Permit Support Document CITY OF TIGARDA '1f. ELECTRICAL PERMIT
II • COMMUNITY DEVELOPMENT Permit#: ELC2017-00068
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/27/2017
I f A Ix_1-) 9 Parcel: 1 S135CB00600
Jurisdiction: Tigard
Site address: 11570 SW TIEDEMAN AVE
Project: LN Curtis Subdivision: None Lot: None
Project Description: Tenant Improvement.2/14/17 REPRINTED to correct address from 11530 to 11570 SW Tiedeman
Contractor: WILLAMETTE ELECTRIC INC Owner: MCCALL PROPERTIES LLC
PO BOX 230547 BY NED MCCALL
TIGARD, OR 97281 5480 NW FRONT AVE
PORTLAND, OR 97210
PHONE: 503-624-3631 PHONE:
FAX: 503-624-2938
FEES
Quantity Description Date Amount
15 crt Branch Circuits wo/Purchase 01/27/2017 $160.06
Specifics: Service or Feeder
1 ea 12%State Surcharge- 01/27/2017 $19.21
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $179.27
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 rre�quuirequires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-001 rough R 952�y(� You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued e:E`-frl-"t-4--kz„I" Permittee Signatu `
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.