Permit Support Document CITY OF TIGARD °, ;� i ELECTRICAL PERMIT
III21- ' COMMUNITY DEVELOPMENT S�i�� _ ' :'' ELECTRICAL
ELC2019 00328
iqf Date Issued: 05/15/2019
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 S
•i Parcel: 1S136DC03200
Jurisdiction: Tigard
Site address: 11780 SW 72ND AVE
Project: 72nd Ave Apts Subdivision: Lot: 8
Project Description: Re-connect/re-feed service drop for existing residence.5/16/19: REPRINT to correct address from 11720 to 11780.
Contractor: WHISKEY HILL ELECTRIC INC Owner: 72ND AVENUE PROPERTY LLC
PO BOX 206 BY CASSINELLI, RICHARD
HUBBARD, OR 97032 11720 SW 72ND AVE
TIGARD, OR 97223
PHONE: 503-981-4640 PHONE:
FAX: 503-981-4643
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 05/15/2019 $100.70
Specifics: amps or less
1 ea 12%State Surcharge- 05/15/2019 $12.08
Type of Use: COM Electrical
Class of Work: ALT 45 Misc Administration Fee 05/16/2019 $45.00
Type of Const:
Occupancy Grp:
Total $157.78
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 9 2-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.198703or 1.800.332.2344.
Issued By: j•„._/•-.....- Permittee Signature: -"" MSN ', O %' 1'g
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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