Permit Support Document CITY OF TIGARD ELECTRICAL PERMIT
ligCOMMUNITY DEVELOPMENT Permit#: ELC2022-00767
t` V 1 Date Issued: 11/17/2022
T(GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 If
• Parcel: 2S103DA00700
T
'*' r Jurisdiction: Tigard
Site address: 13205 SW WATKINS AVE
Project: Anderson Subdivision: DERRY-DELL
Lot: 7
Project Description: Converting oil furnace to gas.
Contractor: OWNER Owner: ANDERSON, DENNISE
10595 SW 71ST AVE
PORTLAND, OR 97223
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 11/17/2022 $56.18
Specifics:
Service or Feeder
Type of Use: SF 1 ea 12% State Surcharge- 11/17/2022 $6.74
Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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 throuoh OAR 952-001-0090. You may obtain a cony of the rules or direct cuestions to OUNC by callina 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
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'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.