Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2023-00583
Date Issued: 9/28/2023
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 1S133DC15000
Jurisdiction: Tigard
Site address: 13163 SW TAMERA LN
Project: Eldridge Subdivision: VILLAGE AT SUMMER LAKE PARK Lot: 5
Project Description: Wring for furnace replacement.
Contractor: OWNER Owner: ELDRIDGE,CHARLES R AND DEBRA E
13163 SW TAMERA LANE
TIGARD, OR 97223
PHONE:
PHONE:
FAX:
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 09/28/2023 $56.18
Specifics:
Service or Feeder
1 ea 12%State Surcharge- 09/28/2023 $6.74
Type of Use: SF 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 a.proved 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: • :. 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 •- -001-0090. Yo •. . . ..ov of the rules or direct Questions to OUNC by calling 503.232.1987 or 1.800.33�44.• Issued By: l/!1/�J Permittee Signature: (�/�� �'^ A �`
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 RECEIVED
SE
Regarding Construction Responsibilitie P Z 8 ?m1
Oregon Law requires residential construction permit applicants who are not lice tTARD
Construction Contractors Board to sign the following statement before a buildin �rrt°cah 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:
//�j
e� 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
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.
C ({/iVN s A Eam/i2c,e
Print Name of Permit Applicant
Z&x 17 7/'j /A-3
Signature of Permit Applicant Date
Permit#: W toM .00583Air.-
27-
Address: 131b (1(3 S� 1A� ra Ln ;,,.s;. 5
1I NA 13R. 611143 ""•°,4
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Issued by: +t/f MA, Date: gligl14Z3 f1
This Copy for Permit Offices