Permit •
CITY OF TIGARD ELECTRICAL PERMIT
11
a . - COMMUNITY DEVELOPMENT Permit #: ELC2012 -00365
T t GA R O 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/13/2012
Parcel: 2S103BC08100
Jurisdiction: Tigard
Site address: 12242 SW TIPPITT PL
Project: Harris Subdivision: 2000 -077 PARTITION PLAT Lot: 1
Project Description: (3) branch circuits for bathroom remodel
Contractor: HEBERLE ELECTRIC Owner: HARRIS, JOHN
29012 SW EGGER RD. 12242 SW TIPPITT PL
HILLSBORO, OR 97123 , PORTLAND, OR 97223
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PHONE: 503 - 628 -2095 PHONE:
FAX: 503 - 628 -3076
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo/Purchase 06/13/2012 $71.02
Specifics:, Service or Feeder
1 ea 12% State Surcharge - 06/13/2012 $8.52
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $79.54
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 5 -001 -0 0. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332. 23444. �/ l
Issued By: 0 Permittee Signature: Oki 4 PoLi - / / O k.L
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.
06/12/2012 02:39 5036 2837 HEBERLE ELECTRIC INC PAGE 01
Permit Application UCI
Electrical pP n r9 VE a f P
City of Tigard JUN 1 2 012 _ , Permi t N
g f toll 1 a- ��olol x 0 00"
v 13125 SW Hall Blvd.. Tigard. OR 97223 Plan Rev
1,
' 0 ; Phone: 503.718,2439 Fax: 501.59R.1 1�f Dat& V: �..
Other pcnna:
-- Inspection Line: 503.639.4175 D 1 T1' OF TIGAR Date Ready/By: avr ( � See Pngc 2 far
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T i ii A It 13 Int mel: Www.li and Or.gQv BUILDING t rosined/method: � G h Supplemental lnformntian
,a'r:Iac .3'.�rJ • ' r'�d1.9':.....i '. r '.+i •: .`a ,� ,w: -0. " ,.,.. ;.iii ^ .' ,r . ; . = ' ^. `
d.l ..•!.� !: 1n Y?, , a' 1 W�,Fv7 , y4 :1'1.__ ' J. .. -o: -. .�oTi w-
,1 .�. ,?; ..., j i, +ti- ; �",f• I '. . ' AUK; .*.'" ' '''''&"''''-' - ,1 •''. -... ":{ ''i' : . , .. . . n r G :,
❑ New construction " rl Addition /alteration /replacement Ptcose chock a tl+at apply (submit a sets of plans w /items checked below)
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ['Other: where the avaitnble fault Current 0 Marinas and boatyards
' '' exceeds 10 ,000 amps at 15n onus or ❑floating buildings.
less to ground, of cscccda 14,000 ❑ Cummerclol•u ?c agricultural
/'I 1 and 2- family dwelling 0 Commercial /industrial ❑ Accessory building amp%fnr all other installations. building.. i
i
❑ ulti faintly [] Master builder El Other: ❑rircpump. Q InuallntottaF 75KVAor
C:1 EmcrFCncy �yatcm, larger separately derived system. • 41 ; . ' • ;J.b ;• •` !► FA Q' - lil t }�, . 1b : . . .: . _ , . li Addition of new meter lead of ❑ "A' .. P' "1.2" "1.3
Job no.: Job site address: % 'ZZy'Z_ $ L f f C I1' L I °r more, e s:a i
❑ Six or mere reeld enlinl Wis. 0 Reaeationnl vehicle pules.
City/State/ZIP: - 1T1 ❑ Hanitlt -care facilities. ❑ Supply voltage for more than
t,�, '? '� ❑ Harmdtnta locations. 600 volts nominal,
Suite /bldg, /apt. no.; I Project name: ,ft, ❑Service or feeder 600 amps or more.
Cross 5treet/direetipns to job site: K -- 1-44- ` _ ..- Description Qt 1 Vo ' fTot ii
New restdentlal single- or multi- family dwelling unit.
b TS
A ki Includes attached garage.
Subdivision: Lot no.: 1 1,000 sq. ft. or less 168,54 s
na. add'l 500 sq. ft. or ponion 33.92 1
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Tax map /parcel no.
�� - Limited rgy, residential Li ed ens en 75.00 2
'
: : :, , '.':f_;': %:.. ' ii' --t; ' :W4 6 1 . 074 `:'. ; : 1�# . ,,;, i ,,,., • :. . : :,::
A � G ,
i_____2_5‘ /� I, . (with above sq. 11) - mlr energy, multl•(Amily 75,00 2
.i
I LW 1°r 4 (( � 0 If t4 S i residential (with above sq. t1.)
( Services nr feeders installation, alteration, and /or relocation
d. C ., 1 ' ' 200 amps or legs 100.70 2
• 4 1c `' ;*r 1 ': „ ` LR . a .id. .. _. ' , li. 3.Y:! .G i �- Tral 4yj 1 " • "a. 'I ...Nil amps l0 40Oamps 133,56 7. •
�t,p /� 401 amps to 6(10 amps 200.34 2
Name: + ._ • 1 t �! s T"�J \ C • .. , � ,,.,..,,,,. - . +, 6(11 amps to l,Ol'+0 amps 301,04
Address: Over 1 .000 amps or volts 552.26 2
City/State/ZIP: — Temporary services or feeders instntladon, alteration. and /or
_ relocation _
Phone: ( ) Fax: ( ) 100 amps or less 59,36 I
Owner installation: This This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sate, lease, rent, or exchange. according to ORS 447, 449. 670. and 701. 401 slops to 599 am ps 168.54 2
Branch circuits - new alteration or extension, , er panel
I Owner signature: - r Data _ A. Fcc for branch circuity with .
�': t:X above service or feeder fee,
•'• r .. -!, : q .A )y8 'CO :rnl,3'(1G�,. each branch circuit 742 2
Business name: , i , e, B. Fee for branch circuits Jrhout LF
SC mice or feeder fee, first
Contact name: .V� - % I O branch circuit__ 1 R ,
' ' ' Each add'l branch circuit 7.42 i tt •
.
Address: „, Miscellaneous (service or feeder not included)
City/State /' • Each manufactured or modular
67.84 2
dwelling. service and /or feeder
Phone: ( Fax; . ( ) - Reconnect only 67.84 2
E-mail: or irrigation circle 67.84 2
Sign or outline lighting 67.84 2
- •' , • ■-••' •"; , '':„ '`!: % ":' ' Signal c(rCUt1(s) or [Milted-energy •
Business name: laeberle Electric, Inc. _nonei, alteration, or extension . Pa:e 2 2
Address 29012 SW Egger Rd bath additional ins I ection over allowable In any of the a bove
Additional inspection (I hr min) 66.25/ hr
City /Stato/ZIP: Hillsboro /OR/97123 ^ Investigation (I hr min) 66. 25/ hr
- industrial plant (I hr min) 7R, 18/ hr
Phone; (503) 628 -2095 (503) 628 -3076 _� In for which no fee is
w
�B Lie.: 152342 C s, • Ilit:all listed % hr min 90,00/ hr
eetrical c.: 34-160 :oars. Lie.: 3053 -5
Suprv. Electrician signature, required: .tt/� tar l :•i. ; ;: <5^ <, , :. !:;
_ Subtotal , p
Print name: J01'0
L, hleberlc �t` Plan review (25%ofpermit fee): -
Date (.' (� State surcharge (12 °s of permit ti e); ; .
4utlavrizcd slgtttuttr• ��� TOTAL PERMIT FEE.
11115 p ap giCntlnn exp if a 1rerinit ei not obtained within 180
Print name:
-. -. Date: )' Z J days after It harp boo Accepted es complete,
V 5 Number of inspections allowed permit. 7 ' 5 '1f
IlugdinglPC.mlt +lgl,C•Ver Aop one aver, o r' I
C6 (
aaa-.ra 17T(1 IA7520M/wep 9 -