Report Feb 22 2021 01:55PM HP Fax page 1
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`-zir",• Request to Energize an Electrical Installation RECEIVED
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Name of supervising electrician: Douglas R McCauley
' Date of request: '2 ira 2 Supervising electrician's license number:57815 Date installation was completed: i 1
Electrical permit no.: te., zk.- *a temporary permit is ported at the job site,please include a copy of it with this form.
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Name of electrical contractor:Moaenheuer Enterprises,'Inc, DBA Mike's ; c 1
e � Electric
Business address:
11070 SW Allen Blvd.
License no.:C643
City: Beaverton State: OR ZIP: 97005
Phone; 503-849-8991 Fax: 503.641-1902 E-mail; mikeselectricemikesekectric,biz
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Customer's name: "' (3YY1 Q.S i �
ittekon
Customer's address: q t) 1 E54- h- i '4--
City: V( State:j ZIP: r'►. „, 4,46 Address of installation if different than customer's address: 1 14(As i. ,�,,.,Oh ,,,
City:
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Authority having jurisdiction to inspect: .11 . �. Aa Phone: -
Address:
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Name of electric utility receiving request; t Phone:
Address: `
City: State: ZIP:
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• A. Restoring electrical service that was interrupted or disconnected because of either a:
❑Service change or [ incontrollable event,such as fire,flood,or severe weather;
or
B. Electrical service at 4 remote location needs to be:
0 Initialized ❑Restored
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Supervising electrician Electrical contractor
Note:After sending this form to the electric utility Note:By close of business on the first business day following
named above,you must send a copy of this form to: energizing of a completed installation in response to the above
(1) ' e electrical contractor,(2)the customer,and request,you must (1)notify the authority having jurisdiction
(3)t '•7..-.., ., • ..:k that the installation has been energized, and(2)request that the
'2_1 ri."2,11, authority inspect the completed installation.
Supervi. g eke a aignature Date Electric utility
Note:Please consider notifying the inspecting authority
identified in this request when an installation is energized
before inspection,
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440-094$-COM(10/08/COM
CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Per ELC2021-00086
1, ,, 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 2/22/2021
Parcel: 2S103AC01100
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Jurisdiction: Tigard
Site address: 11465 SW FONNER ST
Project: ADI Subdivision: None
Lot: None
Project Description: WEATHERHEAD REPAIR DUE TO STORM DAMAGE
Contractor. MIKE'S ELECTRIC Owrwr. PHELAN, THOMAS C
11070 SW ALLEN BLVD 904 ESTHER ST
BEAVERTON,OR 97005 VANCOUVER,WA 98660
PHONE: 503-649-6991 PHONE:
FAX: 503-641-1902
FEES
Quantity Description Date Amount
SDeCifictE 1 ea Services or Feeders-200 02/22J2021 $100.70
amps or less
1 ea 12°h State Surcharge- 02/22/2021 $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. Specially 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 503.232.1087 or 1.800.332.2344.
Issued By: Permitle.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.
tail 503.639.4175 by 7:00 a.m.for the next available Inspection date.
This permit card shall be kept Ina 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.