Permit (2) CITY OF TIGARD ELECTRICAL PERMIT
1111
' 1 COMMUNITY DEVELOPMENT Permit#: ELC2023-00587
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/2/2023
Parcel: 2S 103DB 13500
Jurisdiction: Tigard
Site address: 13030 SW 115TH AVE
Project: Subdivision: 2019-031 PARTITION PLAT Lot: 1
Project Description: 2 inch conduit from house to garage for new solar install.Solar PV system to be pulled separately.
Contractor: OWNER Owner: BOROW, HARLAN S
SCHULTZ, ELLEN B
13030 SW 115TH AVE
TIGARD, OR 97223
PHONE PHONE:
FAX: •
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 10/02/2023 $56.18
Specifics:
Service or Feeder
1 ea 12%State Surcharge- 10/02/2023 $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 Munidpal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance . app.ved plans. This permit will expire if work is not started within 180 days of uance, or if work is suspended for more the
180 days. ATTENTIC•.. Orego law requires you - o ow the rules adopted by the Oregon Utility Notificati Cent . Thos ules are set forth in OAR
952-001-0010 thr••ah OAR: r 01-0090. rt..- a,obtain- • of the rules or direct Questions to OUNC by calling 50 .2 2.19 or . 0 . 344.
Issued By: �/I?�� 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:
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.
(VW\
Print Name of Permit Applican
t(O/2 7
Si a.ureo Permit Applicant Date
Permit#: •E LC,/4,3 OOS81 o
t3O SW 1`STh -IAu.� -
Address: ��O
AlAard Z3
, OIL 411
Issued by: fkili L1YId., Date: 181'14 03 I ,
This Copy for Permit Offices