Permit Support Document (16) CITY OF TIGARD i ' ELECTRICAL PERMIT
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COMMUNITY DEVELOPMENT ���� Permit#: ELC2017-00566
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/31/2017
Parcel: 2S102BC00900
Jurisdiction: Tigard
Site address: 12825 SW GRANT AVE
Project: 1 Subdivision: NORTH TIGARDVILLE ADDITION Lot: 29
Project Description: PANEL CHANGE. 9/28/2017: REPRINT permit to add(2)branch circuits.
Contractor: MIKE'S ELECTRIC Owner: SCHULZE, LLOYD&EVELYN FAMILY T
11070 SW ALLEN BLVD BY LLOYD H EVELYN M SCHULZE TRS
BEAVERTON, OR 97005 8780 SW INDIAN HILL LN
BEAVERTON, OR 97008
PHONE: 503-649-6991 PHONE:
FAX: 503-641-1902
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 07/31/2017 $100.70
Specifics: amps or less
1 ea 12%State Surcharge- 07/31/2017 $12.08
Type of Use: SF Electrical
Class of Work: ALT 2 crt Branch Circuits w/Purchase 09/28/2017 $14.84
Service or Feeder
Type of Const: 0 ea 12%State Surcharge- 09/28/2017 $1.78
Occupancy Grp: Electrical
45 Misc Administration Fee 09/28/2017 $45.00
Total $174.40
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: Ore.•n 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 O :5 0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
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Issued By: 111,19-4 '. V . Permittee Signature: DA/' (97-7/° e 4-774/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.
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Electrical Permit Atiolication FOR
OFFICE USE ONLY
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City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
12825 SW GRANT AVE, TIGARD, OR, 97223 October 30, 2017 at
1 :42:52 PM
Record Type: Record ID:
Residential - Electrical ELC2017-00566
Inspection Type: Inspector:
199 Electrical final David Young
Result:
FA I L
Comments:
No access for inspection.
No answer at door, 1 :40 pm.
Left message at number provided with inspection request.
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
12825 SW GRANT AVE, TIGARD, OR, 97223
Record Type: Record ID:
Residential - Electrical ELC2017-00566
Inspection Type: Inspector:
199 Electrical final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor