Permit CITY OF TIGARD ELECTRICAL PERMIT
111111 t ` • COMMUNITY DEVELOPMENT Permit#: ELC2016-00229
T IGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/24/2016
Parcel: 2 S 104AA08500
Jurisdiction: Tigard
Site address: 12650 SW KATHERINE ST
Project: DODSON Subdivision: BELLWOOD NO.2 Lot: 100
Project Description: Panel replacement. •
Contractor: EDWARD MILLER&DOMINGO DEOCALES ELECTRI' Owner: DODSON, ERIC J
2928 ROBINWOOD DR NE 12650 SW KATHERINE ST
FOREST GROVE, OR 97116 TIGARD, OR 97223
PHONE: 503-502-9667 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 03/24/2016 $100.70
Specifics: amps or less
1 ea 12%State Surcharge- 03/24/2016 $12.08
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112.78
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 a set forth in OAR
952-001-0010 through OAR 952-001-0090. You I.. _ •• of the rules or direct questions to OUNC by calling 503.232.1* ,-r 1.800.332. 4r
Issued By: � '� ••' ee Signature: � -e+®
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.
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