Permit (14) CITY OF TIGARD ELECTRICAL PERMIT
8
COMMUNITY DEVELOPMENT Permit#: ELC2023-00395
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 6/27/2023
Parcel: 2S110AD01800
Jurisdiction: Tigard
Site address: 14630 SW 106TH AVE
Project: DUECK Subdivision: LANG HILL Lot: 15
Project Description: (4)branch circuits for kitchen remodel.
Contractor: OWNER Owner: DUECK, STEPHAN &STEPHANIE
14630 SW 106TH AVE
TIGARD, OR 97224
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
Specifics: 4 crt Branch Circuits wo/Purchase 06/27/2023 $78.44
Service or Feeder
Type of Use: SF 1 ea 12% State Surcharge- 06/27/2023 $9.41
Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $87.85
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 issu- e, or if work is s ded for more the
180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification : let T rules are e forth in 0/5R
952-001-0010 throuoh OAR 952-001-0090. You may obtain ow/ a rules or direct Questions to OUNC by callina 503.23.. • . 1.8• 2314.
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.
Property Owner Statement
Regarding Construction Responsibilities
Oregon Law requires residential construction permit applicants who are not licensed with the
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: RECEIVED
I own, reside in, or will reside in the completed structure and my general contractor 2 7 2023
CITY OF TIGARD
BUILDING DIVISION
Name CCB#
Expiration Date
I will inform my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
or
V 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 Nam ermit nt
Signature of PeriWt Applicant Date
Permit#: 9a69-3-003�j�—
Address: /z > /per 2�
Issued by: g i. Date: /.17/jy) /44:
This Copy for Permit Offices
'.: ' Information Notice to Owners About
- Construction Responsibilities
v?".!.-;
� (ORS 701.325 (3))
Homeowners acting as their own general contractors to construct a new home
or make a substantial by being aware of the following preventructure, can many problems
responsibilities:
e
• Homeowners who use labor provided by workers not licensed by the Construction Contractors
Board, may be considered an employer, and the workers who provide the labor may be considered
employees. As an employer, you must comply with the following:
• Oregon's Withholding Tax Law: Employers must withhold income taxes from employee wages
at the time employees are paid. You will be liable for the tax payments even if you don't actually
withhold the tax from your employees. For more information, call the Department of Revenue at
503-378-4988.
• Unemployment Insurance Tax: Employers are required to pay a tax for unemployment insurance
purposes on the wages of all employees. For more information, call the Oregon Employment
Department at 503-947-1488.
• Oregon's Business Identification Number(BIN): is a combined number for both Oregon
Withholding and Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or go to
http://www.oregon.gov/DOR/BUS/docs/211-055.ndf for the appropriate forms.
• Workers Compensation Insurance: Employers are subject to the Oregon Workers Compensation
Law, and must obtain Workers Compensation Insurance for their employees. If you fail to obtain
Workers Compensation Insurance, you could be subject to penalties and be liable for all claim costs
if one of your workers is injured on the job. For more information, call the Workers Compensation
Division at the Department of Consumer and Business Services at 503-947-7815.
• Tax Withholding: Employers must withhold Social Security Tax and Federal Income Tax from
emloyee waes. You mayFor paFederalgEIN number, call the IRS at 1-800-829-4933 or visit their website atywww.i the withold tax.
e liable for the tax payment, even if you didn't rs.gov.
Other Responsibilities of Homeowners:
• Code Compliance: As the permit holder for a construction project, the homeowner is responsible
for notifying building officials at the appropriate times, so that the required inspections can be
performed. Homeowners are also responsible for resolving any failure to meet code requirements
that may be found through inspections.
• Property Damage and Liability Insurance: Homeowners acting as their own contractors should
contact their insurance agent to ensure adequate insurance coverage for accidents and omissions,
such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be
redone. Liability Insurance must be sufficient to cover injuries to persons on the job site who are not
otherwise covered as employees by Workers Compensation Insurance.
• Expertise: Homeowners should make sure they have the skills to act as their own general
contractor, and the expertise required to coordinate the work of both rough-in and finish trades.
CONSTRUCTION CONTRACTORS BOARD
PO Box 14140, Salem, OR 97309-5052
Telephone: 503-378-4621 —Fax: 503-373-2007
Website Address:www.oreaon.govlccb This Copy for Permit Applicant
f/property_owner adopted 9-23-08