Permit Support Document y n CITY OF TIGARD a ELECTRICAL PERMIT
• COMMUNITY DEVELOPMENT Permit#: ELC2014-00239
T[CARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 ��• Date Issued: 05/13/2014
Parcel: 25111 DB07500
Jurisdiction: Tigard
Site address: 15515 SW ALDERBROOK DR
Project: Jasson Graham Subdivision: SUMMERFIELD NO.7 Lot: 369
Project Description: Panel Change. 5/19/14,reprinted to correct address from 15515 Alderbrook Circle to Alderbrook Drive.
Contractor: PDX ELECTRIC LLC Owner: HUGHES, SHARON MARY
7933 WHITFURROWS CT 15515 SW ALDERBROOK CIR
DURHAM, OR 97224 TIGARD, OR 97224
PHONE: 503-997-1989 PHONE:
FAX: 503-200-1362
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 05/13/2014 $100.70
Specifics: amps or less
1 ea 12%State Surcharge- 05/13/2014 $12.08
Type of Use: SF Electrical
Class of Work: NEW
Type of Const:
Occupancy Grp:
Total $112.78
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 a nce approved plans. This permit will expire it work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATT ION: Oregon I- requires you to follow the rules adopted by the Oregon Utility_ N.t ffi Center. Those rules are set forth in OAR
952-001- 10 through OAR 952-00 %••O.lY•. may obtain a copy of the rules or direct questions to OUNNC by ca 232.1987 or 1.800.332.2344.
Issued By: _ _'L. 4.' /LL_.4. Permittee Signt e: ) i'.
,.
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: ,t)//�/./-
7
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.