Permit ' n CITY OF TIGARD ELECTRICAL PERMIT
. •- - . • ' a , > COMMUNITY DEVELOPMENT Permit #: ELC2013 00122
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/20/2013
Parcel: 1S 133DA05900
Jurisdiction: Tigard
Site address: 12940 SW GLACIER LILY CIR
Project: Shanks Subdivision: AMART SUMMER LAKE Lot: 81
Project Description: (6) branch circuits for kitchen remodel
Contractor: HEBERLE ELECTRIC Owner: SHANKS, MARK S & MARY M
29012 SW EGGER RD. 12940 SW GLACIER LILY CIRCLE
HILLSBORO, OR 97123 TIGARD, OR 97223
PHONE: 503 - 628 -2095 PHONE:
FAX: 503 - 628 -3076
FEES
Quantity Description Date Amount
6 crt Branch Circuits wo /Purchase 02/20/2013 $93.28
Specifics: Service or Feeder
1 ea 12% State Surcharge - 02/20/2013 $11.19 •
Type of Use: SF Electrical
Class of Work: ALT
Type of Const: -
Occupancy Grp:
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. 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 001 -009 You may � btaiin a cop of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: �' �C Permittee Signature: 0Q. 41 ° PLI e 4- t 010-
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.
02/19/2013 22:38 5036283076 HEBERLE ELECTRIC INC PAGE 01
Electrical Permit A licati
CEA D
other Permit:
supplemental Information
! 0 New construction ii Addition/alteration/repracement Please check all that apply (submit 2 sets of plena w/items checked below);
CI Service or feeder 400 amps or more 0 Building over throe stories.
171 Demolition El Other:
' 1- and 2-family dwelling 0 Commercial/industrial 0 Accessory building amps far all nth= installations. buildinp.
0 Multl-family 0 Master builder Ej Other: CIFtre pump. El Installation of 75 KVA or
0 Recreational vehicle parks.
0 S is or more residential milts.
Suite/bldg./apt, no.; I Project name: ,../4 _. 0 Service OT fccdcr 60o amps or more.
I Cress street/directions to job site; . 4 67'5S — 13 c Acitx Le to , Qt7. FoN TOW P
New residential single- or multi-family dwelling unit
Includes atbiched garage.
L000 sq, A. or los 168.54 Nis
SuhdiviSion: Lot no.:
Ea. WV 500 so. ft. or portion 33.92
Tax map/parcel no.:
Limited energy, multi-fami ly
ib-v .. residential (with abolt scl. ft./
Services or feeders Installation and/or reitieatiOn
200 amps or 111.1.R 100.70 2
Mana 201 amps W 400 amps 133.56 2
Name: Arark .10 Al.
ci--1 k Aim. 401 amps to 600 amps
601 amps to 1,000 amps 200,34
301.94 2
2
• Address:
Over 1,000 amps or volts 552.26 2
' Temporary services or feeders insmliation, alteration, and/o
City/Statc/ZI P:
relocation
201 amps to 400 amps 125,08
Owner installation: This installation is being made on property that 1 own which is not —
401 amps to 599 amps 168.54
intended for sale, lease. rent, or exchange, according to ORS 4 4 7, 449, 67 0, and 701,
A. Fee for branch circuits with
above service or feeder fee.
each brunch circuit 7.42 2
Business name: . G 13. Poe for branch eircu' a without —
I I ,-• ; service Or fteder foe, first
Contact name: ... , '.8s014Q\,),.. branch circuit
Each add'l branch circuit 7.42 ii
AIIIIIIIIIIIIIIIIIII Miscellaneous service or feeder nnt included
I City/State/ZIP! Each manufactured or mndular
1 67.84 III
_clwellina service and/or feeder
Pump or irrigation circle 67,84
Sign or outline lighting 62.84
' Business name: Hcber/e Electric, Inc. tancl alteration or extension. Pa!e 2
--__________. Each additiOnal ins, ection over allowable in an of the above
Address: 29012 SW Egger Rd
Additional inspection (1 hr min) 11.1 66.25/ hr
II
Ci ty/State/ZI P: Hilisboro/OR/07123 Investigation (1 hr min) ME 66.25/ hr
Industrial plant (1 lir min) Ill 78. f 8/ hr
Phone: (503) 628-2995 Fax: (503) 628-3076 Inspections for which no fee is
s.eciticall listed V, hr min II 90.00/ hr
Print name; Jeffl'ey L. Hcberlc °IP- Date: z.4:743-- E State surcharge (12% of permit fee)i / / . I
Authorized signruurc: ....7._
TOTAL PERMIT FEE; 1 0
Print name: A 7 Date: ThiS perMIT appiicot=m apires No permit Is not obtained within IRft
cer
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12940 SW GLACIER LILY CIR, TIGARD, OR,
97223
Residential - Electrical
199 Electrical final
04/12/2013 00:00
ELC2013-00122
PASS - No C of O
Violation Summary:
Inspector Contractor