Permit Support Document .• CITY OF TIGARD ELECTRICAL PERMIT
erk
2. COMMUNITY DEVELOPMENT � �''.� ` Permit#: ELC2017-00940
/Pett,r Date Issued: 12/20/2017
[GAR[GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.243 ' �i S� Parcel: 1 S135DA02400
‘0\ Jurisdiction: Tigard
Site address: 11045 SW HALL BLVD
Project: Commercial Home Subdivision: METZGER ACRE TRACTS Lot: 7
Project Description: Install 100 Amp Temporary Service. 10/25/18:REPRINTED to correct address from 11035 to 11045.
Contractor: WELL DONE ELECTRIC Owner: BROOKSIDE RCF LLC
17045 SE ROYER RD 5987 SE ROBHIL DR
DAMASCUS, OR 97089 MILWAUKIE, OR 97222
PHONE: 503-209-4006 PHONE:
FAX: 503-558-1297
FEES
Quantity Description Date Amount
Specifics: 1 ea Temp Services or Feeders- 12/20/2017 $59.36
200 amps or less
1 ea 12%State Surcharge- 12/20/2017 $7.12
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $66.48
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 the rules or direct questions to OUNC by calling 503.232.1987 or 11.800.33(2.2344.
3.
Issued By: Permittee Signature: OC1Yt `C- i—C\CM
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.