Permit �. ,e_ r'k in+ -6r vu orb . (j2o /df Stn)
kr 1 9' 4 CITY OF TIGARD ELECTRICAL PERMIT
�a " PERMIT #: ELC2007 -00247
w COMMUNITY DEVELOPMENT
" R DATE ISSUED: 4/18/2007
T IGAD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
'•!"• g PARCEL: 2S111AC -00500
SITE ADDRESS: 14570 SW 91ST AVE ZONING: R - 4.5
SUBDIVISION: PINEBROOK TERRACE LOT : 046 JURISDICTION: TIG
PROJECT: KLEIN
Project Description: Job No 07 - 3648 kitchen remodel. 6/20/07 ADD (2) more branch circuits.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL /PANEL:
MANF HM/ SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 5 IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
JULIE KLEIN ALL PRO ELECTRIC INC
14570 SW 91ST PO BOX 280
TIGARD, OR 97223 6327 -C SW CAPITOL HWY
PORTLAND, OR 97239
Phone: 503 - 650 - 5036 Contact #: PRI 503 - 246 - 0361
FAX 503 - 246 -0406
FEES
Description Date Amount Reg #: ELE 26 - 1099C
[ELPRMT] ELC Permit 4 /18/2007 $66.80 LIC 148108
[TAX] 8% State Surcharge 4/18/2007 $5.34 SUP 4630S
[ ELPRMT] ELC Permit 6/20/2007 $13.30
(additional fees not listed here) REQUIRED ITEMS AND REPORTS
Total $86.50
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in
OAR 952 - 001 -0010 through OAR 952-001-0110. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By:40110i lit /7 / ,' ?V Permittee Signature: e 4/3 2 /t(a77'
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'N: 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.
Jun 2,Q 07 11:32a All Pro Electric, Inc. 503 - 246 -0406 p.1
E lectrical Permit Appli , Ok c E 1 1 (1 1I'I O l \ 4
. ",° � Permit N o.: ,' ,���:�� � City of Tigard �,{�,`�.,� � - rate, ev� ( 20 � S �. � 7-• 40.� `{
III � " . • 13125 SW Hall Blvd., Tigard, OR 972 Plan Review
07, 1 Phone: 503.639.4171 Fax: 503.598.] Date /Bv: Other Permit:
' 4. ' 41 ' '' Inspection Line: 503.639.4175 JO 20 2001 7 Date Ready/By: 1 El See Page 2 for
". �y�° ? '�x ,, Ai Internet www.tigard- or.gov ,,��11��� [[ � y,, 9a �„ f � g� 1UAR ' Notiiied/Method Supplemental Information
TYPB.A7F I�/1 A PLAN REVIEW
❑ New construction ® A t a l tI S ION Please check all that apply (submit 2 sets of plans w /items checked below).
� ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps al 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use aiiculturai
® 1 - and 2- family dwelling ❑ Commerciallindustrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
1 El Emergency system. larger separately derived system.
JOB SITE INFORMAT AND LOCATION _ ❑ Addition of new motor bad of ❑ "A', "E ", "I -2 ", "1 -3 ".
Job no.
Job site address: 14570 SW 91 Ave lOOHP or more. occupancy.
i ❑ Six or more residential units. ❑ Recreational vehicle parks.
CI /State/ZIP:Ti ard,O ❑Health -care facilities. ❑ Supply voltage for more than
❑Hazardous locations g 600 volts nominal.
Suite/bldg. /apt no.: I Project name: k'Lt ( i ❑ Service or feeder 600 amps or more. -
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. 1 Fee. 1 Total I •
New residential single- or multi- family dwelling oait
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 . 4
- Ea. add'1 500 sq. ft_ or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
75.00 2
DESCRIPTION OF WORK ( above sq. 0.)
- Limited energy, multi - family 7500 2
Bathroom remodel tp u& -,,, \56 ,- F ,! D e A. 1 L_, residential (with above sq. ft.) _ _
Services or feeders installation, alteration, and/or relocation
P t ` 4k 'T14�N 1' Y / OI"- / 200 amps or less 80.30 2
PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 10685 2
Name: Julie Klein 401 amps to 600 amps 160.60 1 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Temporary services or feeders Installation, alteration, and/or
City /State;ZlP:
Phone: ( ) I Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps (00.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch circuits — new, alteration, or ex Tension, r panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT I El CONTACT PERSON above service or feeder fee, 6.65 2
. each branch circuit
Business name: B. Fee for branch circuits 1
without service or feeder fee, 1 85 16 2
Contact name: first branch circuit _
Address: Each add'1 branch circuit a 6.65 .663 2
Miscellaneous (service or feeder not included) / 3.5d
City/State/ZIP: Each manufadured 9090
dwelling, service and/or feeder
Phone: ( ) I Fax: : ( ) Reconnect only 66.85 2
E-mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: All Pro Electric Signal p al r limited -
energy p alteration, or
Address: PMB 280, 6327C SW Capitol HWY extension. Describe: Page 2 2
City/State/ZIP: Portland, OR 97239 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (503) 246-0361 Fax: (503) 246 -0406 Investigation per hour (1 hr min) 6250
CCB Lic.: 148108 I Electrical Lic.: 26 -1099C Suprv. Lic.: 4630S Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required:,. C /-' Subtotal: -53750 i3.&)
Print name: Kevin E. Poole I Date: 6120/07 plan review (25% of permit fee):
_ State surcharge (8% of permit fee): _A-28
Authorized signature: v i TOTAL PERMIT FEE: 5 - 75-1[�.
This permit application expires if a permit is not obtained within 180
Print name: Sherri G. Poole I Date: 6/20 /07 days after it has been accepted as complete.
• Number of inspections allowed per permit.
1 BuildinalPcrmits 'ELC- PcrmitApp.doc 05/23 /06 440.461 ST( 11 /05 /COMI/WEB
"''VA) CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2007 -00247
I*' 0 '''" COMMUNITY DEVELOPMENT DATE ISSUED: 4/18/2007
i t441 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S1 11 AC -00500
SITE ADDRESS: 14570 SW 91ST AVE ZONING: R -4.5
SUBDIVISION: PINEBROOK TERRACE LOT : 046 JURISDICTION: TIG
PROJECT: KLEIN
Project Description: Job No 07 - 3648 kitchen remodel
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL /PANEL:
MANF HM/ SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 3 IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
JULIE KLEIN ALL PRO ELECTRIC INC
14570 SW 91ST PO BOX 280
TIGARD, OR 97223 6327 -C SW CAPITOL HWY
PORTLAND, OR 97239
Phone: 503 - 650 - 5036 Contact #: PRI 503 - 246 - 0361
FAX 503 - 246 -0406
FEES
Description Date Amount Reg #: ELE 26 -1099C
[ELPRMT] ELC Permit 4/18/2007 $66.80 LIC 148108
[TAX] 8% State Surcharge 4/18/2007 $5.34 SUP 46305
Total $72.14 REQUIRED ITEMS AND REPORTS
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow 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 copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By: 7711.7r Permittee Signature: /J1 iy ♦,
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'N: 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.
Apr 17_07 09:48a All Pro Electric, Inc. 503- 246 -0406 p.1
�a � i 'Sri.- � +� p )i:�p +i < [+rra ^ms AFt a N -' + >-
I M iI 5� , 11ui �J I 11 (' .: O"m v
trical Permit Application � x ; �, - a %,R "ot I r t l Ic. l S �+' K4 ,
r p �_.a,, +� h � .., r�l, ,i :t. r +�n a r� tea`
t r , . . City of Tigard ���Jr11 N.C f Receive R 1 7 � 007 ' 'cC� G'C5 cx 1../-7 Date. Permit No.: 7 —
ry ` 13125 SW Hall Blvd., Tigard, OR 972 Plan evrew
7t ! Phone: 503.639.4171 Fax: 503.598.1960 Da r _ o e, ; - a Other Permit
, 045 ,, : Inspection Line: 503.639.4175 D ate'" ' r �. ` 9y�+ p, Juris: Elf
See Page 2 for
A l i k, A Internet: www.tigard or.gov / N , i� t . O1V IS lO N Supplemental Information •
TYPE OF WORK PLAN REVIEW
❑ New construction ® Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w; items checked below):
❑ Service or feeder 4130 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
Tess to ground. or exceeds 14,000 ❑ Commercial -use agricultural
® 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family 0 Master builder ❑ Other: ❑ Fire pump. ❑ tnstallationof75 KVAor
❑ Emergency system. larger separately derived systerr
JOB SITE INFORMATION AND LOCATION ['Addition of new motor load of ❑ "A ", "E ", "1- 2 ", "I -3 ",
Job no.: 07 -3648 Job site address: 14570 SW 91" Ave. 1001-LP or MOM. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: Tigard, OR 97224 ['Health-can, facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 000 volts nominal.
Suitelbldg./apL no.: Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 Qtr. 1 Fee. 1 T°, 1 •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. S, or less ' 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 I
Tax map/parcel no.: Limited energy, residential
75.00 2
DESCRIPTION OF' WORK (with above sq . ,)
p
Limited energy. multi- family 75.00 2
Kitchen Remodel residential (with above sq. R.)
Services or feeders installation, alteration, and /or relocation
200 amps or Tess I 80.30 2
❑ PROPERTY OWNER 1 0 TENANT 201 amps to 400 amps 106.85 2
Name: Julie Klein 401 amps to 600 amps 160.60 2
60] amps to 1,000 amps I 240.60 2
Address: Ovct 1,000 amps or volts I 454.65 2
City/State/ZIP: Temporary services or feeders installation, alteration. and/or
_ relocation
Phone: (503)650 - 5036 I Fax: ( ) 200 amps or less I 66.85 1
Owner installation: This installation is being made on property that I own which is not 20] amps to 400 tamps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 40] amps to 599 amps 133.75 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT 1 L] CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
without service or feeder fee 1 46.85 46'85 2
Contact name: first branch circuit
Address: Each add'1 branch circuit _ 3 6.65 19.95 2
Miscellaneous (service or feeder not included)
City/ State /ZIP: Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR , Sign or outline lighting 53.40 2
Business name: All Pro Electric, Inc. . S ignal circuits) or t i o n d-
energy panel, alteration, , or
Address: PMB 280, 6327 - SW Capitol Hwy extension Describe: Page 2 2
City /State/ZJP: Portland, OR 97239 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (503) 246 - 0361 Fax: (503) 246 - 0406 Investigation per hour (1 hr min) 62.50
CCB Lic.: 148108 I Electrical Lic.: 26 -1099C I Suprv. Lic.: 4630S Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required:�___<____ ,, e _____--e e ___ Subtotal: 66.80
Print name: Kevin E. Poole I Date: 04/17/07 Plan review (25% of permit fee):
m
r1 State surcharge (8% ofpermit fee): 5.34
Authorized signature: % . „ .....„ . 6 t 4r T"7 _ TOTAL PERMIT FEE: 72.34
Date: 04/17/07 This permit application expires if a permit is not obtained within 180
Print name: Sherri G Poole
days after it has been accepted as complete.
• Number of inspections allowed per permit.
I: 1Building 'I'cro,tseELC- PermitApp.doc 05/ 440- 4615T(11 /05/COMIW2a
•
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2007..00247
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/1812007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 2/20/2008 TIME: 7 :OOAM PAGE: 66
SITE ADDRESS: 1.1570 SW 91ST AVE CLASS OF WORK:
SUBDIVISION: PINEI3ROOK TERRACE LOT #: 046 TYPE OF USE:
PROJECT NAME: KIJIN
DESCRIPTION: Jot, No 07.3648 kitchen remodel. 6120/07 ADC) (2) more branch circuits.
OWNER: JULIE KLEIN, PHONE #: 503 -650 -f3036
CONTRACTOR: ALI..PRO ELECTRIC INC PHONE #: 503. 246.0361
Inspection Request Scheduled For: Date: 2/70/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 065184 -01 503-246-0361 N
Corrections/Comments/Instructions:
.PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
- , ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G► (1\)(43 Date: 2.'2O ' " ) Phone #: (503) 718 - 2-4
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I
CITY OF TIGARD
BUILDING DIVISION ' . PERMIT #: ELC2007 -00247
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/1W2007
Phone: (503) 639 - 4171 .�-°',�, � ,
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 6121/2007 TIME: 7:03AM PAGE: 23
SITE ADDRESS: 14570 SW 91ST AVE CLASS OF WORK:
SUBDIVISION: PINEBROOK TERRACE LOT #: 046 TYPE OF USE:
PROJECT NAME: KLEIN
DESCRIPTION: Job No 07 -3648 kitchen rernodel. 6/20/07 ADD (2) more branch circuits.
OWNER: JULIE KLEIN, PHONE #: 503- 650 -5036
CONTRACTOR: ALL PRO ELECTRIC INC PHONE #: 503 - 246 - 0361
Inspection Request Scheduled For: Date: 6/21/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
120 Electrical rough -in 050671 -01 .503-6464635
Sa3 3Da -s 3
Corrections/Comments/Instructions:
1:1.1 ) - 3 v —(0 O 41L O.AA.,-,n___ fejt.
N. PASS I P TIAL APPROVAL ❑ CANCEL U NO ACCESS
n FAIL CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: _ � �F Date: 6 7 a P hone #: (503) 718- Yr-
CIT ■ OF TIGARD 1
BUILDING DIVISION PERMIT #: ELC2007- 00247
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/16/2007
Phone: (503) 639 -4171 ' ■ r r#
Inspection Requests (24 Hrs.): (503) 639 -4175 IdTI�
INSPECTION WORKSHEET FOR DATE: 4/20 /2007 TIME: 7:00AM PAGE: 66
SITE ADDRESS: 14570 SW 91ST AVE CLASS OF WORK:
SUBDIVISION: PINEBROOK TERRACE LOT #: . 046 TYPE OF USE:
PROJECT NAME: KLEIN
DESCRIPTION: Job No 07 -3648 kitchen rernodcl
OWNER: JULIE KLEIN, PHONE #: 503. 660.6036
CONTRACTOR: ALL PRO ELECTRIC INC PHONE #: 503-246.0361
Inspection Request Scheduled For: Date: 4/20/2007 Pour Time:
Code # Inspection Description Confirm - # —� Contact # Message
120 Electrical rough -in 046861-01 N 5003.516 -7635 N
\
Corrections /Comments /Instructions: N, _ `_
t\ LL (L.'�� e CA..e o \i lam` S_ i i
\(..t1 c-sr‘,0 sikoLL, ciaphet aq-lf
tl PASS ❑ PARTIAL APPROVAL fl CANCEL n NO ACCESS
n FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G • K • 1-G. Date: / 4U10 / 3 Phone #: (503) 718- Z11410
rl 4 , CITY OF TIGARD
•
�� x �►' . ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELC2007 00247
DATE ISSUED: 4/18/2007
TIG RD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 25111 AC -00500
SITE ADDRESS: 14570 SW 91ST AVE ZONING: R -4.5
SUBDIVISION: PINEBROOK TERRACE LOT : 046 JURISDICTION: TIG
PROJECT: KLEIN
Project Description: Job No 07 - 3648 kitchen remodel
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL /PANEL:
MANF HM/ SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 3 IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amplvolt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
JULIE KLEIN ALL PRO ELECTRIC INC
14570 SW 91ST PO BOX 280
TIGARD, OR 97223 6327 -C SW CAPITOL HWY
PORTLAND, OR 97239
Phone: 503 - 650 -5036 Contact #: PRI 503 - 246 -0361
FAX 503 - 246 -0406
FEES
Description Date Amount Reg #: ELE 26 -1099C
[ELPRMT] ELC Permit 4/18/2007 $66.80 LIC 148108
[TAX] 8% State Surcharge 4/18/2007 $5.34 SUP 4630S
Total $72.14 REQUIRED ITEMS AND REPORTS
• This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow 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 copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
A
Issued By: Permittee Signature: ` s ✓ � .
• 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'N: 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.