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Permit CITY OF TIGARD ELECTRICAL PERMIT - S • COMMUNITY DEVELOPMENT Permit #: ELC2012 -00650 T IGAAD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/13/2012 , Parcel: 2S110DD04700 • Jurisdiction: Tigard . Site address: 15625 SW OLD ORCHARD PL Project: Keroes Subdivision: SUMMERFIELD NO.3 Lot: 149 • Project Description: (3) branch circuits Contractor: MOLLENHAUER ENTERPRISES INC Owner: KEROES, SUSAN M 11070 SW ALLEN BLVD 15625 SW OLD ORCHARD PL BEAVERTON, OR 97005 TIGARD, OR 97224 PHONE: 503-649-6991 PHONE: 503 -430 -5454 FAX: 503 -641 -1902 FEES Quantity Description Date Amount 3 crl Branch Circuits wo /Purchase, 11/13/2012 $71.02 Specifics: • Service or Feeder 1 ea 12% State Surcharge - 11/13/2012 $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 OA -001 -0 0. You ma obtain a co y of the rules or direct - questions to OUNC, by calling 503.232.1987 or 1.800.332.2344. A� Issued By: W L.( Permittee Signature: M..1 4 PL/ C ,q Ti 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. °iV 11/12/2012 22:35 #1581 P. 001/002 Electrical Permit Ap (/cation 20 t 1 13 FO 2.02 CSE ONLY City of Tigarfl � 110414/ i Recei.•ed / 13125 SW Hall Blvd.. "! pia ,! 5 , � � it 3 �! a .. Tigard. a7zz ;' �Pemlit vo a- CC -lola- co {p Phone. 503 639.417! `•titc• 503 iyg 191 �1r ?Iau Kchcµ' — Inspection iO3.5:9.d17] ��„�11�� '- i "c'�` Cn;e: ?� - Ltne gard 9.4 I I .c.. — i`, — r � method — Page C Internet: a k 6 8 P P mv 1 n fOr maiion ❑ — NeW cpnStructi°I1 1 Addition /alteration/.a L—" ail P- � — ' placenlent : ?Imo check Ow ,1 a 1,6 ❑ Demolition `! Other: :I Servi�c ur ; , apply ( m.1: I ye-g p( u , e rc 1 ! Del , eecr, -1',K: sups or ;no,c c Ieekee.� 0 8u;id:rg OVeT th :ee s;unh CA»fi what :he available Saul: current .... . fr t. 'C ::CU *t Ill\ escpeC !C. ;u G ;. , d grins; znd bnAr� �.c 1 IV (.1 ? iarnily dwelling ~ � x' ::54 0l ❑ ?iOdflM, Ja:iC7: ;_a ❑ Commercial/industrial aria( 1 '�a to 4r0 nd. u: a \u'Ca$ ; . U0l I - 0 ACC:essory buiidirtY J COT , st s . A.- r Mu!lt- family Master builder '1 Other: L i re: :Or rll O:nerIflStrlia[ions. Gmgi, ` .; ; �... b LJ uteri 0 i /'Ire pump wi e •• : :c Lr • : . a rt ^ 'J� • � � .. L::o1Cl gcnC) hymn: ' 5 u IA7 n0.: L:. nCvv - 3 i icpa. ?;clv '!drNe d e1 4tr! �!IOno noes:( > i 10 . oE� o: site iidd" !Ofrr'? ur rrvre City /Stalc'ZiP: Ti ,y` n Q`� J t - 5.� o: ;,ore resec::na+::n,;; i--,—___. 1 i 0 i ieal: ii t:lre t:nfulc. Suite/bldg./apt. nu,: I — -- tti:ridrduu.' 1 0 supple ,.../ra tp: mnr :ha C `p u,. rxar +olu. P roject name: 600 vol:s,wmu•;rl _ _ 0 Service u: Seale amyl ,�r o,urt. Cross street/directions to job site: — - - rd -- • \ ew residential single- ur tnuiri. F"= Tout _ - -- id K family dwelling unit. r includes attached garage. Subdivision: — - ___ _ _ Lot np.; j ■ .OGG s). ft. or less i — Tax map/pa no -- — — _ I • r - - - -. !bs St �� SOC sy. ft i_,_, i_,_, r Ea. c'1 w porlon ! T 33 4; Limi:etn n trey, r ro at --1—T —.—j. — — ' (with 12.} 7 . )() r . �) / A — " i ; Limited energy. multi- Camily ; I — 1 i '' _ _ ' :csrdent :el (with above so. et.) ?5.00 • —1 Semtiices or feeders installation, alttranOn an or reiot'ation — 1 ., ...©, :?�'RQ `-XVh'ER — —.. amps or less _ — .. T I �1 � 0 . `iT 201 ;imps to a0o amps — T— Name: �I i :i3 5ti ., j es �,� i amps to 600 amps - -- 2 .— Address: � lies_ �/��^,� /I ^c: — ?�_ sL l _Ot d_otsU-aud amps .Oir<1a — — (jv'i' i ..t)l) an or vpit5 . ' — - . C ;ry/s�rtztr: — s ;2 2f1 . • i Ti , �, a n �� ; Telnpurar) services or feeders installation. alteration, and/or P'hOr1C: (�3 - - • relocation —. - -- - ' Fax: 1 1 : X Wimps Cr icsi • 68.54 i ' Owner installation: This in' Lellatio -t is being rddc on properly _ — >4 .36 _ , ?C I amps :o »00 env; intended for salt, tease, rent, or cxchart 1 P' fn at I own whi�i! s no: p � — . 1,s u& ; . gc, at c prdiP.g [a ORS 44?. 1 • 40: cmPS to 599 am• s ; — — 9 . 6 70 : and 701. :' Owner signature: Dare: — — : 1 $ ranc h circuits - new_ alteration, or extension, r net . . . . . :e thr rant •e. With —. �` hFt�FC"1 I — h 4 cr � t • 1 CO q' C [ 1?ERS()N = wv a se trice n(;ec fee B us i ness name: — - -y i :ach 5rancil _/rent ' :? , re ar e. c o ! I ii Fse : o f ch circuits wuhr,t� I . .. — • — f Contact name: serv or xaCr fee. first branch eirl:uil ' ) l i Address: —� - -- --- -; Each aEach add" branr tr chant I -1--;.-1 I l , Z� 7 47 ■ — 1 ; I %lisccilaucuus (service or fender not inducted) — � ! Ciry /StatG21P: _�� — —.— I i Each martuf>u tureai or module( 1 i Phone: ( • � — — dwellinv seni i 07 ga 1 T — e artC/or °ceder 2 r _. . i Fat:. • ( ) ■ R «on :,icton :. — — _ — ''a,n1; o: : ; ;4m:on c _ I � -- -- l ! ts= �• :� -`(]1i Stec or uut';n_ li nil _ • e 'g j 6734 i B u sines s naIT1C: .a: circuit(s) o r !lmtre0- there i — — — Mollenhauer Enterprises Tnc. t o r 1>^ pecti JaIA Mike's Ele s additional inspection a v Y , c _ Address: Each addit over on allowable in :4132: of the ab 1 1070 SW :1I1 n Ti _ Additional �,. vd inspection t 1 h min :—i 1 Go 2 11 ! Ciry /Statc/Y.1P: Beaverton OR 97 - - -. —... ._ ( ves :•ys, tion (: hr:nin) — — _ , ! — Phone:( 503 1 649.6 — OUP - - j I ^.¢(! hr 8 i51 hr _ — _ ... 6991 ��.: { ) 1 ; t>r hr T — SO3 641.190') inspections which no 1s fo: wh ! 1- -- • CC (3 Lk.: 1 1 ! Electrical — InSoCc ca!! y 10 w h ' /r +r mu. y0 ; fti `r 9 094 a. I.i;.: (;643 - Supn. Lie.: 42305 ' al;sru �r Es — Suprv. Electricia sign , re. f C �WI' Cd: / , ,A` T — i Pri nt name �Ull la j -- V� Plan review (2 °i of permit fee): ` / !1/11 / �� ) i ' ° c: I ( I L? J State '�o� ( r � o U. ilCrnl ll C) T. ! Autnoriccd signature: �,�' J ! I Print name: Darryl ��- TWA Hermit 2 peliC9ti r expjrb been a portal: is not :Atli–A within 1t;0 a Mel enhauer Date: : 7 days after it has p aaccept e d as complete_ — II J / ' . , • ., : :a3;uc: ;Sues P !' 8111 :e,r`�,pcirnal- :.c ; A, ' 40c ;7:.K,::1:. T ed ]Gr x nu,. rn 1 I.n.,r ....wen