Permit •
CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00649
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/13/2012
Parcel: 1S134CD07600
• Jurisdiction: Tigard
•
Site address: 11705 SW TIGARD DR
Project: Schoeneman Subdivision: BURLWOOD N0.3 Lot: 28
Project Description: (4) branch circuits for hall & bathroom remodel
•
' Contractor: HEBERLE ELECTRIC Owner: SCHOENEMAN, THOMAS J & MARY E
29012 SW EGGER RD. 10210 SW TERWILLIGER PL
HILLSBORO, OR 97123 PORTLAND, OR 97219
PHONE: 503 - 628 -2095 PHONE: 503 - 675 8704
FAX: 503 - 628 -3076
FEES '
Quantity Description Date Amount
•
4 crt Branch Circuits wo /Purchase 11/13/2012 $78.44
Specifics: Service or Feeder
1 ea 12% State Surcharge - 11/13/2012 $9.41
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $87.85
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 may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 4 32.198 'r�
7 1.800.332.2344.
Issued By: 2IL ti a1 }
Permittee Signature: l//4 r/- �`�O�
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.
11/11/2012 22:08 5036283076 HEBERLE ELECTRIC INC PAGE 01
Electrical Permit Applica 1.1■R M. 11SI f1NI.1
ivtb
City of Tigard Received !L �3� a- S.T PermllNo.;CLri a01e-co I�
13125 SW Hall Blvd., Tigard. OR 97223 Plan Review
R • Phone: 503.718.2439 Fax: 503.59 V6G' 132012 Onre/13 : Other Permit:
r i c:.n t . Inspection Line; 503.639.4175 pare Ready/By:
See Page 2 far
Internet: www.tignrd- or.gov Notified ���'!�w
/Mahod: Supplemcntnl lnformptino
I► •: a
{ , . ti !� t s: -t.., • y- ,l f. _ids ?�k` cm r..:. 7
^f . r� i' ':e Ltr 4• '1 .'zC��ifr. .:<1M^,ir,. etl, k' . ' u1.�i,83,'..1.:�'. Ire.: ':'!h'.::.: " .A:ia c � .� t_ .n.i: r Jn:�
El New construction )".71 Addition /a tcration/rep acement please check all that apply (submit a sere of pietas wide checked below):
0 Service or feeder 400 amps or more ❑ Building over three stories.
El Demolition ❑ Other: where the available (Ault mirror( 0 Merino and boatyards.
.r .�� ': :k 4 C +.`�4`4 a' f ��1:. • i1 +.r ' • - exceeds 10,{00 *nips or I 5o volts or ❑ Floating buildings.
` lets to Brelthd, or exceeds 14,000 ❑ Commercial •use agricultural
K I- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other inatnllnlinnc buildings.
j ❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. of 75 KVA or 0
l' ;''ty ' ` Ter: �s;� , � , � {I ' , �11 I �� � t A ii11Y' `7�` ❑ Emergency system. larger separately derived system.
,
: ':.� «. .... .. ••r . ., . L.. '�:iiiv"hF:'- .. , f � ❑Addition of new motor load of "A ", °E ", "I.2 ", "i -? ",
Job no.: Job site address: i 170.5 51,j " n 6. 04,447 p �� p �,,,, 100HP or more. occupancy.
0 S i x or more residential units. 0 Recreational vehicle perks.
�� p � Q ❑ Health-care facilities. ❑ Supply voltage for more than
City/ State/ZIP:
_ - °�"'" 7 . - . � Cl Hazardous locations, (+n(I volts nominal. lqj Suite/bl /apt. no.. 1 Project name: 8 � � E E. �,�.•.j 0 Service or feeder 600 amps or more.
t . �...• G Iii•cfr,' ,;,,.? ,.:... t'sg�}YY�..��01:4 n1 7V. . L �. ,, a;r1:i ,:.•
..
,�� ..:
Cross streetidirections to ,job site: ' Crs�"' . Daerl d os Ei' p... In p
Ncw residential single- or multi -family dwelling unit.
Includes attached garage.
Subdivision: Lot no.:
1.000 s<1• ft. a IC" 168.54 4
Tax map /pier ci no.: . odd' 500 s O. or portion 11/ mai 1111
_, .. 5 00
Ea I q. R porno
, / , - .,.;r,.. . :i••: j;` .. ,.. - .; , : • Limited energy, residential 7
is t;:, i i' � ,s _ li.� :.;, F':° ;:.. ; +'r;.-,.' with above . R.
2.T � e,o0 �� �� ID Limited energy, multifamily 75,00 2
I t4 i t -, residential with above ft. ) 1
1 • Services or feeders installation and/or relocation
6? 200 amps or lass 100.70 2
Wi ., . ` . c . tr .� i t A : t!i h i rr " ss.�tid' 701 amps to 400 amps 1 33.56 1 2 2 p� t, 1 401 amps to 600 amps 200.34
Name: t �r •� , 4\ ►r6� `Tr yr, SC _ f QS 601 amps to 1,000 amps 301.04 2
Address: - ) Over 1,000 amps or volts 552.26 ' 2
City/State/ZIP: • Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) (17 4 J",,,..SZ o Y Fax: ( ) 200 amps or less 59.36 I
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that 1 own which is not
intended for sale, lease, rent, or exchange. according to ORS 447, 449, 670, and 701. 401 amps t o 599 amp 168.54 2
Branch circuits- new alteration or extension r noel
Owner signatu : A. Fee for branch circuits with
,'. : r ., 4;-19 . .i4 ti G ' r 4f . ;, tiN] j�+,A la - above service or feeder fee,
rrix lr ' ; ° . 7.42 2
each branch circuit
Business name; A, Fee for branch circuits without
service or feeder fee, first
Contact name: branch circuit / 5 / ` w
56.18 ( 2
Address: Each add'l branch circuit 3 f 7.42 Z2, -. 2
Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular
67.84 2
- dwelling, service and/or feeder
Phone: ( ) I Fax: : ( ) Reconnect only 67,84 2
E Y Pump or irrigation circle 67,84 2
••` ':';; : w.;: ;: _;;rr:;ti Si4nor outlineli lighting 67.84 2
' .- • , j , : ' • I. :`.+ Signal ctrcuit(s) or limited-energy
Business itiune: Heberle Electric, Inc. panel, alteration, or extension. T Page 2 2
Each additional ins ■ ectlon over nliowahie in any of the above
Address: 29012 SW Egger Rd Additional inspection (I hr min) 66.25/ hr
City/State /ZIP: Hillsboro /OR/97123 Investigation(i hr min) 66.25/lir
Phone: (503) 62&.2095 - industrial relent (1 hr min) 78.18/ hr
-
Far; (503) G28 3076 Inspections for which no fee is II
5 .- ificall listed % hr min 90.00 / hr
CCB Lie.: 152342 Electrical Lie.: 34-160 C
Suprv. Lic.: 3053-S 9 �r� {��
Suprv• Electrician signature, required: -.411 Subtotal:
- Plan review 25% of permit fee);
Print name: Jeffrey L. Heberle Date: 11- �� ME
b
6 - State surcharge (12% of permit fee):
Authorized eignaturc: TOTAL PERMIT FEE. 7
hin 180
Print name; WM. Date:
This permit app lieat n aptree if a permit Ia not neaed ..it da sin it c boa bcern aeexpted u tome a ln te
umber of ins � • p aonO m9 lo a110vred It
1 : 1 BuYdia9lAermi ,el6L[•Pp,alv 0)r01 /In
4 n0- atci cT(IIr05/COMAYBB nom,