Permit (9) CITY OF TIGARD •
ELECTRICAL PERMIT
1111- COMMUNITY DEVELOPMENT Permit#: ELC2013 00465
T[G AR.D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/06/2013
Parcel: 1S 135DD00800
Jurisdiction: Tigard
Site address: 11847 SW PACIFIC HWY
Project: SALVATION BOUTIQUE STORE Subdivision:\RBER TRACTS NO.16 TO NO.40 INCL Lot: PTS 19
Project Description: (2)branch circuits for additional lighting.
Contractor: CANBY ELECTRIC INC Owner: SANOKEE
790 S IVY ST 375 NW GILMAN BLVD, STE C-203
CANBY,OR 97013 ISSAQUAH,WA 98027
PHONE: 503-266-7878 PHONE:
FAX: 503-266-5543
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo/Purchase 08/06/2013 $63.60
Specifics: Service or Feeder
1 ea 12%State Surcharge- 08/06/2013 $7.63
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
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 : or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.,
C i
Issued By: - �i Permittee 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.
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.
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Electrlcal.Permit Ai�plicationREC Fi,KOFr•IICEUSEOi`LV
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City of Tigard AUG ,te,Fw 3 ""' _' 4�u%3-2e/3
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CITY OF TIGARD
TtI:AI:F) p NptifiedRterh d' Jy tiupt,temcnrallntormarion
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TYPE OT W PLAN REl'IE1V — ;.,
—
please check all than ap;Ir".I n I C,5 ! ,i nI item:,heuked below):
Q New constnlctiun addition%ahcruii,n/rcplat erncnt I ❑service 01 fewer 401 ,.np,,u II, , .ilm drm:r,•cr three Srones. . • '
•0"Demolition . L Oritcr. ; „here the•vadab!c;i.::,,,,:rrr.n: ',Win:,.inn boatyards.
CA T FI'ORY' Or cONS'TRUCTTON . 11 exceeds IoAnn:,rill,.;n ! I l,:•,r ,I L]aaatlnr;b:I,,dinE
, I less io ground,nr ctceed, 1.1.0G.: U CounterCl��•(INC agric.uliTal
1•:and2-family dwelling t�11111n1e1-i,t;t11riduSt1'Ia ❑ Accessory building ;,,, , for allorherlm;l:dln!�iu: h1ldingS .
_ — l 0 1 c pump, rl:n!;tallat'nn rd'75 KVA or
❑Multi-fflrnily D M tact huilt(ci 17 Other:
,,,--, I?mergeuey System hrl gr:i separately derived system.••
1013 srrr tohc.►x1vIArION AND LOCATION ! r
. . ❑nddiliptt anew mnlol load n.
y Six nr'nIOIC residential un:IS I..I LcrCaucv .
.; �1 tlnHl or more
Job no.; .Inh>itC acklive,;' ' 1 Li-7 1l_) pet t tcereational vehicle parks. , .
. -.r-- x a[� Q
- Hcalth-carc tac,lnlr Supply who for more than
City/State/LIP: , —_�.^ []H,zardous location. ah. nom nal.
^0 + •
Suite./bld'g:/apti,no Project name c r.cn tie c10,
�S•rw• r(cc ll Amp,:
,Cross.StreeVdirectionc to job vile' i _uesiriRryun.•_ �— l , ru. ' 1•,re..__l-! "To(el 7-
-W--- --i f New residential sing)e-nemulti-rsmilydwellingunit.'
' Inciudee attaehed garage.
Lon()Sq fl or less ' I hk i•I
I. Subdiv:ision: : . , Lot no _�_. i�
_,... — ..: .... —....: r_add'1 500 v.: 11.tit prowl S3 92 I I
•.•..Tax trift / areel no.: ned dneYat,resldenual .....-..-4____" _. .
P.P �, I lm 75.00 i 2•::*.• : DESC1a1f'il'IOTCr"iF V1-7)R 1 (bath ubevr RI n I __
.., — -- I i.united energy.motel-ti,nn!∎ ■ o .•
ffwA�d
e L 2. )iG rl:— n Page I
residential(with above•:;v I1
- '`'�� Rcncwabir EDCrk)' L Sec
Services or feeders insialtatinn,.+iteration or relocation
:r• •..,..` .PROEERlY OWNER TENANT: f less I00.iu ; 2
. ."_, 200 amps�._ �-. , 1 2z Sn
_Ol amps to 400 tunpa .
Natnc:; : ,. ---., j 401 amps to 600:Inv.. 4 .—�-7a. ,. 2••
Address: ---....._ ..-
b01 amps to 1.000_imps 3111 04
- Over 1,000 amps Oi volts i _552 26 j 2
_ — _4 pp - .-- 'etm installation.alteration and/or'
"City/State/ZIP: •
-_- T-- relocation
�'Icm ran'services t,r fred
( ) _._ L;O amps or Icss ;t);0 j [I.
Owner mstallation:'fhis installation is being made on property that I own which is not 17.) '— '° --
r P �l amps li,911tt amps. ......,.... I2i IA 2'
intended forsale. lease.rent.or e\change.according to ORS 447.449,670:and 701. -
j Owric�stgnaturc: Date: I--41)1'imps
circi its rnnC„_alter:rrinrt. 168 54 I 2
ur•rsrenswn,drrr panel
`p APPLICANT _? 0 CONTACT PERSON I rl Fri,fa'braoih Cl.,,c.t,rri,
. .,,..- _..._...•_.,-,l 1 above;erv„:c or;teeter tee. 7,, I 2
'.13uSineSS name: (/� _� each branch Circuit _--- ... _
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Contact name:: G;47t1 • � feeder I Ivt r r r 1 I it;I ti l Y�,t'$. 2 j
service o-I' !c i I
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Address. r S rti — ` li.0 ii add'I branch tiro:_ —_._.. _..) ?4:'• _ yz 2
Cit /StattlZlP; f •J °1-701.3 I Mkellsnenas Service or lecder•nor included) I ,]_.
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Phone:(5113)_Z.( _7 t I%ax: :(✓�3') (4- 55 f _...._
�..... .I., Reconnect only 67.tt4 2'
E-mail: ,, _(4:11_ ,.).1 r
[ hC LtY�� Pump or rcneau0n cct A: h7 fd j 2
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CONTRACT/0U SiE 67.ea
J_ �n or ot+tlin¢lighluu I 2
Signalcirwn(,lor!mulcticl,r:gv ,
Business name: l r I 2
Lid 1— E����� ) _....r.. panel,alteration,or cvicn•ngn I avr Z
F:aeh tIdditinnul inspection over auowablc in arrylof the above
Address: G' / 7� ` .... .. f
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Phone;(563) '/..6., , ~J7g , , I ;,I( 5 ) 55b_� „ i ";nlYhr
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Print name: i ),. ,,, / 1);ox.: _......._.. .''t
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Authorized sign:lrurc: , ...,.I i 12.3
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yrint name: Dail. hi 100, a,pli,ari•,❑r,p ,• ml,Is nut uuuinl11 within 180
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