Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00478
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/14/2012
T I i; r1 li p g Parcel: 1 S134ACO2635
Jurisdiction: Tigard
Site address: 11065 SW COTTONWOOD LN
Project: Wood Subdivision: ENGLEWOOD NO.3 Lot: 192
Project Description: Service and one branch circuit
Contractor: MOLLENHAUER ENTERPRISES INC Owner: WOOD, WILLIAM G & MICHELLE M
11070 SW ALLEN BLVD 11065 SW COTTONWOOD LN
BEAVERTON, OR 97005 TIGARD, OR 97223
PHONE: 503 -649 -6991 PHONE:
FAX: 503 -641 -1902
FEES
Quantity Description Date Amount
•
1 ea Services or Feeders - 200 08/14/2012 $100.70
Specifics: amps or less
1 crt Branch Circuits w /Purchase 08/14/2012 $7.42
Type of Use: SF Service or Feeder
• Class of Work: ALT 1 ea 12% State Surcharge - 08/14/2012 $12.97
Electrical
Type of Const: VB ' -
Occupancy Grp: R -3
Total $121.09
,Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through OAR 952- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: /Irk Permittee Signature: OA/
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the Job site until completion of the project.
Approved plans are required on the Job site at the time of each inspection.
08/12/2012 #1370 P. 001 /002
8/12/2012 23:41
Electrical Permit Applicatio FOR OFP10E USE ONLY
City of Tigard . , 1 3 2012 Received •
II 13125 SW Hell Blvd„ Tigard c g 97223 Plan Rev �✓ JP-1'1-2._ I Perm' N° "� LC.10 i a. - 00 ?$
• k ... . • Phone: 503.639.4171 Fax: 503.598.190 /‘
Ti :D Inspection Line: 503.639.4175 CA TI ur �CJ� Date/By:
Pea nrt
•
8 See e 2
Internet www,tig,8rd�r.gpv ,, itt n [r\t�' y DIUISION I ��: loco: � Page for
Supplemental Information
»r. :... :rc' :- :� »w..... _ ..._.. •� • ' •y,�t - .... .. •. � .:. ..
. ❑ New construction ] Addition /alteration /replacement Plea a chock all that apply (submit z seu of
plans W /aems eheeked bele .)
❑ s or fader 400 amps or more C:1 Building over threw s+ °ries.
❑ Demolition ❑ Other:
..,. .. : '.,.,,. ,. r S - where the available fault current D
,,.;' . - :� ......� :. Its ' • :. 577., : :; J j(� , ;. -' - - • 1s• _ - 7.- " -�• boatyards.
•
•
» .
- -. . _ : , ...._._. :. __ {�?' , • : - !c "x ' - . �e< .:' 5 ��. . . ;� : °.._.._. eszeeedalo,OpOetnpcatlwvo
.,.. _.'v- - _ r•'.. .. , :....,._ :,.. +T'_. -;t OF1offiingbuildin�s, .
1 -a 2-farml dwelling less
mpsfor all ether uaet,er instal buildings. ® Y S ❑ COmmerciaUindustlial [ Accessory building amps for iasralu,°ns. il°tngs
❑ Multi - family El Master builder ❑ Other: i ❑ Fire pump. ❑ Installation of 75 KVA ur
I r - ` •' . 1. =....:;..;i2..:03.7....-. - _ Feeney new m. m
.. •, •r . : : :.- :.. :..;' : ., • •'. ; t,.,, . 18f�'vFCT1aIa[Cly
.'� ❑ Addition o new moor load of
�' - •e -• "I , ' 1 -.;"
Job no.: 30842 Job site address: , _...: :,- : -.. tooHP or meta
1 11065 SW Cottonwood Ln. occupancy
City /State/ZIP: Tigard, OR 97223 ID Health-care facilities. a onus. ❑s ew' �p for more t
0 u....dms locutions 600 volts nominal.
Suite/bldgJapt. no.: Project name: ❑ Se7vioe or feeder 600 amps or more.
•
Cross street/directions to job site: r a :::
Fee Total 7
- New residential single- or multi - family dwelling unit
' Indades attached garage.
Subdivision:
- {Lot no.: 1 •� sq. ft. or les 1 168.54 !
" Ea. add 500 ft. or portion -
Tax map/parcel no •: sq. po 33.92 f`
:`— 'r :n;- „ :'& "K ' ! : :: ,_ - .. - r y . . . ti ,.. _ _ - . Limited energy, residential ; • 1
, t': : < <-= 'TS :sue , 1.0" .' .. — :. ! s' 1 ` . _. ,..Fla ' :"v (with abov il.) 75 • 2
: ' Limited I
energy, multi - (amity
Service & micro hood residential (with above sq. R) 75.00 J 2
Services or feeders installation, alteration. and/or relocation I
- „_....- 200 amps of less
4 -- , g 2U1 amps to 4 0U amps 133.56 i _�
I N..e: Michelle Wood
401 amps to 600 amps 200.34
601 amps to 1,000 amps 301 _.,.+
I Address: 11065 SW Cottonwood Ln. g _ over 1,000 amps or volts I 552.26 i --
•
City /Stat�JRiP: Tigard, OR 97223 Temporary services or feeders installation, alteration. and/or
relocation 1 •
Phone: ( 503) 524.3278 f Fax: ( ) • 200 amps a less 59 3/I 'l i
_ Ii
Owner installation: This installation i s being made on pr that I own which is not zo1 LO amps 125.08
intended for sale, lease, rent, or exchange, accordingto ORS 447, 449, 670, and 701. aol amps to 599 amps 168 54
Branch circuits - new, alters n. panel 1
Owner signature: •• extension. r I
Date: A. Fee for branch circuits with I � t
•.vtv ;:'-`"17. •a, .Y�•,'. J'� _ _ _ {a.e `t�3� - ” - _ -- - ,
`: ; ' :`; . .. , ".':- __...,.. 4 ' above service or feeder fee each i I 7.42 7.42
blanch circuit
Business name: R. Fee for branch circuits without
•
service or feeder fee, first
Contact name: _ branch circuit 56.18 2
Address: Each add'l branch circuit 7.42 2
Miscellaneous (service or feeder not indaded)
•
[ /Stare/ZIP: Each manufactured or modular _i_......1
dwellm ;, service and/or feeder 67.84 12
Phone: ( ) E a x: ( ) Reconnect only 67.84 n 2 + .
E -mail: r vrigatio cue
` 2
'-;-..-.';-7 •z : _,'. ?s.. -� ..::y �.. :. - � ..; _ _ - - r t7uttirte lighting
6 7 8 4
r. .,: ._ ... Sip o 67 84
a.r� '. :-,;.,:'i": w _, ' . r.:.: ;'.._.:':.w'.:= c '` ` is Sigel cucuu (e) or 1==d-energy i
Business name: Mollenhauer Enterprisizs, Inc . DBA Mike's ' Elec _panel, alteration, or extension. Pa ge _ 2
Each additional inspection over allowable in any of the above
Address: 1 1070 : 1en : v. Aaaitiooat
Inspection (1 hr min) 6625/ hr
City /StatelLjP: Investigation (I hr min) 66.25/ hr ' 1
Beaverton. OR 97005 lttduser:al plant (I hr min) I 78 18/ hr !
Phone: ( 503) 649.6991 Fax: ( 503) 641.1902 Inspzetieuts for which no fee ix 90.00/ h
f
specscall listed (�4 hr min)
CCl3 Lie.: 191094 Electrical Lie - Suprv. Lie.: 4230S C643 S ;
.. = "•'- _ _:. •
- 31. : tom. .
Suprv. P,lectrician sig c, requi - : Subtotal: I
".„ ` _ P lan review (25% of
( permit fec): 7
Print name: Dougla - - ®, 't.•.. 08.13.12 State stlrch � fi
atge (12 /o of permit fee). 121.091
grt _�f 2 " d �1 ,., TOTAL PERMIT FEE:
Authorized signature; j
This permit application expire, a a permit is not obtained within 180
Print name: Darryl !tot enhauer Date: OS .13.12 • . days after it has n 'aep as complete,
Number inspections allowed per permit.
e
tAnuiteingweruutatc- PermitApp 07q1/10
440 -451 M I IM_Vetnt/wEB