Permit Support Document 11 CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
I COMMUNITY DEVELOPMENT Permit#: ELR2020-00034
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 3/2/2020
T[GARD 9 TES
�� Parcel: 1S126CA00700
Jurisdiction: Tigard
Site address: 9500 SW WASHINGTON SQUARE RD
Project: JC Penny#0288 108316070-S Subdivision: None Lot: None
Project Description: Relocate Manual pull station in reception area to entrance. 7/1/2021: REPRINTED permit to correct site address
from 9350 to 9500.
Contractor: JOHNSON CONTROLS SECURITY SOLUTIONS LLC Owner: PPR WASHINGTON SQUARE, LLC
6305 ROSEWOOD ST SUITE A BY J C PENNEY 0288-1
LAKE OSWEGO, OR 97035 TAX SERVICES
PO BOX 10001
DALLAS,TX 75301
PHONE: 855-201-1482 PHONE:
FAX: 503-675-4412
FEES
Description Date Amount
Specifics: Restricted Energy Permit 03/02/2020 $75.00
12%State Surcharge-Electrical 03/02/2020 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio&Stereo: 0 Boiler Controls: 0
CCTV: 0 Clock Systems: 0
Data&Telecommunications: 0 Fire Alarm: 1
HVAC: 0 Instrumentation: 0
Intercom/Paging: 0 Landscape/Irrigation: 0
Landscape Lighting: 0 Medical: 0
Nurse Calls: 0 Protective Signal: 0
Security Alarm: 0 Other: 0 Total $84.00
Other Desc: 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 may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: `� Lp//, f._' ' - ------ Permittee Signature: 0 V --/A1'
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.