Permit p CITY OF TIGARD ELECTRICAL PERMIT
a COMMUNITY DEVELOPMENT f Permit #: ELC2013 -00040
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/17/2013
Parcel: 1S135CD04700
Jurisdiction: Tigard
Site address: 11865 SW 95TH AVE
Project: Good Subdivision: RUTH Lot: PTS 1 -2
Project Description: (5) branch circuits. 2/14/13, reprint to add (1) additional branch circuit.
Contractor: MIKE'S ELECTRIC Owner: GOOD, JAMES JR & JULIA
11070 SW ALLEN BLVD 11865 SW 95TH AVE
BEAVERTON, OR 97005 TIGARD, OR 97223
PHONE: 503 - 649 -6991
PHONE: 503 - 560 -3868
FAX: 503 - 641 -1902
FEES
Quantity Description , Date Amount
5 crt Branch Circuits wo /Purchase 01/17/2013 $85.86
Specifics: Service or Feeder
1 ea 12% State Surcharge - 01/17/2013 $10.30
Type of Use: SF Electrical
Class of Work: ALT 1 crt Branch Circuits w /Purchase 02/14/2013 $7.42
Service or Feeder
Type of Const: 0 ea 12% State Surcharge - 02/14/2013 $0.89
Occupancy Grp: Electrical
Total $104.47
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. ATTENT : Oregon law re uires you to follow the rules adopted by the Oregon Utility Notifi Center. Those rules are set forth in OAR •
952- 001 -001 through OAR 952 0 0 /You may obtain a copy of the rules or direct questions to OUNC by call' -50 32.1987 or 1.800.332 344.
Issued By. , \ Permittee Signal e:
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.
•
CITY OF TIGARD ELECTRICAL PERMIT
• COMMUNITY DEVELOPMENT Permit #: ELC201300040
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/17/2013
Parcel: 1 S135CD04700
Jurisdiction: Tigard
Site address: 11865 SW 95TH AVE
Project: Good Subdivision: RUTH Lot: PTS 1 -2
Project Description: (5) branch circuits
Contractor: MIKE'S ELECTRIC Owner: GOOD, JAMES JR & JULIA
11070 SW ALLEN BLVD 11865 SW 95TH AVE
BEAVERTON, OR 97005 TIGARD, OR 97223
PHONE: 503 - 649 -6991 PHONE: 503-560-3868
FAX: 503 - 641 -1902
FEES
Quantity Description Date Amount
5 crt Branch Circuits wo /Purchase 01/17/2013 $85.86
Specifics: Service or Feeder
1 ea 12% State Surcharge - 01/17/2013 $10.30
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $96.16
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 -00 . You may btain a copy of the rules or direct questions to OUNC by calling 503.23 Q 2..1987or 1.800.332.2344.
Issued By: Permittee Signature: D f / T1 1. Pu CA U&J
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.
02/13/2013 15:15 #1776 P. 001/002
Electrical Permit A lica •
• EIVED
C . Received FOR OFFICE USE ONI.N
, •
City of Tigard
IN --
. 13125 SW Hall Blvd . Tigurd, OR 97223
Pl
Phone 503.718.2439 Fa s !:(...59EEI 1 3 ? rTa r,)13 Daw..a..
an Review
teiEly .
1 Other rerrno•
^-1
Inspection 1.ine. 503.039.4 ! 76 Date Ready:13y. P
i on. 7 Ill See Page 2 for
T1C,Akfl i •
. Internet: www.tigard%ol.euv
Cal OF TIGARD . Notified/Nis:thud.
.. i ,.,
., I Supplemental Informal:ion 1
-
'"NINIDING DIVISION PI AN REVIEW
l'hatsc checi: ull Mai apply tAli111111 2 WS of plan; w• items chccited belenst
0 New construction Additionialtcrationfreplacemeni
0 Sc:\ lee is feeder 400 amps .e more 0 Beildir4 O r !hree c orks i
0 Demolition 0 Other: %here the Jvt;labiu L4i.C..t current 0 Marinas and boatyard: 1
1
CATEGORY OF CONSTRUCTION cs,:ccds I 0,000 ompx at NJ volts or 0 Fioat rim. bt,i Idingx. i
lii
- and 2 dwelling 0 C.ornmercial/inclustrial L _,r 1 Acccssor:. building ill! IV :t uunti. or exceed; I - I, OM 0 Coo trim c ial aRri C ullU I di I
amps for all orhee instanatio. buntlines 1
0 Multi-family 0 Master builder 0 Other: °Fire pump. 0 lustallarion of 73 KVA or l
0 Emergency &Weal larlIcr NerafiliCLY 11.71Ved rent
FO i
JOB SITE INFORMATION AID LOCATION . '
0 Addition of new morot load of 0 'A .. "1".... - 1-Z' . . '1-3- yc
oc:upanC!,. 1
Job no.: Job site address: 100111' or more t
0 Si■ or MOtc icslacruial unit 0 Re‘vextional vehicle MA! ■
C. II yi SI at C/21 n (th 96-Y8_1, 0 !!ealtn-cart facilities 0 Scopl voltage for more than
-
01liltardOuSIO:ations 0(X) voltb nommal
• 0 Service nr feerio 500 amp% or
Suite/bldg./apt.. no.: 1 Pmle name:
' FEE SCIIEDULE
Cross street/directions to job sire:
()est nenon 1 Qr.'. 1 yr.. 1 . tetti •
—.... . .._,.. ,,
' --1 New residential single. or muIti-fandly dwelling unit i
Includes attached garage. i
(
- 1 1.000 sq ft. or lex.% I 1
Subdivision: I Lot no.:
r adel 300 sq. 11 or portion I 1.3 I 1 I
._..i
Tax mapiparccl no.:
r 7i7Zed energy. residential
', T 1 1
1
DESCRIPTION OF WORK i with above so ft ) , 00 2 I
.•
Lonitud en,T mlti-fal
gy. uiniy -
—-.- 1
hild,_OMbc<lifjfIA acCij --- Ft pery,44- 1 7:in„ .
: FL) •
I 2 •
Services or feeders installation. Alteration . and/or relocation
200 am:, car let's I 100.70 1
- 2
--.....
0 PROPERTY OWNER . i s 0 TENANT 201 amps to 400 amps I 111,56 ' 2
Name: J
401 amps to 600 ansps--- 2
oUl amps to !.000 an 301.04 I
2
Address:
Oyes 1 Poo ;imps or volts t I 1
552.26 1 1 2
City/Stat&ZIP- Temporary services or feeders instalbstion, alteration, and/or
r
-
Am •imos or icSS I .:■ — F - I
i ,_
Phone: ( ) i Fos: ( )
! amps I
Owner installation: This installation is heinu made on property that I ov.'n which is not amps
I . I
- 201 in 400 amps 125.05
4
intended for sale. lease, rent, or exchange. according to ORS 447. 449. 670. and 701. • 01 amps to 599 amps ittt.54 .. 2
-
, Brunch circuits - new, alteration, or extension, per panel
Owner signature: _ Date: I A. Fee for branch circuits ‘s' TT I I 1
' or fd
i ■ above soma' e.eer fee. I ! ., ..,
0 APPLIC:Anrr 0 C7ONTACI* PERSON a . ,...
•—l--••• •---- .._... ...... .. .... ... r each branch eneun . i .. ; i • 1
H : l'Or branCh ticeilit. ircul:”10
Rosiness namc:
H service o: reciter fee. firs: ; 1
! 7 I
Contact name: I brunch c:rcus; 1 i :i6
" ' ' Each add': b(sncit circuit i i 1 7
_ .±L1.28a14
i I.
Address:
1 I Nliseella neous (service or feeder not included)
• 1 i Eactv7nufacturcii or ?nodular I ; - I
City/State/Z IP:
' thvellina, service 4roi or feeder 67.34 1 III
Phone: ( ) i -
• I'm: : (
) I , Reconnect only
I D.,.ii,,,i, 67.14 : 1 1 7
.„ or imganou c,;eie i 6 1.:
Email: , -------:( 1
.-
, I .c.•;gn or outline lishling ! --- 67.84 .1 — TT;
CONTRACTOR
. Si.;nal circuigsi or timited-enerks
i
I I
Business name: Mollcnhauer Enterprises, inc. DR.A NI ike's El alteration, or exension. Pace 2 Each additional inspection over allowable in any of the above :
Address: 11070 SW Allen Blvd Actsinunial inpection (1 hr min) 66.25f hr ' .1
_
66.23
,
I Investigation (1 hr min) : hr i I
City/StaterLIP: Beaverton, OR 97005 1______.
•—•
I Inclustnai plan! 11 hr min) 78.18, M I
.J....._.
Phone: (503) 649.6991 i rax: (53) 641.1 9 02 I nspeenons lin whiCh tal fee is I . I I
—, -- speei kali listed (l hr min) 90.00. hr
I_C Lie.: 191094 I Electrical tic.: C643 I Sum,: Lze.: 4230s
t • • ..„ ELECTRICAL FERNirr FEES
Sebrotat: i
Suprv. Electrician signature. required: , • - / ,, - ..
,_. 7 _,.... 1t ---1 Nun reviev. (25% ot permit fee). ,
Print name: Dogulas 1. NI i 1 ler J
,-- ; ,..) vs i3 , su.surci.2, 2% of pen-nit fee). l
-- e . --I
Authorized signature: je t :7 _,. /" j. ", ol e r i. ,, , - . , I TOTA1 ISERMI11:12C: ; Q .31 ;
,
I This permit application expires He permit ix nor ootairkial Within 180
i (I, . —1
days alter it leis been arrepted Ai complete. Ckit.
Print name: Darryl Mollenhauer
I___...,., . . .. 133 13• ! - Number or inspeo;ioux allowcd pc, p,,,,i,
• .. .
1...3WICitw■Put mut. \ FI.C.Poxrnil. 63: 0 7, 0 / ':6 :40 gs' yr( : : ,), ( ON! `,XV:i
•
#1 6 9 8 P . 0 0 1 / 0 0 2
01/16/2013 00:48
Electrical Permit Aaplication RECEIVE
City of Tigard i R..,vco
JAN l 6 20 ; D al, , , a, . 1 (1 7 13.. -4- j • - . .& 3 —000
•
IN 13125 Sw Hall Blvd . Tigard. OR 97'
Phone. 503.7)8 /439 )'vx. 501 ic4(.;
• f/En.:.- by.
------!--
( 'crnm
l
Inspection 1.inc: 503.639.4175 CITY OF TIGARD F miTe RendYik' i Jun: I RI See Page 2 fur " 1
Tit:ARt)
Intemer www.uganl-ur ?..;ov _ N NotificcUmeihodi
.1 "1 CO 1 S.oplemonia) Information
I — —
I: TYPE OF WORK PLAN REVIEW
._.__
— .
, I PlCsie check All tiny apply 0:ohm:it 2 setA of plans 1...;flurns 42 hCeked belOw ,:
I 0 New construction 13 Additionl'alleration!repineernent
; I := Service or feeder 40e amps ,,, :we 0 13cildthe ow: Ihree c:ooeN !
0 Der:101410n 0 Other:
____., _
....j : %here :lye avallaOle lho:: Cut Kill 0
----, _ _ .
•
CATEGORY OF CONSTRUCTIO
N I c.,..1.7,;4i. l 0 000 :ono+ .,, , 0 ml:s k): a ■ Ot.uidmrS •
!Voulla co CAcceds 1 0 ( :wk.:in.:a:
ffil I- and 2-family dwelling 0 Conunerciallindustrial Ell Accdssory building ' 1 an lir all why: in.vollflOon
I ' r-i ... ' . bui!eany.f. ■
I 1:I Multi-family 0 Master builder
0 Other: 1 i__ICire pump.
D lzulalinfion of 7 ',' K vA 0 ,
`--
0 La A r: u. o .p..i scr: ,.c. a ). 7 . 1 2 c.) ..> . L.4 .1. 1;■-co siC111.
JOB SIT)... INFOILVLATION AND LOCATION
0 ,i7 k th cicl e icion ..c 7f '' ne Y : 7 :71o . tor iced of
I m.
• _
Job no.: Job site address: %I _ 100) IP nr mo
8 (,, 5 SW '1S 4 Ave
i 0 Six Or more jCstdenziat w.u, 0 ReCrtae1071:1; Vehiele pnrkS.
-•••
•
City/State/ZIP: T cac thore than
, og, c . 2 _ 2.3
i 0 f f.ahh-cuiu fk,siius. o suppl vottage for
i
s 7, ,,,,,,,..,. ., $. os
m
Suite/hIdgl m
apt. no.: i Project nae: ,
_ _ _
or nwi 1/4.. 1
.—...--,—,____■-- _
FEE SC:FIEDULE
Cross Street/directions to job sit,:
1 a-win/Jon --, - =1,,.. - 77;77 - ' - 1 . ,, '
_
New residential singic- or multi.ramit dweilin* unit.
! Includes attached garage.
I
, — J !
Subdivision:
1 I ..ot no.. i 1 1.000 sq. It el less 168 54T
____, _L_1
_____._...__ 1 Ea. mid': 500 sq Vt. or portion
i_ 32_92
Tax map/parcel no.:
,...._
, I i Landed encrav, residential 1
DENCRIP1'1ON OF WORK
___— 1 I twit ahoy,: sc. ft 1
1 , r; IMIZed enc:tty. muil:-tanl:!!, 1
I 74.° - 1 -- — 7 - 17
-0 1
1 i . fOcraiiii I with above sq 11 i , •:'00 1 t _ I
_
' ; Services or feeder installation. alteration, and/or t —i I
! ,relocaion
. 1 I 200 amps or leis
—. I .—.
0 PROPERTY OWNER 1
0 TENANT I 201 innps r.o 400 amps
! •r_._____,._r______ .= ;
! • 40 l amps to 600 amps I i 200 s4 2 I
Name: 1 c.,1 e 6,4
I t - 60) amps to 1,000 amps 1 301 04 1 , 2 1
1 Addrcss:t I 8‘,5 SW 16 A
1 1 chvr l amps ot voli. . — 55: I
I -7-
/State/71P 1 ! Temporary services or feeden ins : tallation. alteration, andtor -1
1 CIty9oLf c) . ( I - ) 2..l 3
. ! rd7ation 1
; 200 amps or less 1=-- 59.36 I I I
Phone: ( SQ3 ) iS& . .nC 5i i
I 1
--___--.
- "
, amiss
Owner installation: This installation is he' ing made on properMu
ty t I own -I 01 arms 10 400 amps 125.08 which is not 1 I - '
; 1 5 1 168 54
L l
intended for sale. lease, rem_ or exchange. according to ORS 447, 449, 670. and 701, 40; amps to 99 amps
i i iitinch circuits- new, alteration, Or extension, per panel
Own . er signature: ..
Date: I I A Fee for branch circuits with - I
PERSON 1 — i 1
l above service or feeder fee. I
I 7 42 ,1 •
0 APplAc,*---n'
PERSON - ''''
. 1 .. ON1ACT
I i _l each branch el Mod
—.—
„ ---1— / ! -- 1
Business name:
1 1 B. Pee tbr branch circuits villa, H
— .. _! • or feeder lee. ruSi
56.;8 1 SC
1 ,,
hra,,ch
1 k:ontact name:
,:iicui,
. , . . , _ .
m -
_
--; , i.ach add't branch eiretvi 4 i !.42 4._
, - 4.9. VLI 2 1
I Addre . — ss:
Miscelb aeons (service or (ceder not inc:12
_ .
I Each intinufactured or modular r I ----!—
City/StatelZIP:
1 1 _,,1 dmeliin... service anitot feede: i 67.84 • )
1 _I -
Phone: ( ) Fax: : ( I • I Reconnect on only
.,, y i 67.84 ' IT
___;___
[ Ilf ortgarion orcic — 17:
E-ma 7 67.84 1 --til
il:
..
I Sign or outline ittenting I I 67.84 1 n
CONTRACTOR
_
l3usiness namc: N1ollenhauer 1 nterpriscs, Inc. DBA Mike's Electric
F 1 Signal crrcuit(s) in i inlliede.nergy I
j panel. suer:mon. or evellSiOn. ; I Pre 2 j . 2
I
_
_ _.. _. ._ _ .._ ....---; Each additional inspection over allowable in am of the above]
1 Address: 11070 SW .11Ien Rlvd
L
. ;
1 Addiiional inspeelion it hr min) ! . 66 7 hr
City/State/ZIP: Beaverto, OR 970 i ! 1 1
,
i I frp.ostigation (1 hr mini 66.25.. hf 1 j 1
I_n ;
.......__ — . I industrial plant ( I hr ruir) s, hr I I
Phone: (503) 649-6991 ' Fax: (53) 641.1902 I inspections for which nt) fee IS
. I
i . _
, ,
l seccifie-d lv listed 05. hr into) Y0.00: hr : 1
_
CCB Lic.: 191094 I Flecuical Lic.: C643 Suprv. L.ic.: 4230S I 1, ELECTRICAL PERMIT PEES -
• --1 ;_____
Suprv. Electrician signature, n.Nuired:
j Plan rcv iew (2i% or:wa tce). I
T•
.---7/ , H .
r-
, --;
Print nainc; Doguias J. Miller ■-- i DOW: ■
i— , SI:IK Sill Charge t ! 2% of pcnnir fee): I It....5 (II, I
_ ,
_
IDTAI
—:. Prrzmrr p....7
1 i
Authorized signature: 4 4,
• •.: j„:,... A.
- rn;$ permit application expires if a penott not obtsto withi )80 .
. ...._ ..
1 days after it has been aesepted MD COnlrar IC.
I Print name: Darryl Mollenhaucr t
_ __ _ 1_ Late: _. ,.._: • . ,,,,I,,,, or:nspee:inn allowed oe: permit
1 :Iluiklinv - Pc.mes\EL('.PprnnApp...u. e 07 ':o
.:4-46:‘ I ::5•COm,AvEa