Permit CITY OF TIGARD ELECTRICAL PERMIT
Permit
a COMMUNITY DEVELOPMENT #: ELC2012 -00266
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/08/2012
Parcel: 2S 103AD02100
Jurisdiction: Tigard
Site address: 10950 SW PATHFINDER WAY
Project: Leach Subdivision: PATHFINDER Lot: 12
Project Description: Grounding
Contractor: MOLLENHAUER ENTERPRISES INC Owner: LEACH, TOM
11070 SW ALLEN BLVD 10950 SW PATHFINDER WAY
BEAVERTON, OR 97005 TIGARD, OR 97223
PHONE: 503 - 649 -6991 PHONE: 503 - 620 -6068
FAX: 503 - 641 -1902
FEES.
Quantity Description Date Amount
1 ea Services or Feeders - 200 05/08/2012 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 05/08/2012 $12.08
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112.78
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 0 952- 001 -0090. You may copy obtain a co of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: i � 'l � tiff Permittee Signature: om • / I'z-i
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 503.839.4175 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.
05/03/2012 23:52
/
. • #1129 P.001/002
Electrical Permit Application
city of Tigard Recel Oarery: 5/ 8' i a- l'crmit 1 ' 1 ° . &toll) -ooa4(0_,
11 13125 SW Hall Blvd., Tigard. Ole MED Plan Review
Other Pcninn
: - - Phone: 503.639.4171 Fax: 503 DateiBy:
las Line: 503.639A175 Mae Ready/By: • A 1 la See page 2 for
T 1 c A F. 'D
Internet wvavtigard-orgov MA‘f - 4 2012 Nolificdthfetha ' Acts I Supplemental InfOrmation 1
_I
-- ::;;;°: . : -., " 77 1fv , ?L'..7::: , ' . '''W'',' i: . :1;':4cilP14; i
0 New construction [ Addition/a - ; 1 !. tifffiliMON Please check all that apply (submit 2 sets of plans switerts checked below).
0 Service or feeder 400 amps or more 0 Building o or three sto
0 Demolition ries. I
0 Other: B UILD '
where the available fault current 0 Marines 4d boatyards I
... ,: ,,. :% , :7.:;;tyzsincrz..,:,'... ,!..,..." ,-it, tyv v. ......i .. ' ,. , ■ , . , 4 , 71'1 exceed:110.000 amps a/ 150 volts or 0 Flowing b ildinp. ;
A • A _ ..,, t'..9”.-Av• ...■ • 7 . e ,...... .1 . ;7..7....,c.v.:.....,:t,-4,......,,k;:-4...,..i.
:
less to ground, Of exceeds 14,000 1:1 commix' -‘4,e a :
El 1- and 2-family dwelling D Commercial/industrial 0 A C O e s s o r y building amps for all other insrallations. buildings.
LI Multi-family 0 Master builder 0 Other: 0 Fire POP- 0 histatlati of 75 KVA or
larger y derivcd sysiceLi
'''' ::., - ?"_7 1 ' - '. -'.;., ' , '".:' - 'i ., ' ' 5 ' ' '--!4 0 Addition of sew motor load of
1001-1P or more. manxmcy
Job no.: 30296 Job site address: 10950 $W Pathfinder Way [I Six or more residential units, 0 ReCreatioi whiCIC pas ks
0 Hesilthre &Irks 0
City/StatdZIP: Tigard, OR 97223 Supply vo ge for more than
orb.rocus locations. 600 volts mirad.
StritribldgJapt no.: Project name: EI Service Or feeder EDO amps or more. I
- `;-iZE1Fig.. 7 al' . Ti .. : .D''.i '.F . . .
,
Cross street/directions to job site:
owe ' lea • . Win. Taxi . EZ
.----.
New residential single- or multi-family dwelli unit
,
Includes attached garage.
1,000 sq. ft or less 16834 .____r
..
subdivision: • Lot no.:
Ea. addl 500 sq. ft. or portion 33.9:2 :
LI
Tax map/parcel no.:
Limited energy, residential
754) ii
re ..., .__. , . ,
1 LI
'.::t:Arr,r t . T****WrAtRi~ . .. ,i •r: , ;;!i , '::•a;; , ..t... --- = --'—' 71 - rtiiff'1` . 1:4 _Lwitb above sol. it)
Grounding residential (with above sq. ft.) 75.1i0 2 1
• Services or feeders installation, alteration, and/or relocation
• 200 or ten 100./0 U)o 70 i 2
' ' 1 e .11 fiiPT;74 4 2°1 tif°1:° t° 4® am 133 .* 2
_
401 arnps to 600 amps 200.4 T.
-_______,_
N ame: Torn Leach
---__________ 601 amps to 1,000 amps 301.14
Address: 10950 SW .Pathfinder Ws . Over 1,000 amps or volts 552 l 2
Temporary services or feeders instaiLvtion, alleration. andkr
City/Stale/ZIP: Tigard, OR 97223 relocation
I . ______
200 amps or less 59.36
Phone: (503 ) 620 .6068 Fax: ( )
201 amps to 400 amps 125.08 ' -- 1 1 7,. l
Owner installation: This is being made on property that I own which is not .
401 amps to 599 amps 168.
44 . 7
_
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. _
Branch circuits - new, alteration, or e tensio_a_p per ..ancl
Owner signature: Dille: A. Foe for branch circuits with
above SerelOC OT "coder fee,
...=2.'...:.-...?:,..';i:itatUlt.:*r,T......i...";:.'..-tr.:, ....:' 7.e2 7
B Fee for branch circuits without —
I3usiness name:
service or feeder tee, first
56.18
b
Contact name: ranch circuit
---. • . Each addl branch circuit 742
Address:
• Miscellaneous (service or feeder not included)
Each manufactured or modular 1
City/State/ZIP:
dwelling, scryiCe and/or feeder 67.14 77
Phone: ( ) Fax: : ( ) Reconnect Only 67./4 2
I
Pump or irrigation circle 67114 2
E
Sign or outline lighting 67.1,4 I 2
;Zzar Signal circuit(s) or liralted
t panel, alteration, or extension. Pc 2
Business name: Mol 1 enhauer Enterprises ,Inc. DBA Mike s Elec., Each additional inspection over allow hie in slay of abov
Additional inspection (1 hr min) 6625 hr
_ SW Allgn ' Investigation (I fir min) 66_25/ lv
. __._
CitY/State/ZIF: Beaverton OR 97005 : Industrial plata (I hr min) 78 IS/ hr
Inspections for which no foe is '
?hone: ( 503) 649.6991 vs/ _ Fax ( 503 ) 641.1902 speafically ( hr min) 90.00 hr
CCB Lic.: 191094 I, . - trical Lie C643 10 Syrt Lic.: 4230S ii.:r7;i2cafi.1.314014.4.11iCitittitelES...
Subtotal: 100.70
/Suprv. Electrician si y. ., - requ .:
.." A . . .
, TaL.-ef - 'Lan. Plan review (25% of permit fee):
Print narnc: Dougla- J Mi11-A( i
° " . - 05.04.12 State surcharge (12% of permit foe): . 12.084
TOTAL PERMIT FEE: 112.78 I
Authorized signature; /1 O A(ife.4‘...4_:., We permit appliesitteei expires if a permit is not liained within 180
days atter it bas been accepted as compete.
Print name: Darryl Mol enhauer Date: 05.04.12 . Number of helix-aims allowed per permit
•
1.‘131,44mg\PerminVELC•Permii4pp.4oc OVOMO
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