Permit Support Document (39) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
` s. ' COMMUNITY DEVELOPMENT Permit#: ELR2023-00069
T IGA.I2.D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 r A.1 ) Date Issued: 6/5/2023
j Parcel: 1S136DD05300
Jurisdiction: Tigard
Site address: 11850 SW 67TH AVE, STE#160
Project: American Family Subdivision: WEST PORTLAND HEIGHTS Lot: 9
Project Description: Low voltage for data telecommunications,security,and access control.
Contractor: COCHRAN INC Owner: PNWP LLC#2
PO BOX 33524 PNWP LLC
SEATLLE,WA 98133 6600 SW 105TH AVE#175
BEAVERTON, OR 97008
PHONE: (206)367-1900 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Restricted Energy Permit 06/05/2023 $75.00
12%State Surcharge-Electrical 06/05/2023 $9.00
Type of Use: COM Misc Administration Fee 06/12/2023 $45.00
Class of Work: ALT Restricted Energy Permit 06/27/2023 $150.00
Total Number of Systems: 3 12%State Surcharge-Electrical 06/27/2023 $18.00
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: 1 Other: 1 Total $297.00
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 18D 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 95522,-0001/1--0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.119877oor 1.800.332.2344.
Issued By: / -it.l. �Gtrvrt . Permittee Signature: aim/ y .0
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.