Permit CITY OF TIGARD ELECTRICAL PERMIT
• COMMUNITY DEVELOPMENT Permit #: ELC2012 -00360
T l GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/11/2012
Parcel: 1 S135DD04400
Jurisdiction: Tigard
Site address: 11900 SW GREENBURG RD
Project: Southwest Family Physicians Subdivision: LOMITA TERRACE Lot: 9
Project Description: (2) branch circuits for TI
Contractor: DEKORTE ELECTRIC INC. Owner: BC ASSOCIATES LLC
5331 SW MACADAM AVE #258 -113 1128 SW ENGLEWOOD DR
PORTLAND, OR 97239 LAKE OSWEGO, OR 97034
PHONE: 503 - 288 -2211 PHONE:
FAX: 503 - 292 -8237
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 06/11/2012 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 06/11/2012 $7.63
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
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 OA 952- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. �(
Issued By: Permittee Signature: t � 4P 0. LI t / UrV .
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.
06/07/2012 13:04 FAX I�j001 /002 C
. J
/ 0411
RECEIVED . -
-
Electrical Permit lay : •
�.pla ca#i�et JUN 7 l •�. .:y_�i • i�;l �.��:,_ �,��:,
City of Ti rd 2012
13 12s SW Holl Blvd, r Bard, oft + n b l 1 I Z . pa:m s r l,�'/ -o0 3 46 Phone: 103.7 i 8 2479 fay 503.3 9 VFV A1�1 P Pisa
iisseBY. Oahe! s>eamC: •
T,,, r: : r) ci g "3 ' 639 ' 4175 - BU1LdJ1 JG DIVI /aim (� g � tie"
..,'r.. ; '-+r tin. = .. .. .: t,;,-,---..• _ r
constructs cd.
Q
On tion la ite t�odtepl8retlterlt - _ .. , � .. pieea'e cheek au that *say ( -• .. Zama ofyt Vitale abeclxd below):
10Demohtion [ mps ❑ Btulditta ovrer tams stories.
: w.bere the avaitadle roan O mai= end boatyards.
y 7 „ 11 -, - r, , ; ; - , } : 10,000 =pa pa a 1 so lls dr b F1Oatu tualdiept
, ss . _. -:..-_ _
-: :.tee.: r. : ` _,. -:. -at !on totgaaIDd ateaedt 144:10 0 commerolat -use agicutttaol • ■ I • and 2- family dive •• iii.w.mmereial/industrial ❑ Accessory building , isles au otha of new • aattaltati t+aiidiaga,
I] Multi- o �
Q 1+ to b1n1dQ . - . . :X. ,1r Foe pares I 0 tam se of 75 KVA or
n .111.11653:.-7.-z.-:.....",..,,. "1S ? lcp ssystem 1 % derived gsat:fR
y `r ;Million rtteter lead o� i'
Jub no.: 2: • Job site address: I VO 5 - 1 ❑ - A'. e . ° t : 't. .
10 01artaote eeeupaaer.
AZ s • I - C • biz moo jai mate. 1 ❑ Reaemioeal vela& plats.
City tat - / Q I w. faeltifia O s • Suite/bl / no.: t epPNOh ° °°'D'n' �
apt Pro ect gone: ■ or>l t.QOO r
Cross ab eetldirec j ,ns to job ate i • -t.- - 7 ' '" - _
N- raadeutbdfsblale -or . -• fatm*y tkrekIns fit.
i, -i , :. OitasDetlgw, a
Subdhision • Lot..11o.: . . 1 419ff4 Q t1 a• • 16B.14. 4
Tax map/parcel no.: OA 5OO.siw$ or portion 33.91 1
w__�_�rit Ott:_• t "'"° Q .y� — R .. 73110 IIE
(auith eboro 6¢ ��
L r mummy 75,00
t ^ , all �w a dlor.selocation
NEE w „ ,. .-;,-,, .., '" �E , n r ( :., t to ' 133.56
IC � � �� 100 70 MIND ..44 •-•`�',...rrrr_�...^.-;.. , &. ..m t ° . 40t to 400 aQ1�6 i 0
Name: 404 atetps to 600 amps l 200.34
Address: 60t to 1,000 4112 30144
-:.O .m vser ',ohs $5236
• CihlState Z1P: t ';. a bt ea. gltet86ofl d/or
Phone: ( ) .Pgjx ( ) erbus • 39 ,26 1
Owner installation: made This installation is being on property that I own t ichis.ngt a at 400 maps 12i.tis 2
intended for sale, lease. lent or exclumge, ace0: hg,'tp ORS 447, 449, 670' and 701. to f99 ads , MC54 2
Owner signature: _Date: • -ter, or eztemelt ,Her wend
3 - •'•- --:'�` ..<� a. c :+ ,. A above far alloo er with
^ ' ` ' W. - ._ � ..∎ _ ,- T , , Above e eevits oa f eoda fez: 7.42
_ . �.•. ..., 'bunch circuit 7 . 4 2
Business name: B. $m ... bo altcetra waked►
Canract name: R �° Eta 56.1s 2
I Adds Css: wi iidtti bursar 1 7.42 2 •
• fsitm ante der not. balloted}
City/State/ZIP: Va t roataf eea
ede madtttat
357.14 12
' � eandlarttaader
Phone: ( ) . 'oa1y 014- _ 2
do ioa a5rele 67 t34 2
' v kint x,. ,,,a6, ; .. 67.84 2
BUsinessname: . •
�,..� oral/0210a.
Address: II • y . Pac allowable to any oldie above
533! V - - y - ub � • rs= 66.2
City/Statc/ZIP: - (�iatl:m3 ,
Phone — . .. : tP (E1$.fm) t • 1H4 ■
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( T e a ) vas -ZZ 11 Pale (s'�3) 1 - 4 -z a k 1 ' .. for which no ha is � t. F
1 listed Aratm soao<
Elecaical Lie.: 5c l .'1 S 5 3 — , _;
red: r
- 3 �-' � �. <�'. Li t:.. 07 �'�
Supr.. Electrician signature, required: f w /e% 1 —' tiubtoW: � ,. , .2
` �/ • Plan review (2 oaf pamrt fell):
i Print name: late- , 7 /7. • surcharge (12 ofpennit fas}l. - 7 (e,?
Authorized signature: . ' TOTAPAR FMS: - 1( •
• Print name: 1 `f ' as °" " � e + ISo
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