Permit a CITY OF TIGARD ELECTRICAL PERMIT
•
1114 a COMMUNITY DEVELOPMENT Permit #: ELC2012 00362
TI G A RD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/11/2012
Parcel: 2S103BD02900
Jurisdiction: Tigard
Site address: 12020 SW CARMEN ST
Project: Horak Subdivision: CARMEN PARK Lot: 2
Project Description: (2) branch circuits for kitchen remodel. 6/19/12, reprinted to add grounding for new water service.
Contractor: OWNER Owner: HORAK, TRAVIS
REVI;ED 12020 SW CARMEN ST
l f q 1? I TIGARD, OR 97223
PHONE:
PHONE: 541 - 231 -8161
FAX:
FEES
Quantity Description Date Amount
• 2 crt Branch Circuits wo /Purchase 06/11/2012 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 06/11/2012 $7.63
Type of Use: SF Electrical
Class of Work: ALT 1 ea Reconnect Only 06/19/2012 $67.84
Type of Const: 0 ea 12% State Surcharge - 06/19/2012 $8.14
Electrical
Occupancy Grp:
Total $147.21
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 through OAR 5 001 -009 . 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: Permittee Signature: 9 AfP�f- J'Q ( .
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 603.639.4175 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.
/ .
CITY OF TIGARD 40 4444v - ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 00362
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439
Date Issued: 06/11/2012
Parcel: 2S103BD02900
Jurisdiction: Tigard
Site address: 12020 SW CARMEN ST
Project: Horak Subdivision: CARMEN PARK Lot: 2
Project Description: (2) branch circuits for kitchen remodel. 6/19/12, reprinted to add grounding for new water service.
Contractor: OWNER Owner: HORAK, TRAVIS
12020 SW CARMEN ST
TIGARD, OR 97223
PHONE:
PHONE: 541 - 231 -8161
FAX:
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 06/11/2012 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 06/11/2012 $7.63
Type of Use: SF Electrical
Class of Work: ALT 1 ea Reconnect Only 06/19/2012 $67.84
Type of Const: 0 ea 12% State Surcharge - 06/19/2012 $8.14
Electrical
Occupancy Grp:
•
Total $147.21
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. A TION: Oregon law r- • ires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 010 thro gh OAR 952 -0• -00 may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
'
Issue B y: � Permittee Signature: O� � /
I /'1 P ' -' GI` 4 ►� D
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 603.639.4176 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.