Permit CITY OF TIGARD ELECTRICAL PERMIT
$ • COMMUNITY DEVELOPMENT Permit #: ELC2012 -00729
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/20/2012
Parcel: 1 S125DB03001
Jurisdiction: Tigard
Site address: 9310 SW 74TH AVE
Project: Bekey Subdivision: BOULEVARD HEIGHTS Lot: 5
Project Description: (2) branch circuits to replace heat pump
Contractor: MIKE'S ELECTRIC Owner: BEKEY, RONALD
11070 SW ALLEN BLVD 9310 SW 74TH AVE
BEAVERTON, OR 97005 TIGARD, OR 97223
PHONE: 503 - 649 -6991 PHONE.
FAX: 503 - 641 -1902
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 12/20/2012 $63 60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 12/20/2012 $7 63
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
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 O • ' • 52- 001 -0090 You may obtain a copy of the rules or direct questions to OUNC by calling 503 232 1987 or 1.800 332.234 4
Issued By: ��. / \ L Permittee Signature: O A-PPu C 411.0
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.
12/20/2012 03:05 #1856 P.Ou1/V42
cit., of Tigard
11 1‘ 1312'5 SW Hall Blvd...14prd. OR 97223
Inspection Linc: 503 6.19.4173 Date Reielvriv: i rt.,. ' 8 See Page 2 for
Internet: wwsv.ugaril-or ;toy
TYPE OF WAV116/) IN"' PLAN REVIEW
•
D New conbtruction Ig Additionallerciiionireplaeemetit Please check all thai apply (submii l sets of pi u,:h c h ec k e d h
5) 1 - and 2 dwelling 0 Commcreial/intiustrial El Aec.es*ory bli i !dine 1 ;!nntS &wall Other inarnlintions. build;a1p,
0 Multi-family 0 Master builder 0 Other: ; 0 t pump 0 installariow of 7:, Kv,.% o
JOB SITE INFORMATIO:si AND LOCATION
Job no.: Job site address: Q k 1 I 0 SW 1 1. Ow.e_
CiLY/SLitteaie:Iir4 1 09%, 17 0kcaith facilities. 0 Supply voliaga lin moro ;ban
FEE SCIfEDIlL
Cross street/directions to job sOe:
! i • New residential single. or inulti-famil■• dwelling unit. -- I
Includes attached garage.
Tax map/parcel no.:
— - • — . or feeders installation, alteration, end/or reloci
1 401 amps to 600 amps 200.34 r 2 '
Ill
Owner installation: 'Ibis installation is being manic on property that I OWIl WhiCh IS 1101 ff • . .:---;-...
intended for sale. lease. rent. or exchange. according to ORS 447. 449. 670. and 701 .
Branch circuits– new. altenttiou, ur extension, er panel
Owner signature:
1:1 APPLICANT 1
0 CONTAC1' PERSON — I above service or feeder fee, :
' each branch envoi!
7B name:
1 Nliseellanenas (service or feeder not included)
E-mail:
I 71
1 CONTRACTOR
Business name: Mollenhaner Enterprises, Inc. OBA Mike's Electric . _
„— . I Each addittunal Inspection over allowable in anv of the above :
i_ticiress: 11070 SW Allen Bled
lovNiluallon () 11;• rmo
City/SOteL II': Beaverton, OR 97005 .
1 1 CCR I.iC.1 191094 i Electrical 1.ie.: C64 Suprv. Lie.. 42305 I I KLECTMCAL PERMIT FEES