Permit (114) a
CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2016-00008
13125 SW Hall Blvd. Date Issued: 01/11/2016,Tigard OR 97223 503.718.2439 Parcel: 1S136ADO6300
Jurisdiction: Tigard
Site address: 10955 SW 65TH AVE
Project: Verizon Wireless Subdivision: VILLA RIDGE Lot: 2
Project Description: (2)feeders and(3)branch circuits for new ground equipment and generator to a cell tower. Access from Coronado
St.to 64th Ave.
Contractor: KIDS ELECTRIC LLC Owner: PORTLAND GENERAL ELECTRIC COMPAN
PO BOX 1694 121 SW SALMON ST
PRINEVILLE, OR 97754 PORTLAND, OR 97204
PHONE: 360-921-0095 PHONE:
FAX
FEES
Quantity Description Date Amount
2 ea Services or Feeders-200 01/11/2016 $201.40
Specifics: amps or less
3 crt Branch Circuits w/Purchase 01/11/2016 $22.26
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 01/11/2016 $26.84
Electrical
Type of Const:
Occupancy Grp:
Total $250.50
Required Items and Reports(Conditions)
This pennit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire d work is not started within 180 days of issuanceor if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through CAR 952-001-0090. You may obtain opy-eF4hernlaipr direct questions to OUNC by calling 503.2322 11,9,887�or 1.8000x/3332 2
Issued By: Permittee Signature: '4y \ 4 y/ i , '
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale,lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Application
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❑ Nnv construction ❑Additiontalterationi "1t, f` KcauchecY-all nam Apply(submit j¢R ofpbec
Lmw'ic'na ekedl:
fir \���t' ❑Servw'e.a&MmAI%angs nr mrrz ❑Huildrng over rhrrc none,
❑ Dernolition ❑Other S rr luou driroalobie@ult cuncnf ❑Nan.,nicl I.W'Iaii.
_ CATfEGOR1r'OF CQN$ ON ramie 10.00a turps at 130 whr or ❑Phvong boildiny
❑ 1-and?-family du '�
elling 1'-'ComfnrrequUindu.trial ❑Acc-ssory building lin,to onnuml.nr escerds 1..000 ❑<Lrmrrcr.ul-uc aurkubu.al
\tuln-family Master builder Other: amtx for all other lmra!griam. bwldi:grx.
❑ ❑ ❑ _ ❑Frzc pvrx{, ❑IoAdkx'..(l 30 AYA or
308 SITE INFORMATION:AND.LOCATION ❑Em,!rymty swsrm Inrpu Urrmrly dmved
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Cr... sueeCdi2'crionx brjoh site FEE .SCHEDULE -
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_ Nor raxldenlist single-or multi-family dxreNlaR unit.
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0"'PROPERTS' OWNER 1 -__ TEN ANT Senicee or finders mslallolian,alleratinn,onllo r relncatain
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Temporan'serviees or reeders installation.alloratiou.and/or'
into an,
O r ner insrallation I his installation is being made on property that L own which is ilot 2w mn6s or Icy
nt'vded lir, Salt~!case.rcnl or exllongc,according to ORS 441 44u,6713,and'HI 'aI nota m 4W,our'u 2 5.03
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