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Permit CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit #: ELC2011 -00648 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/17/2011 Parcel: 2S 102CC00500 Jurisdiction: Tigard Site address: 13500 SW PACIFIC HWY 54 Project: Community Pet Clinic of Tigard Subdivision: FREWING'S ORCHARD TRACTS Lot: 15 Project Description: (3) branch circuits to extend surgery circuit and for fish tank. Contractor: MOLLENHAUER ENTERPRISES INC Owner: MERCER INVESTMENTS LLC 11070 SW ALLEN BLVD 629 NW SEAN CT BEAVERTON, OR 97005 BEND, OR 97701 PHONE: 503 - 649 -6991 PHONE: FAX: 503 -641 -1902 FEES Quantity Description Date Amount 3 crt Branch Circuits wo /Purchase 11/17/2011 $71.02 Specifics: Service or Feeder 1 ea 12% State Surcharge - 11/17/2011 $8.52 Type of Use: COM Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $79.54 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 952- 001 -00.0. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. • CIA 4 174 / :5 1 , /C/3 7O Issued By: ' � � � Permittee Signature: / 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. 11/16/2011 00:48 #0739 P.001 /002 Electrical Permit Application - FOR OFl� ICE USE ONLY .0 City of Tigard Oa' = // /7 // - NrpritNto.:E C / %OD G`/e 13125 SW Fall Blvd Tigard, OR 97 pl Review _ Phone: 503.639,4171 Fax: 503.598,1960 1 6 1. Other permit: Ins ion Line: 503. 639.4175 vanclsy: r fade Ready /By: }ir' Sec Page 2 for' TIQA1-LD In(enet: www.ti and -0r. ov N Q v R olifiad/Method; g g IV" I . � a( Supplemental information where the available .. 2,;e;= t":` t v ; r r K, ,e, 97. A7�M 7.1 t Y , *3% da Fti •�,^ 1 ,.. ( kY >,' rq.,..AL, -. W' f V.,.;;'=.7, . .._ , 1r OCY• ^ r G.Y. ..... ,. j � ..i w:�l.'.w... (,:. A. �:.,v, n.. .Y .L:. 'dam'. .., .hr �' . . . e:. _... .4 ". ": "'. .. .- _. . .. .. 0 • Pl ease au that apply (submit Z seta of plans w /itans checked below). Demolition Other. cnt ❑ Ser New construction Addition /alterat 1 A". ir acem vtoa or feeder 400 amps or more 0 Building over three srorieS. .- ;..: ',"'''''''''/9;';'f*'. .� 9- : . :, ; current ❑ Marinas and boatyards • fault a t• t q r "° " ° mpe at 150 wits or © Floating u ldin ' ' ` ,� 1µ,i , ,. ^�, .f, a n `• tcF "1 .a x M a' :,,.'± , .. exceeds 10,000 a less Y - . 14,000 ❑ Commercial-use agricultural © 1- and 2-family dwelling Commercial /industrial ❑ A ccessory buildtttg a for all other installations. bnildcnps. ❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. © installation of 75 KVA or ;> k . *.7 a""" t u c.;:F'• Em ysystem- larger separately enved sstcm. :. „'g u E7 1 n c 77 �• , a Y 31. r 6 F �' f , • .c atger�c denved b. a '+ •* = r ❑Addition o f new mo tor load of X 3 , 7 T> ,cc• ei:1 4 :a. . ❑" E ! -:. Job no.: 29463 Job site address: 13500 si4 Pacific Kw 104HP or mme. ❑ R oaie ane y . six Or MOM residential units, ❑ eoreattonal vehicle parks WS/ 0 Health- re facilities. 0 Supply voltage for more than City/State/7,IP: Tigard, OR 97223 ❑ Hazardous location. 600 wits nominal. Suite/bldg. /apt. no.: Project narpeia t p,) irf ? r C -,' ' 0 «T amps a more. till^ rv�:' at:' P.cwTi.4s'�:�n. i;:�flkt;. iti" 1A7'I.'-t,•,. Cross strcct/difections to job site: - Doe • •a i 1 i Total ( "- _..... New residential single or multi - family dwelling unit. Includes attached garage. SubdIvision: Lot no.: 1.000 sq. ft. or less L 168.54 4 Tax map/ parcel no.: Es. add'( 500 sq. R. or portion 33.92 1 map p tial +..�::_ . -.:. ..... w ;ck; s .,.. _�. - • . y .. P'n_ a 75.00 2 Limited energy, t en &Y . w ... , ...:..: ......7:o..w»� ,:SW...:- ��s...;::5,^� ""�"�, � % ',+nl' ..,ayor�. ;i'��" P"`�s:ai (with above 'Ll„:': a *,1•Zlua.P1 - '7 .4,1', :l:a;i -. --. d ��rt" s - , `: ** . ' -'•, , •'''''' °', 59. Limited energy, multi-family 75.00 2 Extend surgery circuit & fish teak residential (with above sq. ft.) _ Services or feeders installation, alteration, and/or relocation 200 amps or less 100.70 2 ._. . ,. " 4'' ' ' 's , 1,.,:.:,, : ^ ... ' . u . ._ r . . 't,.,` J �p f Mr: r.. s:.;a ; T. ..wort ml�il r4 {t,:' ' a'; to 400 am Ps � - r!! :3 . a1 k . r :-^, ..r:,.1-_,...-71. ?'7 201 am ps ps 133.56 7 :�.. � �' :,]SwSt:z�.Wla-+,•.4,°� � i ,¢Y , ,%, ... ' 9. . ry:,v C• «rra' 401 amps to 600 amps 200 34 -. 2 Name: Community Pet Clinic of Tigard 601 amps to 1,000 amps 301.04 _��._ 2 • Address: 13500 Sid Pacific Hwy #54 over 1,000 amps or volts 552.26 2 Temporary service or feeders installation, alteration, and /or City /State/ZIP: Tigard, OR 97223 relocation • Phone: ( 503) 670.9707 Fax: ( ) 200 amps or less 5936 - II 201 amps to 400 amps 1250g Owner installation; This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 intended for sale, lease. rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits - new, alteration, or extension er anel Owner signature: Date: • A. Fee for branch circuits turrh ;• -.i , 1- ,.. ,' .°:; ' :;: w. above service or feeder fee, E. °,:M.... te at :y each branch circuit 7.42 Business name: B. Fee for branch circuits tvrrhpur _ service or feeder fee, first 1 56. i 8 56.18 Contact name: branch circuit Each add'l branch circuit 7 7 14.84 2 Address: Miscellaneous (service or feeder not included) Each manufactured or modular • City /StateJZIP: dwelling, service and/or feeder 67.84 2 • Phone: ( ) Pte(:: ( ) Reconnect•only 67 84 ' 't Pump ar irrigation circle 67.84 2 E - mail: • outline lighting 67.84 .;; ' , , a a > g , .. ti,p t.,x -- ,, . Aa q • - • • ::r': Sign circuit s or limited -energy .. .. ,.,�,.,_,,:,,_, , ,� ». „,.,., . • J:'ea .., .ni'ct.rt ' , ' +� . • r; ",:;, a: '. :. signal O gY • ; panel, alteration, or extension. • Page 2 7 Bus name: Mollenhauer Enterprises ,Inc . DBA Mike's Elec l:,ach additional inspection over allowable in any of the above Address: Additional inspection ( hr min) 66.251 hr - 11 071 W Allen Blvd . _ _ . Investigation (1 hr min) 66.25/ hr • City /State/ZIP; Beaverton OR 97005 - Industrial plant (1 hr min) 78 18/ hr ( 503 ) 649.. .6991 Fax: ( 503) 641.190`L ins for which no fee Ls 90 00/ hr / �::a SpeC listed `h hr min) I CC13 Lic.: 191094 E lectrical Lic.: C643 ✓ Suprv. Lic.: 4230S ;^'.`': :: „•_) ' 4 . • ._._.'` • . S Suprv. Electrician sign. e, requir-d: Subtotal: 7 . ,,`�... 4,..4.E. �� Dou • l / Plan review (25% of permit fee): Print name: g 'a 1 .1 6 . 11 State s urcitare (12% of permit fee): 8.52 a- _ ,� TOTAL PERMIT FEE: 79.54 Authorized signature: r i VA/ __ This permit application expires if a permit is not obtained within ISO • days after it has been accepted as complete, Print name: Darryl Nol enhauer Date: 11 .1.6.11 • Number of inspections allowed per permit. i:\ ituilding \Pmmits\EZ.GPa'miiAppdoe 07/11 /10 440.4615T( I1/6s/COMIWE6