Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT / �2/ �� Permit#: ELC2015-00748
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/16/2015
Parcel: 2S104BB05000
Jurisdiction: Tigard
Site address: 13983 SW CHEHALEM CT
Project: MPD Subdivision: CASTLE HILL Lot: 17
Project Description: LIGHTING. 1/14/16 REPRINTED to add(2)additional branch circuits.
Contractor: MIKE'S ELECTRIC Owner: DELIMA, STEPHANIE ANN ALVES
11070 SW ALLEN BLVD DELIMA, JORGE ALVES
BEAVERTON, OR 97005 13983 SW CHEHALEM CT
TIGARD, OR 97223
PHONE: 503-649-6991 PHONE:
FAX: 503-641-1902
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo/Purchase 09/16/2015 $71.02
Specifics: Service or Feeder
1 ea 12%State Surcharge- 09/16/2015 $8.52
Type of Use: SF Electrical
Class of Work: ALT 2 crt Branch Circuits w/Purchase 01/14/2016 $14.84
Service or Feeder
Type of Const: 0 ea 12%State Surcharge- 01/14/2016 $1.78
Occupancy Grp: Electrical
45 Mise Administration Fee 01/14/2016 $45.00
Total $141.16
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specially Codes and all other applicable law. All work will
be done i ccordance wi approved plans. This permit will expire if work is not started within 190 days of issuance, or if work is suspended for more the 180
days. ENTION: Oregon r uires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-0 1-0010 through OAR 952- -009 yc9 may obtain a copy of the rules or direct questions to OU NC b 2 1987 or 1.800.332.2344.x1
Iss ed By: d / Permittee Sin i ". //
9 19
OWNER INSTALLATION ONLY 0
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:
r
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.
01/13/2016 1227P FAX 00002/0002
Electrical Permit Application
City of Tigardn[eei ed
13125 SW Hall Blvd.,'i"ignrd,OR 972.23 nntd / lrf !(per Pa,mt a 6—OCr7
a t Plane: 503,719.2439 Fax'. 503.598.1960 plan aevicw ItOlnmd Ibnnil a l
l t I I
Inspcuhm Linc: 503.6394175 Neatly 0avi0Y^ )utrs. la See I'Me2 for
Internet: mvsvllgard-ofgov Nalilied/hletl�od: supplemental hlfurmmion
YPE OF WORK — — I'I.AN REVIEW —�
❑Ncw onstruetIon ET Additiouhahm'nlion/Itpl(Iceruenl Pleas[chock All tlml opplypubinir Is,"ofplh,-svlitoa,s checked):
❑service orlm
rude,400 amp,or o+e ❑Building overia
three slor .
El Demolition 0117CYf when dienvailabl[@ull cu,rcm ❑hndnRs alta wontyards.
_ CATEGORY OF CONSTRt1CTION _ es ccde 10.000 anlln At 130 vdl,m ❑slluuinp buildings.
k and 2•Ruuily dwelling mnar
Cmciul/in(FWII01 ❑Ass
cceory t+uilding lose a inound.m exceeds KOO QColomu,,o lse ugrlc0hurnl
amps thrallogmr hundbiws. buildings.
❑Mulli•fnmily ❑Master builder ❑Other: ❑file pomp. ❑Imslallatwo of 150 KVA or
JOB SITE INFORMATION AND LOCATION L7 Sne,lT.1c3•sysmnl. Tape,xeparmoly dc.ivnd
❑A,ldl Wn of lbry nmm.lIOndof nYllblu
Job It: Job sllc atlrh'css; 10011P m'mbrt IV.'T "1-2","I--�'
City/Sklte/ZI P' JI ❑si.oruam rcsidelumi unit, occuppnc,
ti—l��„L ❑Honllx-cmc rucililiol. ❑Rttluatinnnl v[hiol0l�'In.
Suite/NdgJapt.IRI Plo,lccl nolle: ❑nnlmtlou.lomoon., ❑sulpdy lwb,fm able dun
CIMS street/dlre01101Le lujob site: — QService oifeeder 600 a_np,or woo. No ,oh%nnmiuid,
FEF. SCHEDULE
`— tu,SMlOn r RnehT[ml
--
New rerdden 1101 yingle-or 111u111-fantlly dwe11111g linin.
Subdivision: __-----J 1.pI U( Includes atlachedgarxae.
Tax snap/parcel}{: -2-0—or R.or less 168.54 4
Fa.add'I50019.IL0rpnmon 33.92 1
DF:.SCRII"PION OI+ WORI(_ _ Linl)MA energy,rcsideu[ial^"
al
with above all.ft) 75.00 2
+ { Limited energy,muaif0mily
l••!�1'l(`(� a !�� �t�ss I'axidentiN with nhnvu ss.fl. 73.00 _ 2
'N I, Renewable^Ener• 40 Pn'e2
❑ 1'ROP6R'rl' ON'NFN O l'EN'AN'"I' --._
—— - Services a'feeders installation,alteralian anNor relocation
Name: 200 ampsor less 100.70 Z
Address: 201 awl's to 400 Rmpa _ 133_56 ?
—�--^ 401 amps to 600 amps 20034 2
City/Stele/ZIP: 601 amps to 1,000 amps 301,04 2
Phone:( ) fax:j( ) over 1,000 amps on vu11s 552.26 2
'•— `— "—�-- Ierrglonlry services or feeders 11151011adon,eller•ntlon,xnrl/Or
i'.Illllil: relocation _
Owner installation:This installation isbeing made on property tlta[I own which is mol 200.mpa or ltrs ------7T 59.36 I
intended for sale,Icase,tont,of exchange,according to 0125 447,949.670,and 701. 201 amps t0 400 angle IZ5.08 2
owner slgnallIN:_ __ Disc! 401 ions to 599 amps 168.54
❑ APPLICANT !� C'ONTA(? PERSON Rrenchcircuils-new,alterati0o,or extension err Panel
A,sec Por branch circblls,vllh
Business name: above ncrvtoe or seeder kc' 742 2
elicit branch circuit
Contact same: D.Fcc for brand)circuits airhnor
service or feeder fee,Inst
Address: 56,1a
_ Innnch cundt _ _
CRY/Slnlc/ZIP'. �— --- lath add9 branch circuit -- --742 2
Miscellaneous service or ferde'not included
Phone'( ) Fax; :( ) Lnch mvmtbclurerl or modular
dwellin set vice m¢gor feeder 62'84 2
r111a11;
Itecoumn only 67.84 2
CONTRACTOR Pump or irrigation circle
Business name:Mollenhauer enterprises DBA Mike's Blectric _ _ Sian or online l iduing07.811
Addru4n: 5iamd circuil(a)m
_en lily
Ll See Paget 7
11070 S W Allen blvd land,aitemlion,or extension.
coy/SWtc%L1Pr Beaverton,OR 97005 Each additional Inspection over n11ow0ble in ally of the above
_ Additional lnspeaiah(I hr min) 66.25/hr
PnOno:( 503)649.6991. Fox:( 503)641.1902 Inmulifilion Is hr w0N - _ —- 90.00/In .
entail: lnikeselectriC@inikeselectric.biz Industrial Plant(I hrmin) 78.181 lu
fmil letions Por which nn fee is 90.IHV hl
('.CB Lic.:191094 rlech'ical Lia: CC243 Suprv. t,ia: 42305 J alicnlly 1i=icrw In nln] - 1 _ —-
ELEQ3'RIC.AL PERMIT FEES
Sups v.Elect wean signature,re :quire / /Z( i Z[ Subtotal:
Print nuc:LjOU as N1111CY 7 nate
m : 1. ( ' _ ❑Plan Review Requited(259/0 Of Dermic ice): _—
/y/�--- 7 YS� Slmc s_Ilrchurgr:(12%Of permit l"c):
Authorized signature: ..�f,/ "e.1ti,_ C7 t.� "Ic7TAL PERMIT FGG: ,
'tui[perodl npplkRlion a[p11'G If a perm4 h X01 ab1.6,e11,4thbr IRO
Print name: DRrrVI Mollenhauer Date: ��^ der[a",111 hn.Fn[nntn,Meg,n to„tleey.• _ all
• NuniLmnl'imWwinus nitc,u. per pemduT 5
LW,nl,lmad'n•mn[leu J'em,xnp,�ELR.eaP.duc R[Ver✓1LIOU 044+OHTIIIW4/eUhNVCb