Permit CITY OF TIGARD ELECTRICAL PERMIT
'_ 2 COMMUNITY DEVELOPMENT Permit #: ELC2011 -00663
T1GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/30/2011
Parcel: 2S114BB07700
Jurisdiction: Tigard
Site address: 16279 SW 104TH AVE
Project: Peterson Subdivision: SWANSON'S GLEN Lot: 18
Project Description: (3) branch circuits for A/C, furnace and outdoor outlet.
Contractor: DISTINCT ELECTRIC, INC Owner: PETERSON, BENJAMIN
4742 LIBERTY RD STE 219 16279 SW 104TH AVE
SALEM, OR 97302 TIGARD, OR 97224
PHONE: 503 - 910 -9216
PHONE: 503 - 574 -9622
FAX: 503 - 763 -6880
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo /Purchase 11/30/2011 $71.02
Specifics: Service or Feeder
1 ea 12% State Surcharge - 11/30/2011 $8.52
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $79.54
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 I, . requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OA" • :2-011-0190 You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: � % /�� Alev Permittee Signature: D /l/ /5 e Ow
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' 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.
11 - 15 -2011. 08:25 REC EIVED PAGE3
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