Permit CITY OF TIGARD ELECTRICAL PERMIT
• COMMUNITY DEVELOPMENT Permit#: ELC2020-00295
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/10/2020
TIi7;1I:D 9
Parcel: 1 S 133AD 15000
Jurisdiction: Tigard
Site address: 12632 SW SORREL DOCK CT
Project: QUINTANA Subdivision: SUMMER LAKE Lot: 31
Project Description: Reconnect only.
Contractor: Owner: QUINTANA, STACEY
13867 SW HILLSHIRE DR
TIGARD, OR 97223
PHONE PHONE: 303-912-4309
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 06/10/2020 $67.84
Specifics:
1 ea 12%State Surcharge- 06/10/2020 $8.14
Electrical 1
Type of Use: SF
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $75.98
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 01-00 Yo may obtain a py of the rules direct questions to OUNC by calling 503232.1987 or 1.800.332.2344. JJJ
Issued By: �i; i�%2:L Permittee Signature: C ��/j'/'
OWNER INSTALLATION ONLY j
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.