Permit ,:, �1 .q CIT OF TIGARD
ELECTRICAL PERMIT
a COMMUNITY DEVELOPMENT Permit #: ELC2009 -00608
T 1 G Ax n 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 11/12/2009
Parcel: 2S112DD01601
Jurisdiction: Tigard
Site address: 15755 SW SEQUOIA PKWY 100
Subdivision: Lot: 0
Project: Bridgeport MRI
Project Description: Install (2) 200 amp or less and (1) 201 -400 amp services, and add /alter (12) branch circuits.
Owner: FEES
PACIFIC REALTY ASSOCIATES Quantity Description Date Amount
15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224 2 ea Services or Feeders - 200 11/12/2009 $201.40
amps or less
PHONE: 503 - 624 -6300 1 ea Services or Feeders - 201 to 11/12/2009 $133.56
400 amps
12 crt Branch Circuits w /Purchase 11/12/2009 $89.04
Contractor: Service or Feeder
OREGON ELECTRIC GROUP 1 ea 12% State Surcharge - 11/12/2009 $50.88
1709 SE 3RD AVE Electrical
PORTLAND, OR 97124
PHONE: 503 - 234 -9900
FAX: 503 - 535 -2763
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $474.88
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 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332,2344.
Issued By: __'_ • •_ _ A., .. .11.. 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' S j p p i Date:
LICENSE NO. � YY—
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.