Permit Support Document 1 ELECTRICAL PERMIT
•31/ CITY OF TIGARD
COMMUNITY DEVELOPMENT PAM
Permit#: ELC2015-00356
Date Issued: 05/13/2015
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 25101 DA00101
Jurisdiction: TIGARD
Site address: 13190 SW 68TH PKWY 130
Project: Infocus 64642 Subdivision: VARNS ACRES Lot: 9
Project Description: (1)signal circuit req'd by Jeff Macomb. 5/14/2015 REPRINT permit to correct suite from 200 to 130. 6/11/2015:
REPRINT permit to correct description from"single"to"signal"per inspector's request.
Contractor: CHRISTENSON ELECTRIC INC Owner: PACIFIC NW PROPERTIES LIMITED PA
111 SW COLUMBIA ST, STE 480 STERN FAMILY LIMITED PARTNERSHIP
PORTLAND, OR 97201 STERN, HELEN R REVOCABLE TRUST
6600 SW 105TH AVE#175
BEAVERTON, OR 97008
PHONE: 503-419-3300 PHONE:
FAX: 503-419-3695
FEES
Quantity Description Date Amount
1 ea Signal circuit or Limited 05/13/2015 $75.00
Specifics: Energy Panel
1 ea 12%State Surcharge- 05/13/2015 $9.00
Type of Use: COM Electrical
Class of Work: ADD
Type of Const:
Occupancy Grp:
Total $84.00
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 95 -001-01:• '• ma obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: .41.4■rir/11 4A— Permittee Signature: (2/L // G.le "T 70/v
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.
CITY OF TIGARD v T�,
� ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2015-00356
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/13/2015
Parcel: 25101 DA00101
Jurisdiction: TIGARD
Site address: 13190 SW 68TH PKWY 130
Project: Infocus 64642 Subdivision: VARNS ACRES Lot: 9
Project Description: (1)single circuit req'd by Jeff Macomb. 5/14/2015 REPRINT permit to correct suite from 200 to 130.
Contractor: CHRISTENSON ELECTRIC INC Owner: PACIFIC NW PROPERTIES LIMITED PA
111 SW COLUMBIA ST, STE 480 STERN FAMILY LIMITED PARTNERSHIP
PORTLAND, OR 97201 STERN, HELEN R REVOCABLE TRUST
6600 SW 105TH AVE#175
BEAVERTON, OR 97008
PHONE: 503-419-3300 PHONE.
FAX: 503-419-3695
FEES
Quantity Description Date Amount
1 ea Signal circuit or Limited 05/13/2015 $75.00
Specifics: Energy Panel
1 ea 12%State Surcharge- 05/13/2015 $9.00
Type of Use: COM Electrical
Class of Work: ADD
Type of Const:
Occupancy Grp:
Total $84.00
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 0.'- 9 V90. ou may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: p 71C__ Permittee Signature: L I/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' 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.
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
13190 SW 68TH PKWY 130, TIGARD, OR, 97223
Commercial - Electrical
199 Electrical final
PASS - No C of O
ELC2015-00356
Jeff Grove
Violation Summary:
Inspector Contractor