Permit CITY OF TIGARD ELECTRICAL PERMIT
2: COMMUNITY DEVELOPMENT Permit #: ELC2012 00515
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/04/2012
Parcel: 2S104DC04300
Jurisdiction: Tigard
Site address: 13578 SW CLEARVIEW PL
Project: Hekker Subdivision: BENCHVIEW ESTATES Lot: 43
Project Description: Reconnect only
Contractor: OWNER Owner: HEKKER, JOSEPH
16004 SW TUALATIN SHERWOOD RD #118
SHERWOOD, OR 97140
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 09/04/2012 $67.84
Specifics:
1 ea 12% State Surcharge - 09/04/2012 $8.14
Electrical
Type of Use: SF
Class of Work: OTR
Type of Const:
Occupancy Grp:
Total $75.98
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 9 2-001-0090. You may o btain a copy of the rules or direct questions to OUNC by calling 503.232,1987 or 1,800.332.2344.
Issued By: Ili hi( b4.I Permittee Signature: n/U /7I�Ir UP T7
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.
SEP -04 -2012 10:58 KELLER WILLIAMS 5035975010 P.002
Electrical Permit Applicati l I FOR OFFICE USE ONLY
City of Tigard I V! _ LI Review
n 41 ( Le( (�ix. Pcrnlit „(a'- 00V.5- • n 13125 SW Hull Blvd„ Tigard, OR 97 243� Plan Rev
N
°, • Phone; 503,718,2439 Fax: 503.598.1 ETC P 0 4 2012 mite/6: Other Pcnmt:
TIGARD Inspection Line; 503.639.4175 DatoRoady /8y: runs'. RI SeePage2for
Intcmct: www.ogard- or.gov Notif�ed/Mochud; (p Supplemental Information
C��Y>D�T#�
pFil'rl�llll!'' :I 116 II'iIl,Ft :2..)f,i;l;i,,l ::;a:• t ��� � !� I ,., , .. „ •,' I,•; • I :l i .::I.IfiI 1 I, 1 Illllllsl lill;t�i l':l, 1
". � �,• . � I: l , . ..� :EI;O �,� 9�1'' iii 11 i �1i3[ ! , ; � PlLAN' RE�tiTf,Vtr" ,:; I i
r P lease check all that a I submit 2 sets of lans w /items checked below
❑ New construction ❑ Addition /a tcratlan)rep(acement � y ( • P >:
❑ Service or feeder 400 amps or more ❑ Building over Throe stories.
❑ Demolition ® Other: Reconnection whore the availablo fault current ❑ Marinas and ecotyerds,
. ''. ∎:i;'! „ICATEGORY OF. ,CONSTRUGPIO.N.: ' .. • oxcoods 10,000 amps at 150 volts or ❑ Floating buildings.
Accesso buildin am so a exceeds
calla ons. ❑Commercial -use agricultural
® 1- and 2 family dwelling ❑ Commercial/industrial
❑ 1 'y 8 amps for sll other irtatallationt. buildings,
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump, ❑ Installation of 75 KVA or
- ' i I{ {' t I O Emergency system. larger separately derived ystem.
. 'I I li; hI :II II <i 1211N1,IIIfI,I 9P1:s r : :1NiFORMAT10$ hW(D I L OCATION ,
I ❑ Addition of now rtaotor load of ❑ - n ",'•f ", - 1.2" "I.1 ^,
Job no.: Job site address: 13578 SW Clearview PI, 100h1P or more. occupancy.
a Six or more r sidential units. O Recreational vehicle parks,
City/Statc/ZIP: Tigard OR 97223 ❑ Health -care facilities. O Supply voltage for more than
❑ Hn dous locations. 600 volts nominal.
Suite/bldg. /apt, no.: Project name: ❑ Service or feeder 600 amps or mom.
.! , ' . �� , ''. 11. 1 1 .1E il.JCHrl .W`-C, •..I.na I• ..;I „•'.6ii l i`r i'I ;I
Cross street/directions to job site: Benchview — n«r prron I Qcv. I I'ok I Total 1 •
Bull Mtn Rd to Benehview t0 Clearvicw - New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1.000 Ica. tt. or less 168,54 4
Ea. add') 500 sq. ft. Or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
. I . • „ ', ' ',,DE,SCRIPTIONI OF, WORK ' (with above sq. ft.) 75.00 2
Limited energy, multi• family 7500 2
need inspection and permit in order for PGE to turn on power residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
200 amps or less 100,70 2
,.;' 1 l' ] i -;. : ®!ig..ROP 5IO NER: ii:., ,... !. i : ; i;,,. !: ❑ TENAPIT' . 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: Joseph 1lokker 601 amps w 1,000 amps 301.04 2
Address: 15019 SW Gingko CL Over 1.000 amps or volts 552.26 2
Ciry /State/ZIP: Sherwood OR 97140 Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125,08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 1 G8,Sa 2
intended for sale, leave, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits — new, alteration, or extension, Per panel
Owner signature: Date: A. fee for branch circuits with
''';• : , • . , :.181 iAP.,PLtiCAS T” ; 6 : :i;'•, J; "'' r , ' above service or feeder fee,
, �,: CO1V Af: ['' P$RSON each bran h it cui 7.42 2
c ct
Business name: Keller Williams REalty A. Foe fbr branch circuits without
service or foedcr fco, first 56.18 2
Contact name: Stacy Owens branch circuit
Each add'l branch circuit 7.42 2
Address: 17700 SW Upper Boones Ferry Rd. Suite 100 Miscellaneous (service or feeder not included)
City/Statc /ZIP: Portland OR 97224 Ea manufacttartxl or mod 67 84 — 2
dwell ig, service and/or feeder
Phonc: (503) 267 - 3099 Fatx :: (503) 924 - 3573 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
_ E - mail: stacy t@atacysellsyourhome.eom
'-; i', i:l:: 1. l' �h'• 1; 4+; h:' il. 1, :',;,_ . i :.,, '�.!�Lli,li Y.,' , :ii'.�I ? :;I'y., , Signoroutlinelighting 67,84 2
:t; II•I .;.COI�t'IIRACI'OR•..,, '`.I '.I ' 'I;•:,.;,':ti,;.,,_, Si circa rlimi
snag it(s ) o todtmergY
Business name: panel, alteration. or extension. Pago 2 2
Each additional inspection over allmvable in any of the above
Address: Additional inspection (1 hr min) 66.25/ hr
City /State/LIP: Investigation (I hr min) 66,25/ hr
Industrial plant (1 hr min) 78.18 / hr
Phone: ( ) I Fax: ( ) Inspections for which no tee is 90.00 / hr
specifically listed.''/s hr min)
CCB Lie.: Electrical Lic.: Suprv. Lie.: , ' " EL;ECTRICA1:.• PERINli1T''.FEES "I ''''•' I
Suprv. Electrician signature, required: _ Subtotal:
Plan review (25 %of permit fee):
Print name: Date State surcharge (12% of permit fee);
TOTAL PERMIT FEE: - �5.q8' t�
Authorized signatur ! �/��._ ,_„
�' .. L 4 " ( ' This permit application expires it permit is not obtained within 180
Print name; / , Date; -J _ ` days after It bas been accepted ns complete.
.! % Number of inspections allowed pet permit,
1:1 Building .Wcrmlle\Et.C- PermitAppdoc OZVI /lo 440.46IST(II /OS /COmiwbl3
•
SEP -04 -2012 10:58 KELLER WILLIAMS 5035975010 P.001
a
S tacy Owens, Principal Broker : h ,
KELLER �
WILLIAMS. 503 - 267 -3099
R E A L T Y Fax: 503- 924 -3573 r,
Portland Premiere E -mail: Stacy @StacySellsYourHome.com
S T A C Y
Sc Ili Your tlome
Fax Transmittal Form
To: City Of Tigard From: Stacy Owens
Attn: Permit
Fax number: 503-598-1960 / 1
Dat q '
Time:�pm PST /0 '"'
Number of Pages w /Cover 3
Attached is the application for an inspection for the home at 13578 SW Clearview
Place in Tigard. There will be a contractor box on the property, the code is 4297.1
have also included the credit card payment form. Thank you.
Stacy Owens
503 -267 -3099
Confidentiality Notice
This facsimile transmittal (and/or document) may contain confidential information belonging to the sender. The information is
intended only for use of the individual named above. If you are not the intended recipient, you are hereby notified that disclosure,
copying, distributing, or the taking of any action in reliance on the contents of this information is strictly prohibited.