Permit CITY OF TIGARD ELECTRICAL PERMIT
' • COMMUNITY DEVELOPMENT ELECTRICAL
ELC2022-00161
Date Issued: 3/10/2022
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 2S103CB01900
Jurisdiction: Tigard
Site address: 12240 SW JAMES ST
Project: Davidson Subdivision: None Lot: None
Project Description: Replace bad wiring and subpanel. Install a couple of lights and ceiling fan.
Contractor: OWNER Owner: DAVIDSON, KAREN L&VICTOR L
12240 SW JAMES ST
TIGARD, OR 97223
PHONE:
PHONE: I
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 03/10/2022 $100.70
Specifics: amps or less
11 crt Branch Circuits w/Purchase 03/10/2022 $81.62
Type of Use: SF Service or Feeder
Class of Work: ADD 1 ea 12%State Surcharge- 03/10/2022 $21.88
Type of Const: Electrical
Occupancy Grp:
Total $204.20
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
9 2-001-0010 Issued By.throuah OAR 952-001-0090. You may obtain a coov of the rules or direct Perm itteeQuestions o Signature:OUNC by callina 503�2c.,3^2.19�roar�1r.�800`332^23��
GLI
OWNER INSTALLATION ONLY 1
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'N 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.
RECEIVED
Property Owner Statement FEB 2 8 2022
Regarding Construction Responsibilities (;Ily0F7IGAfi>.)
Oregon Law requires residential construction permit applicants who are not licensed witt>Y)1 (NG DIVISION
Construction Contractors Board to sign the following statement before a building permit can be
issued. (ORS 701.325 (2))
This statement is required for residential building, electrical, mechanical, and plumbing permits.
Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not
submit this statement. This statement will be filed with the permit.
Please check the appropriate box:
a
� 1 own, reside in, or will reside in the completed structure and my general contractor is:
Name CCB# Expiration Date
1 I will inform my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
gi or
I will be performing work on property I own, a residence that I reside in, or a residence that I will
reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction
Contractors Board. If I change my mind and hire a general contractor, I will select a contractor
who is licensed with the CCB and will immediately give the name of the contractor to the office
issuing this Building Permit.
I have read and understand the Information Notice to Homeowners About Construction Responsibilities,
and I hereby certify that the information on this homeowner statement is true and accurate.
Print Na of Perm' ppli t
3/1 /122.0Z
Sign re of Pe it Applicant Date
Permit#: �l-G 20 Z -C)Q( fp 1 _ ,F
'Address: 12 ZT n Sl JAMES 7" rd C2 q7 223 +rra! r
Issued by: 40 - Date: 5/0 (22
This Copy for Permit Offices