,/ CCB Lie.: Electrical 1. specifitall� listed ( he mm) I 90.0U0/ hr i r
191094 i t.al Lic.: C643' 1 Suprv. L yle . : 42305 ';,:?0 , .
Saprti. Electrician sig.. m_ requ :• • - -
Suittfte); ;
Plan review 7 � -�-- -�
Print t>a� (_5% of permit fa); ;
Do 3 . 1'111 f t 05.29.12 _ St atesurcltarge(12%ofpemlit frx): 13.86 /J
C
a : d d,/, TOTAL PERMIT
FEE: r 129.40;
. Y —___ 1 ' :
This pp»r :pptir,tim a rr
Print lie: Darryl Mol entauer tier., after 1[ a t is POT obtained within 180
D aze: 45 .29.12 ate
. Number of mspociom: allowed per ,permit
Jun. 1. 2012' 7:08AM PGE -TCC QUAD A No. 2499' "' P. 1 /1'
I Request to i nergize an 1 ' trical Installation 0 g 37z3 , .
;rn• 13 2012
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PS
Name of supervising electrician: Douglas J. Millet-"� . :
�s�' { .i::_ . : . �ir--',
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' -- :):'?N Date of request: l I 1
Supervising electrician's license number. 4230S I t)ate installation was completed: I I
e s ite please Include a copy of it with this
Electrical permit no.: If a teraporay mit is posted at the py form. j
.may !� � >'-vl��;jsa.- �.:rr:_ 945;=';.::,' ., r. _ - - -- •;,-' - — , :L — = :< .r - _ _.,3� --� -
%F y7__Q•� r T I]),.:...'. u4vi. r � -. ' - -- 1 ' t _c ._ m .r. _ -.: ,.}.I A•`' , -\ ? _ _— 7.7.:. ; %i : -.. � �,77. i _J n� - 4 °_' -< • �_ rt -' 1101
Name of electrical contractor. Mollenhauer Enterprls Inc. DBA Mike's License no.: C043
Business address: 11070 SW Allen Blvd. I _ - 1
City: Beaverton State: OR ZIP: 87005 1
Pho Phone: 503- 649 -6991 Fax :.._5O3 fi41'19. &mail: info(�mikeselectric.biz 0
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Customer's name: A 1 5 7% . - L : 7 z3'/z ._
Customer's address: / 6 9 t'..0 1 . . . 4r,7 S 7- N0
City; Cr /R. State: On. ZIP: 1'72.2 2..,,....
Address of installation if different than customer's address: .
City: ZIP: — ; -
.' -,:c,• q P'T. :ior:. `` _ ^-'_ -r _: �� :.i'c ' .�`:r.:v W�' r F•�''�`�i �.�' � 1<ia .a_ %i•'.<r,
inn a , 1Lf-- ti- :�'. f � °4'. ' i )•.ST (: ,.1 c.. r). 7.,i ,..J ' --;
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Authority having jurisdiction to inspect: ',/ l ac 7 2D ^ Phone:S(04N -917/
Address; /3 / 1 1 r ) sy,. C a L p A'7r e - PY S= /94 e
city: , , b state: 0 It ZIP; 0 g 2. 3
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Name of electric utility receiving request: p Phone:8o3 -7 so
Address; 3 7' 0 c.5 c J 7 r'4 .e. F ,'03 '713 L -- '/
City: _o �7L7' — _ State: Oft ZIP: � il. ` y
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:.' �• �-J F' . '.Pc'. .._= � �7 � _.h is.' ��� -_ .?; �1::il�A��:.`�.u , - -'���
A. Restoring electrical service that was interrupted or disconnected because of either a:
Igi Service change or 0 Uncontrollable event, such as fire, flood, or severe weather;
or
B. Electrical service at a remote location needs to be:
Initialized 0 Restored _
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L er.'.T.I.��.!? %�'�_: N- c- .:. .ii::rr..� �:�. .-._� ....
Supervising electrician Electrical contractor
Note: After sending this form to the electric utility Note: By close of business on the first business day following
named above, you must send a copy of this form to: energizing of a completed installation in response to the above
(1) the electrical contractor, (2) the customer, and request, you must: (1) notify the authority having jurisdiction
(3) the inspecting authority. that the installation has been energized, and (2) request that the
authority inspect the completed installation.
Supervising electrician's signature Date Electric utility
/ Note; Please consider notifying the inspecting authority
identified in this request when an installation is energized
-' before inspection.
IZ, E� t�st" S "1
440. 0948 -COM (I01081COM