Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00528
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/13/2012
Parcel: 2S110BD00500
Jurisdiction: Tigard
Site address: 11790 SW WILDWOOD ST
Project: Stevens Subdivision: SHADOW HILLS Lot: 3
Project Description: (1) 200 amps or less and (4) branch circuits
Contractor: MOLLENHAUER ENTERPRISES INC Owner: STEVENS, MARLIN K &
11070 SW ALLEN BLVD WERNER, CYNTHIA K
BEAVERTON, OR 97005 11790 SW WILDWOOD
TIGARD, OR 97224
PHONE: 503 - 649 -6991
PHONE: 503 - 624 -7946
FAX: 503 - 641 -1902
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 09/13/2012 $100.70
Specifics: amps or less
4 crt Branch Circuits w /Purchase 09/13/2012 $29.68
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 09/13/2012 $15.65
Electrical
Type of Const:
Occupancy Grp:
Total $146.03
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 ini 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 52- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 50 98 3.2232.1987 /f or 1.800.332.2344. , I
Issued By: '.i J k—a ♦ Permittee Signature: all i7PPGIC. 4 / Dom!
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.
09/12/2012 19:48 #1 4 32 P . 0 0 1 / 0 0 2
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Electrical Permit Apphc:i3 e I FOR OFFICE USE ONL'i
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City of Tigard - -
13L25 SW Ho owd., Tigard. OR 9 I .1 3 7.012.
:1 , . Phone: 503.639.4171 Fax 503.5
retig Da 4115117. «•1"
Puro Review
DatetBy: Other Permit: -.—i
Inspection Line: 503.639.4175 Date Ready/By. I ltr 1 Id Sec Page 2 for .
TIGARD ... c y i tiAlai.) Notficdfhlethod: I 11(i. 1 Supplemental Inforusation ■
Internet wvrw.tigard•or.gov cl o t . ..A., i , pt. ,.
- : - .: • '-.' ''''''. '':?'C',..: ' .':'.'' - - 'f.. ' 'r.. :''• ',' - f. - .• - :;•:::..••::::"', - • ::.' :::''• : . " ':::. ' . • 'ti44:1 j
Neese cheek all that apply (submit 2 sets of plard Weems checked helev.
0 New construction El Addition/alteratiorkeplaeement
0 Savice or feeder 400 ergo or more 0 Building ow three stones. ;
0 Dcrnpliti011 0 Other: wbcre be available fault current 0 Marinas and boatyards i
• -.:'. T .1-'•,".'.,7:.:•.',-.:::',:e17,M7.7:...:717.7.:'...4_.7.f.";7:'Z.:T'7,:''.6f;:':'-•:::.'.-.:.....:,".....e-..'• exceeds 10,000 aews .1 150 yaks or C3 Floating buiktuap i
less to gr000d, Of oaccods 14.000 0 Commercial- use agncylini el i
al 1- 811d 2-family dwelling 0 Commercial/indusarial 0 Accessory building amps for all other inseatIations. buildings. !
0 Multi-family 0 Master builder : 0 Other: 0 Fire pump. 0 IngalLseen of 75 KVA or
• • ' .,...' ,.. , i - k 7: 7 7,7Z . ';'-'• czNt5F Iffi, f' , :7. ,-,77 i .-:1 0 ElnefSeacY Aislcm. INV= sePaiatelY tlerwed ss.srein
• • - • .... .•:, ,:„ .,....., „or, '.:) 4 . -- , :.' g ' 7, .',' ' ' i • !..' .,.1 ,,: -`-: -: ....- 0 Addition of new motor load of
I0014P or more. 00;:upaacy
Job no.: 31041 liob site addresS: 11790 SW Wild wood St. osi., Of =ft tesictrnual units.
0 Recreatualat vthiCk !WA.% i
......- ......
City/StatGrZ1P: Tigard, OR 97224 . 0 Health-core 61cilities.
0 Hazardous toealions. 0 SUR* voltage for mare than
600 malts nomsnal I '
• 0 service ei feeder 600 amps or room
Suite/bldg./apt. no.: Projcct name: '
'i::::4
Cross street/directions to job site: • Docripties 411;:. .1 - e_ 1 Tuj 'w , •
New residential single- or multi-family dwelling unit.
' includes attached garage. . ,
•
1.000 sq. ft. or less 168.54 1 rt.
Subdivision: • 1,0t no.: ! :
— . Ea. add'I 500 sq. ft. or portion 33.92 I - 7 1 1 ,
r 1
Tax map/parcel no.: .
Limited enera, residential
75 00 2 ' •
■■■■,—......
Limited energy, multi-family
1! •
Service change & four circuits
residential (with above sq. ft.) 7500 i 2
Services or feeders instalhition, alteration, aotWor relocation
200 arripS or less 17 100.70] 100.
100.701r.
• ........... "_-
:
• •••• . '" -.. : ',' . "Jakaitatztati - . :;,..L:I . :7:',::: lifil';'':: • • -• ':' trOttokei';.' : -.... , ' ...-:::: 20) amps loam amps j I556 i 12
401 amps to 600 amps i-- 1 - 200341 -- h -I,
•Name: Marlin Stevens & Cindi Werner 1 I to I ,000 aMpS ; •--i----. i+ ;
I 301 04 •
1--------__
1
Address: 11790 SW Wildwood St. , i over t.000 amps or volts 552.26 li
-
I Temporary services or feeders i l1stinn, alteration. and/or 1 1 I
C it Y /SLaleiZIP: Tiga rd OR 97224 relocation
1_....
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202 1 1 I I i
Phone: ( 503) 624.7946 . tax( arnps or less . 59.36 ( )
- 201 amps to 400 amps 125.08 I 2 i
Owner installation: 'Ms installation is being made on property that I own which is not
401 599 amps -- il 68.5 1 2
- 1 ,
intended fur sale, lease, rent, or exchange, accunling to ORS 447 449, 670, and 701. arnps to _i. 1 .
Branch circuits - new, alteration, or extension. p er panel --1
Owner signature: ....... • Date: A Fee for branch GICOitS With
-
!
.:•?:','-:.:. - n 7; .1... ,, ,:;,, , ,:',:' ,. '',. , i7;t7A . ..i: . ;r:... - ,..„ . ;?:,:73! , - ..'17:r-;2 Tfikiiiitiett0410:7 above service ex feeder tee. 4 7.42 1 29.68 , 1 ,
B. Fee for branch circuits withow
Business name: ,
• service or feeder fee, first
• ! ,
Contact name: • branch circuit 56.18 I 2
• Each adet'l branch circuit 7.42 2
Address: • Miscellaneous (service or feeder not included)
• Each manufactured or modular
City/State/ZIP. .
dwelling. service envoi feeder 67.84 /1
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Phone: ( ) Fax: : ( ) Recormect only -- h ---- 4 —1-1
E- 7.
mail:
Pump or irrigation effele 67 84 57
•
Sign or outline lighting 67.84 1
2_
fr.,...: ''..-...::::::.*:.::; ;::•1: c :,::::::, ..-- ,.._ : .„...: ••• ... ,. ; . ...-"!:-. ; :"T Signal citcuit(a) of limited-enemy
i I '
wand. alteration, or extension. Pao 2 . 1_ 2 , - ± 1
Business name: Mollenhauer Enterprises,Inc. DBA Mike's Elec, Eaeb addibonal' inspection over allowable in an of the above
Address: 1107g SW All en Blvd. Additional inspection (i hr mm) 66.25/ hr
StaxerZIP .
: ____ _ blveStigatiOn (1 hr min) 66.25/hr
CkI: Beaverton . OR 97005 industrial plant it hr rrun) 78.18/ hr 7 -------1 ' '
—
,., ,• - 503 ) 641.1902 90.00 Ph°ne: ( 503) 649.6991 i rax: k Inveetions for which no fee is
.00/ hr I i l •
; s • - iticall listed Ch hr min) i
CCB Lie __ 191094 Icctrical Lic.: C643 - Suprv. Lic.: 42305
S ._„. c. Subtotal: 130.38
S uprv . t
u.extriciansi: -,. re, reg • .. : 1/1.7/4W.GGIF‹ .... ,
....1..,- an revi (2 ° of perm
't fee):
i
Print name: Dougla - J Mill I 1 04: 09.12.12 -:--- Stat ( I 2 of pamit fee)
Authorized . — 15 I . 65 1
r __...
TOTAL PERMIT FEE: 1
146.031
thorized signature: 04.4„....._____ This Permit applkstion eaPireiirs permit is not obtained wilin lao •
Print narnc: Darryl Mo1 enhauer Date: 09.12.12 days after it has been accepted as complete.
I i . Number of inspections snowed per permit.
. .
IABuildieelPenataF_LC-Persok.ADo OCA 07101/10 • — .