Permit CITY OF TIGARD ELECTRICAL PERMIT
a
COMMUNITY DEVELOPMENT Permit #: ELC2009 -00650
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 12/09/2009
Parcel: 1S133DA04800
Jurisdiction: Tigard
Site address: 12630 SW GLACIER LILY CIR
Subdivision: Lot: 0
Project: Koepke
Project Description: Add /alter (1) branch circuit.
Owner: FEES
KOEPKE, BRUCE Quantity Description Date Amount
12630 SW GLACIER LILY CIR
TIGARD, OR 97223 1 crt Branch Circuits 12/09/2009 $56.18
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 12/09/2009 $6.74
Electrical
Contractor:
POSITIVE ENERGY ELECTRICAL
CONTRACTORS LLC
PO BOX 871543
PHONE: 360 - 885 -4479
FAX:
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $62.92
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 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: i. L _.. 1 ,
Perm ittee Signature:
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 an inspection that business day.
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.
No. 1845 P. 2
Dec. 9. 2009 11:56AM
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