Permit (256) CITY OF TIGARD ELECTRICAL PERMIT
' COMMUNITY DEVELOPMENT Permit#: ELC2019-00558
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/22/2019
Parcel: 1 S 133DA00600
Jurisdiction: Tigard
Site address: 11050 SW SUMMER LAKE DR
Project: WOOLDRIDGE Subdivision: AMART SUMMER LAKE Lot: 28
Project Description: Altering(2)branch circuits for kitchen remodel.
Contractor: OWNER Owner: SHIELDS, BRENT
SHERI WOOLDRIDGE & BRENT SHIELDS WOOLDRIDGE, SHERI
11050 SW SUMMER LAKE DR 11050 SW SUMMER LAKE DR
TIGARD, OR 97223 TIGARD, OR 97223
PHONE: 503-545-6046 PHONE:
FAX:
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo/Purchase 08/22/2019 $63.60
Specifics: Service or Feeder
1 ea 12%State Surcharge- 08/22/2019 $7.63
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
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 952-001-0090. You •bt=n - •• • -- ules or direct questions to OUNC by calling 503.232.1987 0 .800.332.234,
Issued Dy: "�w-t'_+; J— 6 e _- '•nature:
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.