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Permit
1. 4 CITY OF TIGARD ELECTRICAL PERMIT IIIII g: COMMUNITY DEVELOPMENT Permit #: ELC2009-00156 T 1 G AA O 13125 SW Hall Blvd., Tigard OR 97223 503.639 4171 Date Issued: 04/08/2009 Parcel: 2S104BB09400 Jurisdiction: Tigard Site address: 14191 SW WALNUT CREEK WAY Subdivision: Lot: 0 Project: Hutchings Project Description: Install (1) branch circuit for hot tub. Owner: FEES MATRIX DEVELOPMENT CORP Quantity Description Date Amount 12755 SW 69TH AVE #100 1 crt Branch Circuits 04/08/2009 $46 85 TIGARD, OR 97223 wo /Purchase Service or PHONE: Feeder 1 ea 12% State Surcharge - 04/08/2009 $5.62 Contractor: Electrical 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 $52.47 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 BAR 952- 001 -0100. You may obtain �cop of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By: C?i v j QJ\"4 _ ! • L , 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'N 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. 01/07/2009 09:00 5036283076 HEBERLE ELECTRIC INC PAGE 01 Electrical Permit Application FOR Mil( I: 114E (1lNI.N City of Tigard `� '' Renei,«I {�' R`h • ►" (\ij - Dm..:. dcf L-' ♦ bra �F • ' .37_,,,,,, Hall Blvd , Tigard, t. 1 pins Review Other Form Phone: 503.6394171 Fax_ 503 598.1960 See Page 2 for I 2009 DateB Data Rt eotion Line: 503,639.4175 A - 7 aaty/By: tacit: El 1 n'p PR Intcrttct. w�Nw.tigerd- Or.gov Notifed/Moth C Supplemental infernraNmt '.p t, Y � a!n 6 : "'. +; f �i"'yn l ,:, ,�`. , " „ 5 " .. . f . tit ; q ' j., - 3 . i�t : .,n' i - ��y - .; •i: T l fiat p, -r, . ; :.�'�. y.a.' r °� �. ti.i, a, ':, 7 � �. R�� '': (. c ., - �,�4�l dip', ,./ - .n� ✓L: -.. .. 1d>��Y"'`� „' rk Y: t.�, .... .: :',�.,� ,' El New construction L` Addition ?I 'T� 1 '! t - "tR t Please cheek that apply (submit gaotactplans w/items checked bolow): u Demolition El Service or feeder 400 amps or more ❑ Building over three /codes. u O ther: where the available lhult current 0 Marinas and boatyards. ,j. c ^" t }` ,;_ ,', , .../ + •„ r, exceeds 1 0r © Floating buildings. ,! a'� i ., may, �qq�� , . "•.•‘-',, 000 am ps at 150 volt, or � 'l�.l; } y �li, � � ',. ,.... - .c�� • ,, - ,_ ' ,,,!', ,i,x:,f, ,w..,.,,-:.- to to ground, nr exceeds 14,000 ❑Commercial -use agricultural I • and 2- family dwelling ❑ Comncrcial /induairial ❑ Accessory building amps for ail other installations. buildin e, ❑ Multifamily 0 Master builder ❑ Other: El rim pump 0 lurmdlation of 75 TVA or ; , i. pu, 3„ • M , r : �n, , h „ ?; , ^ , { ['Emergency system. larger voparatoly derived system, ii�15�,tt :. J;'',''04 tr' 1 I:yc " , f ,!'!', ,4', A , . D Additton of now motor 1on of ❑ Job no.: Job site address: 1Lit en 3 W 1,. C�tif or momore. oec re a on. Wt ❑ Six 8iR o or r more residential unite ❑ Recreational vehicle parks. City/State/ZIP: .� (� 1 '�7,-. t .44 ` ° Ha�hh -care 6.oilitias O Supply voltage far morn then �} 12 Hazardous locations, 600 volts nominal. Suitc/btdg./apt. no.: Project name: I . te.•f . + - ❑ Service or feeder 600 amps or morn. Cross sheet/diroctions to job site: �( — ��y� S C�bc . rs neseMnttoa 917 r gee 7 Tani '( "^ `� NM NM residential single- or multi - family dwelling unit, � __ _ _ l V l RA y \ X( \. / tJ , O () ( p, Includes attached garage. _ ..._. Subdivision: _T � Lot no.: 1,000 sq, ft. or less 145 15 4 Tax map /parcel no.: Ea add'l 500 sq. n or pattion 33.40 1 ,! ',muted utd energy. residential 75,00 2 l'}' ,b1 91110 !9 '�y (with ,1 i y; yyl , , ' , , i ,1 ' i ', I: + (wth nbovet1 6) ^ T % ^ .� -�^- Limited mere, multr�mily 75 00 2 Lf� Gi C „ '1 residential (with above sq. R,) Services or feeders Installation, alteration, and/or relocation 200 amps or leas 80 30 2 F f , 'rA n 1: ' °‘' ;, '� °' "� �" '- "T' -' 201 amps to 400 amps 106.85 2 Name. (7Y S'n , —ft-t77 , . - •.441, IQ $ (S, 401 amps to 600 amps 160.60 2 601 amps to 1,000 amps 240.60 2 Address: Over 1,000 amps or volts _�._... 454.65 T 2 City/State/ZIP: Temporary services or feeder's installation, alteration, andior relocation Phone: (jb3) 49 4 — L i 01 L 5.c Fax: ( ) 200 amps or less 66 85 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100 30 2 intended for sale, lease, rant, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2 Branch circuits - flew, alteration nr elntetrIon,,per Ltanel Owner signature: Date: A. Fee for branch circuits with '':,,' ° = i P ' ;k ;'„' ; "' 'a' ., ,' � },; I ,, ;, , k -1, ' ;'x ;;',' Hj ;1;• above service or fccdcr fee, _ . i++i�� 6.65 2 each branch circuit T Business name: , ry B. Fee for branch circuits _- � . ".._.__ Contact name: 'TO wa ._r+) without service or feeder fcc, l 46.85 ` 2 � � - r" h eirouit Address: . � : � � � Each add'I branch circuit 6.65 2 •t ' - - - Miscellaneous (service or fender not included) City /State/ZIP: � Each manufactured or modular 90.90 2 --- dwolling service and/or feeder Phone: ( ) Fax :: ( ) Reconnect only 66.85 2 E - mail: Pump or Irrigation circle 53.40 2_ 1,- /,.,' , "A',',`'' .'t 5 '.,. '!'P I i,' ^1',:P 0 ,,; ,, , i„ -', } ' ,i! Tr ---- -- Sign or outline lighting 53.40 2 Business name: Heberle Electric, Inc. Si cirouit(s) or limited - `_ Address: Heberle energy t on D b e: or Page 2 2 City /5t �Q( H�l$� rQ " ^ T Each additional ins anion over allowable in a of the above Phone: ( ) "" (�] `�� ; ( ' Par Inspection 62.50 l )-- Investigation per hour (I hr min)_ 62.50 CCBLie.:1, 5 Z31Z. Electrical Lie, :'3i-t. IL 0 • , , Lic. :31 53 --S Industrial plant per hour •11111151111111M ""' Suprv. Electrician signature, required: Subtotal. Pratt name: r *� 1 _.._ Plan rroviaw (25% of permit foe) • -r Date: 1{ .7-0 State aurehargo (12W of permit fan); !� (p 2_, Authorized signature: TOTAL PERMIT FEE 5 y 7 Print name: Date: This permit application aspires if a permit Is not obta within IRO days After IS lane bear accepted as complete. I:43ullt nalPamiteMIX -penal doe 0 ! 1 23 ! 0 . - * Number of,nrpeafi ns allowed per permit. - 5- . ' . ,`__ AAO- /615T(1ta15�CO , `�_ cede V., 2 `'--'