Permit •
� - CITY OF TIGARD ELECTRICAL PERMIT
E 1 COMMUNITY DEVELOPMENT Permit #: ELC2013 -00284
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/22/2013
• Parcel: 2S102DB06700
Jurisdiction: Tigard
Site address: 9143 SW HILL ST
Project: Homback Subdivision: CHELSEA HILL NO.2 Lot: 44
Project Description: (1) branch circuit for new NC.
Contractor: HEBERLE ELECTRIC Owner: HORNBACK, PATRICIA F &
29012 SW EGGER RD. DONALD W
HILLSBORO, OR 97123 9143 SW HILL ST
TIGARD, OR 97223
PHONE: 503 - 628 -2095
PHONE: 503 - 380 -0274
FAX: 503 -628 -3076
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 05/22/2013 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 05/22/2013 $6.74
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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: Oreg n 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 0 952- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: / Permittee Signature: Al Qxi /i/../ e ry-770
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 603.639.4176 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.
05/09/2013 11:04 5036283076 HEBERLE ELECTRIC INC PAGE 01
0 1. a- 6..- --
Electrical Permit A licatio iiO1 OFFI( l: b i � ON . Y
City of Tigard CEIVED ,a , •i, , armit {VO LCao,3 eoe,VV1
13125 SW Hall Blvd„ Line: 503 Tigard, OR 97223 Finn Review Ot1tu Perm
11; Phone: 503.718.2439 Fax: 503.598.140: AY 21 2 013 bate /B .
is � l �C's,20/3 - Ddb G 3
inspection .639.4175 Date Ready /By: nil 1 Sec Page 2 fnr
TIC :AR I,) Ik ctio
Interact; www.tigttrd•or.gov , ARD • Notified/Method: Supplemental Information
•.J .si -'''''--'4'''' t A ",r,.i( `�'� :.'{lisle... "a ,-,:c ,.4Y,' l i '- ,{ y, ' •" . : : :p n 0 ...... e'. _
-S'. ..,r . j ` � 'i ":',', .i ! 'rr. r' 'n•� •4:' gik "' t .. / tn•V' ,, ,( , .. - tw. '; : i.,
. :' , ice,, .' L^6 ... n ^- 1,4=k .c a ll r, at pp ; , - ..
i,
❑ New construction L: Addition /altcration /repiaoement Plcnse check all that apply (submit acts of pinn;: /ilotrrs checked below); f
❑ S erviCC or feeder 400 nm or more ❑ Duildin9 over Ihree stories.
❑ Demolition ❑ Other: where the nva■lnble Bull current ❑ Marinas anti boatyards.
^'' - it' . rv`;:: J }'�: . , 41i.- _ A? -!.�') r�.:.yy.,�' Y. C %CCCtlS 10,d00 amps at 130 volts or ❑ Floating buUUmgt.
-- - ••• -- Ices to grou,rd, or exceeds 14,000 ❑ Commercial-use nttrirultural
- and Punily dwelling ❑ Commercial /industrial ❑ Accessory building amps for an other inntaualinna. buildings
C] Multi - family ❑ Master builder Other: ❑Fire pump. ❑ Installation of 75 KVA or
- ��y4ky1,:'FV l44 - ' �,,yy,, , .c • •• _,. ❑ emergency !tram. larger separately derived system.
' ;'.7 V- 1A aii*A ?!I?` tiittt tai .,. l' :1J l �t3 f:: s ;:.. C ;; r load or
r .4 '!• ❑ Addition of new motor ❑ "A" •E . I .. l-,
Job no.: I lob site address: r q 1 1 7 10011? or more occupancy.
_ ! ❑ Six or more residential units. ❑Recreational vehicle perks.
C ity /S(:atC /7_,iT': CI MeaIth -ero'e %clinics ❑ Supply voltage for more than
- • � ;,. . ,, - „- ❑ Haxaraoes locaHOn,. WO volt!, nominal
Suite /bid /rt?t, nn.; Project name; ❑ Service or (ceder 600 mops or more,
_ 6 I I y � ; 1yl y y ,� ,
directions to sllc: '1 • - c1 ��- ya ~�
�O J J _.
Cross street / Danu'ICU :a
t . , Fats ...... •
- - _. - New residential single or multi family dwelling unit.
— Includes attached garage.
Subdivision; r__ _ Lot no.: 1,000 sq. ft, or less 168.54 -�
- Tax map/parcel no.: __ —_ -- r ` Ea. ndd'l 500 sq. ft. or portion 1 33,92
Limited energy. residential 75,00 2
,,, �7. '., *. /,, ?„ � iRi - ii* {�' iti4Vidit. :. ti '. with above s fl.)
Li r' • energy, multl•fnmily 75.00 2
(/Z i t in(9 ‘ 7,74;S " C.47 ° .-- C. residential with above s., ft, •
Services or (ceders Installntlon alteration, anti /or relocation _
v '— ( 200 amps or less MI 100.70 2
,,1r : :1, °1 . fJ.� '. .t 1 � y � ,,. , , `._ ,;; 1g!',t,d t , .�7r � :,;,•::•;:::: r'. 201 amps to 400 amps I3
� T,' o.. st: �:' .
_. ..
401 amps to 600 amps 200.34
Name: - C:› C: • ,~ c w
601 amps to 1.000 amps IM 13
Address: Over 1.000 amps or volts 552,26 2
City /Stai.e /7.I :
Temporary services or feeders IosMllotion, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or lees I 59.36 0
Owner installation: This installation is being made on property that I own which is not 201 ani p c to400am p s 125.08 B
intended for sale, lease, rent, or exchange. according to ORS, 49 ' 49. 670, and 701. 401 amps to 599 amps 168.5 2
Branch circuits •- new. alteration or extcnslon,,per „panel —
Owner signature: _ - U e;
A. Fee for branch Circuits t Nth
.∎!: .r ! r ;11 ;:,7 'rti: !'1r` ': = :i'.t ,:. ..; `. , :', � t , .. above service or fi:edc
r fcc,
�;,•�•� ^n';,,,,r;';,, ... ` ._, ; ��`• �ITA? �:T,: %�,tW',' :bN; ;'•• : '. a
:� '''::', 7. Z 2
each branch circuit
Business name: WI All1111 B. Fee for branch circui s Iv; thew III 5 6,18 •
service or feeder fee, first 60. ' 2 2
Contact name: „ - e�'�rq _ - branch circuit +
Address: 0 / '� j izi s
� `('� 2 _ Each add bra nch circuit 7,42 2
V �, _,,• Miscellaneous service or feeder not included)
City /State /ZiP: Each manufactured or modular
67.84 2
dwellin', service and /or feeder
Phone: ( ) Pa: ( .1
<: Reconnect only 67.84 2
F -mail; Pump or irrigation circle 67,84 2
7 i � ai:Lf"� Ci ,, .., . ; • ,,., , ...cas' �'t: - ..., Sign or outline lighting 67.84 _2
L' -�• . . ••'” un:„ ∎ ; Signal circult(s) or limiled•encrgy !
Rosiness name: Heberle Electric, Inc. •noel alteration or extension, Pa_e2 IIIII 2
• Each additional ins .ection over allowable in arty the above
Address: 29012 SW Egger Rd Additional inspection (I hr min) NM 66.25/ hr MIN
City /State/ZIP: Hillsboro /OR/97123 Investigation (I hr min) Gf /hr Mill
• Phone: (503) (,2$ -2095 " industrial plant Cl hr min) 78.18/ hr
Fax; (503) 628 - 3076 Inspections far which no fee is
' CCB Lie., 15234 ✓ 2 El., !I Lie ' 3 s•ecificall listed hr min 90.00 / hr �.
r0 Suprv. Lie .; 3 053 -R r t;.:,,•i :
Suprv. Electrician signature, required:'�� Subtotal:_ .i:.
Plan review (25 %ot'permit Fee);
Print name; Jeffrey L. Heber Date: � _ ( , State surcharge ! 12 "rU of. crtnit feel:
' Authorized signature: TOTAL PERMIT FEE;
Thta par rail nppllrnuinn exp if, permit is not obtained within 180
Print. name:
Date: days offer It has b en emoted no complete. ✓ /
----- Number of inspections nllowod r permit. �j
1 : 113 Pihlinp lPerm■MELC:PnrmitA M/nl/
41046 i sT(I I /05 /C ER 7_,
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