Permit Support Document (16) irhCITY OF TIGARD 3 ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT �� '`��'� Permit#: ELC2017-00614
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/16/2017
Parcel: 2S111 BA09700
Jurisdiction: Tigard
Site address: 9527 SW BROOKLYN LN
Project: 1 Subdivision: SHANNON MEADOWS Lot: 2
Project Description: MICROWAVE, INSTA-HOT,RANGE,PENDENT LIGHT REPLACEMENTS,HOOD VENT OUTLET.RELOCATE;
FRIDGE AND OUTLETS INLAND. 8/17/2017: REPRINT permit to change total branch circuits from(3)to(6).
Contractor: MIKE'S ELECTRIC Owner: ROGERS, KATHLEEN
11070 SW ALLEN BLVD 9527 SW BROOKLYN LN
BEAVERTON, OR 97005 TIGARD, OR 97224
PHONE: 503-649-6991 PHONE:
FAX: 503-641-1902
FEES
Quantity Description Date Amount
Specifics: 3 crt Branch Circuits wo/Purchase 08/16/2017 $71.02
Service or Feeder
1 ea 12%State Surcharge- 08/16/2017 $8.52
Type of Use: SF Electrical
Class of Work: ALT 3 crt Branch Circuits w/Purchase 08/17/2017 $22.26
Service or Feeder
Type of Const: 0 ea 12%State Surcharge- 08/17/2017 $2.67
Occupancy Grp: Electrical
Total $104.47
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 9 0'You'ay obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: 4 ‘,1.4/2-//ifr
Permittee 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 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
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
9527 SW BROOKLYN LN, TIGARD, OR, 97224
Record Type: Record ID:
Residential - Electrical ELC2017-00614
Inspection Type: Inspector:
199 Electrical final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor