Permit (5) CITY OF TIGARD ELECTRICAL PERMIT
Permit#: ELC2023-00504
2 COMMUNITY DEVELOPMENT
Date Issued: 8/21/2023
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S135AD02900
Jurisdiction: Tigard
Site address: 8570 SW SPRUCE ST B
Project: Larsen Garage Subdivision: METZGER ACRE TRACTS Lot: 1
Project Description: Relocate(1)200 amp feeder and(1)circuit for garage addition.
Contractor: OWNER Owner: LARSEN, LANCE L&TINA K
8670A SW SPRUCE ST
TIGARD, OR 97223
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 08/21/2023 $100.70
Specifics:
amps or less
1 crt Branch Circuits w/Purchase 08/21/2023 $7,42
Type of Use: SF Service or Feeder
Class of Work: ADD 1 ea 12%State Surcharge- 08/21/2023 $12.97
Type of Const: Electrical
Occupancy Grp:
Total $121.09
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 throuah R 952-001-90 Y i,r v obtai poov of the rules or direct auestions 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 pro rt I own which i o ntended r le,lease or rent.
OWNER'S SIGNATURE: Date: (-21^Ti-.?
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:
I own, reside in, or will reside in the completed structure and my general contractor is:
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
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.
�une� L�"S oh
Print Name of Permit Applicant
S -21 - 2.3
nature of Permit plicant Date
Permit#: ELc�.�-a -6050`{
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Address: � S
2
Issued by: Date: t l c l 'AA!
This Copy for Permit Offices