Permit Support Document III CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit#: ELR2022 00082
Tr G A R f) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 8/7/2022
,'Z Parcel: 1S1260000300
Jurisdiction: Tigard
Site address: 9546 SW WASHINGTON SQUARE RD H16
Project: Lululemon Store 11704 Subdivision: None Lot: None
Project Description: Low Voltage cabling for Data Telecommunications.8/8/22: REPRINT to change address.
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Contractor: LOW VOLTAGE SOLUTIONS OF OREGON Owner: PPR WASHINGTON SQUARE LLC
PO BOX 883 BY MACERICH RET
GLENDALE, OR 97442 PO BOX 4085
SANTA MONICA, CA 90411
PHONE: 541-203-7582 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Restricted Energy Permit 08/07/2022 $75.00
12%State Surcharge-Electrical 08/07/2022 $9.00
Type of Use: COM Misc Administration Fee 08/08/2022 $45.00
Class of Work: NEW
Total Number of Systems: 1
Audio&Stereo: 0 Boiler Controls: 0
CCTV: 0 Clock Systems: 0
Data&Telecommunications: 1 Fire Alarm: 0
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 $129.00
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 t follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 9 -001-0090. Y u may ob ' a of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: - 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'N 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.