Permit n CITY OF TIGARD ELECTRICAL PERMIT
..• COMMUNITY DEVELOPMENT Permit #: ELC201300415
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/23/2013
Parcel: 2S102CB00302
Jurisdiction: Tigard
Site address: 13185 SW PACIFIC HWY B1
Project: Tamale House Subdivision: NORTH TIGARDVILLE ADDITION Lot: 33
Project Description: (2) branch circuits for dishwasher and paddle fan
Contractor: MIKE'S ELECTRIC Owner: CJ GLOBAL LLC
11070 SW ALLEN BLVD PO BOX 5668
BEAVERTON, OR 97005 ALOHA, OR 97006
PHONE: 503 - 649 -6991 PHONE:
FAX: 503 - 641 -1902
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 07/23/2013 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 07/23/2013 $7.63
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
Required Items and Reports (Conditions)
This permit ' ect to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be don n accordance with . • •roved plans. This permit will expire if work is not started within 181 •. • ' ua ce, or if work is suspended for more the 180
days. ATTENTION: Oregon la >• ires you to follow the rules adopted by the Oreg• Utility - '?'ftty� Center. Those rules are set forth in OAR
952 -0 1 -0010 thro gh OAR 952-%1 0090.AM ay obtain a copy of the rules or direct questions to •UNC by calling 503.23. 987 or 1.800 .32.2344. .- •
Issue y: / / , Permittee Si Lure: i . 01-44P. f 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. 0 7 S
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.
#1 9 8 0 P . 0 0 1/ 0 0 2
07/22/2013 11:07
Electrical Permit A licati FOR OFFIE C 1.1SE ONLY
City of Tigard C
EIVED Received
Datc/Bv: ? 02-5 / ., Permit No.. F 4 1r2/5-7)0 % 5
13125 SW Hall Blvd.. Tigard. OR 97223
mun Review
' 2 . Phone: 503.718.2439 FAX: 503.598.1P'
-nf 2 2 2013 15a11/13y: . • Other Permit
TIC :
Inspection Lino: 503.639,4J75 Dam Ready/By: i r/ p age 2 i• c „: ------
ARD
Internet: www.tigard-or • ; gov Notified/Method: Supplemental Information
! 111 : ) 1
2:iitly.',:,'"'«:::',•?<,:2,-:;;;*;i:WN;:';',:404'i;-:;W.Ws.i*.k.';':."''...-arAtfit.'e,-C,O.,440,,.Migi:'1/.: *tfht440i,g;07%.5.i,,i'Ag,
Er New Wnstruction Addition/altcration/replacement • Please check all that apply (submit 2 sets of plans *films checked below):
ition . 1:1Serriec or f e e d e r 400 amps or more 0 Building over three stories.
0 Demol 0 Other:
6 ; where the available fault current 0 Marinas and boatyards.
i4i n;.: 6
5it0;4460/ :,,: ..:,,.,,.; ..,..ds 10,000 amps at 150 volts or 1:1Floatins buildings.
a less mp t s o fo gro ., u n t, he or r e ins xe l e a j ed: tio l4 n . 5 000 C) b C ui el in une s rcial - USC agricultural
D1- and 2-family clvInei 0 Accessory building
; •
I 0 Multi-family 0 Ma_ster builder D Other: c Fire pump. 0 Intrailation of 150 KVA or
"'"--„..„...,. ,‘,._.,.... „,..,..,, ......,,,, ,,.....„....,,,,.......,,,,,,, ......,;. ,. 0 Emerzeney system
larger scp4mtely derived system.
;•:;,..;,,,,i..1.,•„.•'''W.L;;e4:',4Ar4 VM4 % :: 1:1 Addition of new motor toad of 0 A - 1
ociaipaney.
Job no.: 48, r Job site address: 75
i •-••• t 4 21 5 ‘1 PaCA tijkigArt In I S W ix l or iP Z ni e ° res lc identivi units. Cl Recreational vehicle parks.
Ciry/Stittc/ZIP: Il 0 , 9./....,!_1213 6 0 i lealth-carc facilities. 0 SueDlY voltage for more than
- 0 ilazardow locations. 600 volta nommal.
0 Service or feeder 600 amps or more.
Suite/bldg./apt. no.: 61, P r o ject naMe 111e= - taptykk l e .411,,CP
c '
; ,:., :..1' ....., ::: :' ,:...,: tifEitt.li:Fj7 , :'%:: .. ::`;',(1.*'.:'
Cross .streetAlirections to job site:
Lascrixiod _ I ii?="
....
• ...
7 New residential single- or muiritatuily dwelling unit.
S. _ Includes attached garage.
Subdivision:
Lot no.: 1,000 sq. f t. or icss
_ 168.54 4 •
. Ea. addl 500 sq ft. or portion 33,92 1
Tax map/parcel no.: .
,.. Limited energy, residential .
75.00 2
,:;a.;".'rl...::,::::::.;:4:.=1::•:/,',•;•'.:::.:'.:::::'i'004*kl0iiY*:**'''' ' ' ' ;:' .. . ':.:: : . ; ':. :';•::';': ' i; ; :.: '. 's ' '''; ' VQ' (with ab°vc S q• 11)
— Limited energy, multl-family 75.00
. . , . # , • .
residential (wqh above sci. It.)
a „
— i.Reilewable EllergY . ' '' .:' '::••• • See p 2 :.. - .!
Services or feeders installation, alteration, au&or relocation .._
1
'::'• ; ; . • ;; T. : ;• :, ;: :: •:•• 0 4'.0 1 7.03 ; VW:E ; ,. *R..:.:• :. •...• '7 :' , ,...''''' , : :: ": . - i .... :'•';'•ii';D::;Tifi*.f..::•• 1 ':: 1 •:: : :. 204 aniPs °r icss 100.70 2
. ,
amps to 400 amps 133.56 2
Name: ' 4 ila. i I. ...■ - • 4 . a 0 ' 401 amps to 600 amps IIM 200.34 2
Address:
601 amps to 1.000 amps 301.04 2
'- Over 1,000 amps or volts 1_ 552.26 2
City/Stem/ZIP:
Temporary Services or feeders installation, alteration, and/or
Phone: (603 (003 ‘ If , k 1 Fax: ( ) relocation
200 amps or less 59.36 III
Owner installation: This installation is being made on property that I own which not 201 amps to 400 amps 125.08 El
intended for sale. lease. rent, or exchange, according to ORS 447, 449. 670, and 701. •
401 amps to 599 amps . 168.54 IMIllin
Owner signature: --- Date: _,. Branch circuits - new alteration or extension cr •anel
.--
a,„0,07,..(..,...........-.17::.c.,9*Ac.r.,E,E koi ...,•,',.: A. a F bo ee v r c or sc b rv rIc e h o c r i f rc ec u d it e s r w fee ith •
Business name:
' each branch circuit
- B. Fee for branch circui 7.42 2
ts without
Contact name:
service or feeder fee first -
. i 56.18 i o 3
ill .
. branch circuit 5 k
Address:
Each add'I branch circuit 7.42 IFIMEI
..
Miscellaneous (service or feeder not included
City/State/ZIP:
Each manufacnired or modular 1111
dwelling, service and/or feeder 67.84 2
Phone: ( ) Fax: : ( )
Reconnect only .84
- 67 2
-
F...-rriail:
Pump or irrigation circle 67.84 2
::::;.:,;t:,'•':;;,:•,,.,n).?.:i.:',',...,,:::i ,''':.•,:•:',:::..;,::•.',..;,;',C,41:001Pief,(14.,V:21* ''',:,':;: :..::!..•; Sip or outline lighting 67.84 2
Business sigct(s) or limedcncrgy nal ircuiit-
usiness name: Mollenauer Enterprises, Inc. DRA Mike's Electric p :: , i
t_pilier __ation __, or cxtenSion. 2
Address: 11070 SW Allen Blvd. Each additional inspection over allowable in any of the above
_
Additional inspection (1 hr min) I , 66.25/ hr 1 1
City/State/ZIP: Beaverton, OR 97005
Investigation (1 hr min) 1 66.25/ hr
—
hone; (503) 649.6991
! CCB Lie.: 191094
.
F____
, ( Fax: (503)64L1902
'
I Electral Lic.: C643 • I Suprv. Lic.: 5781S
•,---------' ' Industrial plant (1 lit min) 1
inspections for which no fee is I
scifically listed (A' hr min) J 9°78:°°18// hhrr
- -.: •• - : '. • :ELErnefekir,titIvitt.:176.3
Suprv. Electrician s; _nature, required: . N
7---liblotaj: (45 e 00
..---__....■
name: Doul • an review (25% of permit fee): '7
. , (05
17:rint oas McCauley Mc1.2auley ..ii . 4111
Date:
c I
.
. State surcharge (12% of permit fee):
Authorized signature: A elly 1 I TOTAL PERMIT FEE: i ,) 3
This permit application expires if a permit M not obtained within 180
1
Print name: Darryl Mollenhauer ' ' Date:
days after it has been accepted as complete- fi)1
_.
. Number of iOxpectiOnS allowed Per PerThil.
lAnuileia$Ttz nuts 7 - 3 -C_PermitAtV_ELRER.E.eoc Rev 05/21/201J e4(1-40 I yr( I I USICONVWEB
07/22/2013 11:07 #1980 P.002/002
is City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
= Payment Authorization Form
13125 SW Hall Blvd. • Tigard, Oregon 97223
T I GARD Building Division: 503.718.2439 • Planning /Engineering: 503.718.242]
Fax: 503.598.1960 • Internet: www.tieard- or.gov
Permit No.:
Job Site Address: V3185 3 VOC_A C R4 n
Project Name: ` "^ J
Credit Card Information: Pleas
lease print clearly.
El VISA fl MasterCard 4798 5100 4424 5724
0 Discover (credit card accou n umber
Expiration date: 05/2016 �' Q
Cardholder name on card: Darryl Mollenhaucr
Contact phone number: 503.649.6991
Billing address for this card: 5865 SW Spruce Ave.
Billing ZIP code: 97005
Trust Account Information: For permit fees to be paid from established trust account
'Trust account number_ 191094
Contractor /Business name: Mollenhaucr Enterprises, Inc_ DBA Mike's Electric
Contact phone number: 503.649.6991
I hereby give the City of Tigard permission to pa for the above referenced
permit with the credit card trust account pr. fit. ed above.
Authorized Si �
Signature: . _
Name Printed: Darryl Mollenhauer
Date: j�
Please FAX this completed and signed form to 503.598.1960.
*** DO NOT EMAIL THIS FORM. ***
For your protection, this form will be destroyed after your payment has been processed,
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