Permit IICITY OF TIGARD f oi-M2 ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit#: ELR2016-00026
T IGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/16/2016
Parcel: 1 S135BC00202
Jurisdiction: Tigard
Site address: 10763 SW GREENBURG RD 100
Project: CRC Healthcare Subdivision: None Lot: None
Project Description: Voice and Data. 2/16/16 REPRINTED to correct suite address to 100.
Contractor: PROCOM TECHNOLOGIES LLC Owner: GREENBURG ROAD CENTER LLC
PO BOX 22288 22020 17TH AVE SE#200
PORTLAND, OR 97269 BOTHELL,WA 98021
PHONE: 503-797-0000 PHONE:
FAX: 503-233-8052
FEES
Description Date Amount
Specifics: Restricted Energy Permit 02/16/2016 $75.00
12%State Surcharge-Electrical 02/16/2016 $9.00
Type of Use: COM Misc Administration Fee 02/16/2016 $45.00
Class of Work: ADD
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. ATTENT re law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-001 through OAR 952.001-0.•:. Y• may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued y: 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.