Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2016-00025
13125 SW Hall Blvd.,Tigard OR 97223 503 718 2439 Date Issued: 01/21/2016
Parcel:
1/21/2016Parcel: 2S104BA02800
Jurisdiction: Tigard
Site address: 12036 SW WILTON AVE
Project: Baum Subdivision: COTSWALD MEADOWS NO.3 Lot: 117
Project Description: (4)branch circuits for kitchen remodel.
Contractor: WHITE LIGHTNING ELECTRIC CO. Owner: BAUM, GREGORY H &
7524 SE 52ND SLATER, NITA C
PORTLAND, OR 97206 12036 SW WILTON AVE
TIGARD, OR 97223
PHONE: 503-772-3009 PHONE:
FAX: 503-772-4008
FEES
Quantity Description Date Amount
4 crt Branch Circuits wo/Purchase 01/21/2016 $78.44
Specifics: _ Service or Feeder
1 ea 12%State Surcharge- 01/21/2016 $9.41
Type of Use: SF Electrical
Class of Work: ALT 1 ea Investigation Fee 01/21/2016 $90.00
Type of Const: 1 ea Investigation 12%State 01/21/2016 $10.80
Occupancy Grp: Surcharge
Total $188.65
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Cade, 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 952-001-0090. YovA a -ubtei cop of Chep of the rules ules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ` � ��Bermittee 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' 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 thejob site until completion of the project-
Approved plans are required on thejob site alike time of each inspection.
Jan. 13. 2016' 9:2SAM° " """" � � A� — - _. .— No. 0112 P. 1
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