Permit (59) CITY OF TIGARD ELECTRICAL PERMIT
2 '- COMMUNITY DEVELOPMENT Permit#: ELC2016 00561
T[GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/13/2016
Parcel: 2S102AD03450
Jurisdiction: Tigard
Site address: 8777 SW BURNHAM ST
Project: City of Tigard Subdivision: None Lot: None
Project Description: (3)branch circuits for replacement of island fuel dispensers.
Contractor: SCOTTCO INC Owner: TIGARD, CITY OF
PO BOX 92 13125 SW HALL BLVD
BORING, OR 97009 TIGARD, OR 97223
PHONE: 503-729-9544
PHONE: 503-639-4171
FAX: 503-618-1752
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo/Purchase 07/13/2016 $71.02
Specifics: Service or Feeder
1 ea 12%State Surcharge- 07/13/2016 $8.52
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $79.54
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 ' ith 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. TTENTION Oregon aw -quir.s u to follow the rules adopted by the Oregon Utility Notification Center. Those rules are - =.h in OAR
95 001-0010 through OAR 952-,•',.1-0090.jY u may obtain a,/copy of th rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344./
Issued By: i / d_.`%(/l �1� Permittee Signature: / lis+��6L�Y.
OWNER INSTALLATION ONLY
The installationis eing 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: '7/�?/�0
LICENSE NO. 3I S<j s
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.
Electrical Permit Application , _ 1. (:_ =
Location:
Record Type:
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Inspection Date:
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Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
8777 SW BURNHAM ST, TIGARD, OR, 97223
Commercial - Electrical
199 Electrical final
PASS - No C of O
ELC2016-00561
Jeff Grove
Violation Summary:
Inspector Contractor